List of Your Doctors:

• Primary Care Physicians and any Specialists you see - including your Optometrist and Dentist.

  • (Note: We need the name of the actual MD/Doctor, not the PA or NP)

Your Current Medications:

• Exact names, precise dosages, and frequency of all current prescriptions (copy from the name on the label of the bottle).

Your Red, White, and Blue Medicare Card:

• Showing your Part A and Part B effective dates.

Current Health Insurance Coverage:

• Any private health insurance, employer group coverage, union plans, or retiree benefits you are on or may be offered.

Any Questions or Concerns:

• Specific plan features you are looking for or questions you want to make sure we address

List of current doctors and medications for anyone who is applying for coverage

• Exact names, dosages, and frequency of all current prescriptions (copy from the name on the label of the bottle).

Any information on your current health insurance coverage

• Including premiums, coverage, and benefits.

Information about your household

• Anyone who will be on your tax return, including dates of birth, Social Security Numbers, and gross income estimates.

Details if you are offered other employer coverage and its pricing.

• Include if it extends to spouse/family and what the cost may be.

Income Verifications for the household

• Such as paystubs, unemployment letters, Social Security statements, retirement withdrawals, pension statements, or self-employment income estimates.

Special Enrollment Verification

• If you have any documents stating your coverage has ended or will end.