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Scope of Appointment (Required by Medicare)
To review your Medicare options, Medicare requires a Scope of Appointment (SOA). This simply tells us which types of plans you want to discuss. It is not an application and does not enroll you in a plan.
Quick note: Completing this now can save a step before we talk. Prefer later? We can complete the SOA during our call. Required Disclosure
By completing this form, you agree that a licensed insurance agent may contact you to discuss the Medicare plan types you selected. This form is required by the Centers for Medicare & Medicaid Services (CMS). It does not obligate you to enroll and does not enroll you in a plan.
I agree a licensed insurance agent may contact me about the products I selected by phone, text, or email. Consent is not required to purchase, and I can opt out at any time.
Your information is kept private and used only to contact you about Medicare options. We do not sell your data.
TPMO disclaimer: We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.
Recordkeeping: We maintain each completed Scope of Appointment for 10 years, as required by CMS.
Submitting this form does not enroll you in a Medicare plan. There is no obligation to make changes to your current coverage.
