* If not prepared at time of consult, rebooking fee may apply. *

Under 65 (U65) Health Coverage Consult

Please have the following completed before your appointment:

  • Provider Network Confirmation
    You will need to check directly with your doctors/providers to confirm which individual insurance carriers they are in network with.
    Please reference the email with the list of carriers available in your area.
    If you are unable to locate it or have questions, please call our office for assistance.
  • Current Coverage Information (if applicable)
    A copy of your current insurance ID card(s).
    If your consult is by phone or virtual, please send a copy of your card(s) to our office prior to your appointment.
  • Household Income
    Your current/projected annual household income, broken down by source (for example: wages, self-employment, Social Security, retirement, etc.).
  • Loss of Coverage Letter (if applicable)
    This letter allows us to review coverage options outside of enrollment periods.
    The letter must list the date coverage was lost (within last 60 days) and include all legal names of individuals who are seeking coverage.
  • Consult Fee (if applicable)
    The consult fee must be paid prior to your scheduled appointment.
    If you have questions regarding the consult fee or payment options, please contact our office.

Important:
Having these items ready allows us to accurately review plan options and avoid delays with your coverage effective date.

Medicare Consult

Please have the following completed before your appointment:

  • Medicare Card
    A copy of your Medicare card showing your Medicare ID number and Part A and Part B effective dates.
  • Prescription List
    A current list of all prescriptions, including medication name and dosage.
  • Provider Information (if applicable)
    A list of your doctors and preferred providers, including specialists if applicable.
  • Pharmacy Information
    Your preferred local retail pharmacy and location.
  • Current Plan Information (if applicable)
    Copies of any current Medicare Advantage, Medicare Supplement, or Part D plan cards.
  • Consult Fee (if applicable)
    The consult fee must be paid prior to your scheduled appointment.
    If you have questions regarding the consult fee or payment options, please contact our office.

Important:
Having these items ready allows us to accurately review plan options, confirm prescription coverage, and ensure provider participation before enrollment.

Dental / Vision Consult

Please have the following completed before your appointment:

  • Provider Network Confirmation
    You will need to check directly with your doctors/providers to confirm which individual insurance carriers they are in network with.
    Please reference the email with the list of carriers available.
    If you are unable to locate it or have questions, please call our office for assistance.
  • Current Coverage Information (if applicable)
    Copies of any dental insurance ID cards from the     last 12 months.
    If your consult is by phone or virtual, please send copies of your card(s) to our office prior to your appointment.

Important:
Having these items ready allows us to accurately review plan options and avoid delays in coverage.


Income Update

Please have the following completed before your appointment:

  • Description of the Change
    A brief explanation of what changed (income increase or decrease, job change, household change, etc.).
  • Household Income Breakdown
    Your total household income     broken down by source (for example: wages, self-employment, Social Security, unemployment, retirement, etc.).
  • Supporting Documentation (if available)
    Documents that reflect the change, such as recent paystubs, offer letters, termination notices, or self-employment profit and loss statements.

Important:
Providing accurate and timely income updates helps ensure your coverage and any available tax credits are applied correctly and prevents issues at tax time.

IRMAA Appeal

Please have the following completed before your appointment:

  • IRMAA Notice
    A copy of the IRMAA determination notice you received from Social Security showing the increased premium amount.
  • Qualifying Life-Changing Event Documentation
    Proof of the life-changing event that caused your income to decrease, such as retirement, work reduction, marriage, divorce, death of a spouse, or loss of income-producing property.
  • Household Income Information
    Your expected household income for the year    .
  • Supporting Tax Documentation (if available)
    Recent tax returns or other income documentation that supports the appeal.

Important:
IRMAA appeals are reviewed by Social Security and are not guaranteed. Providing complete and accurate documentation helps ensure your appeal can be submitted correctly and without delay.