Medicare Forms


Scope of Appointment Form

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Medicare New Client Intake Form

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Annual Enrollment Period Review Form

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Download & Print Here


Part B Delayed Enrollment Forms

EmployEE CMS40B Form 


EmployER CMS-L564 Form


Income-Related Monthly Adjustment Amount (IRMAA)

Life-Changing Event - Form SSA-44

Form SSA- 44


Extra Help Application for Drug Plan Costs


Extra Help Application



Life Insurance Forms


Life Quote Questionnaire


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Individual & Family

Health Insurance Forms


English


New Client Intake Packet - Individual Health (English)

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Consent for Broker Assistance (English)

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Spanish


New Clients Intake Packet - Individual Health (Spanish)

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Privacy Notice & Disclosure Statements (Spanish)

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Miscellaneous Forms


Personal Health Information (PHI) Release Form


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Employer Coverage Tool


Healthcare.gov Link to Employer Tool


Calculate Yearly Income


Healthcare.gov Link to Income Calculator