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Medicare Coverage · Client Intake

Getting Ready for Our Medicare Meeting

About ten minutes. Everything here helps me give you real answers instead of general ones. If you're not sure how to answer something, skip it — we'll sort it out together.

Prepared for you by Jim Beckstrom, Secure Investors Group INC · Direct (call or text): 248-289-5663 · Office: 248-414-1529

This is not an application and does not enroll you in coverage. It's how I gather what I need so our appointment can be spent on decisions instead of data entry. For educational purposes only. Not connected with or endorsed by the U.S. government or the federal Medicare program.

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Only visible when the address ends in #agent. Fill in what you know, copy the link, send it. Keep it to basics — the link shows in browser history and text threads.

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1 Basic details

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Is there anyone else who needs a complimentary Medicare review?

A spouse, a partner, a family member — anyone turning 65 or already on Medicare. There's no cost and no obligation for them either.

Please choose one.

2 Where you live

Plan availability is set by county, so the ZIP code matters more than anything else here.

3 Your prescription drugs

Start typing a drug name and pick it from the list — spelling doesn't have to be perfect. If nothing matches, type it however you know it and I'll sort it out.

Or

4 Your pharmacy

Where do you fill your prescriptions? Type the name and pick the right location.

Or

5 Your doctors

The doctors and specialists you want to keep seeing. Type a name and pick the right one.

Your primary care provider

Other doctors

Or

6 Your Medicare timing

7 Your life

8 Your budget

There's no right answer and nobody's going to push you past it. It just keeps us from spending time on options that don't fit.

9 Your income bracket

Medicare looks at your tax return from two years ago to decide whether you pay the standard Part B premium or an income-related surcharge called IRMAA. A best guess is fine — we'll confirm it together.

If yes, there's a form that can get the surcharge reduced. Bring it up when we meet.

10 Things to bring with you to our meeting

11 What have you heard?

This is the part most people skip, and it's the part I find most useful. Anything you've heard from a neighbor, a relative, a mailer, a TV commercial, or something you read online that's been sitting in the back of your mind. It doesn't matter if it sounds silly — usually what people have heard is almost right, and the gap between “almost right” and right is where bad decisions come from.

Submit

Please complete the highlighted fields above.

Almost done!

Thanks —, your information has been sent.

For the last step, I'll have you fill out a Scope of Appointment form. This lets you choose which products we'll discuss in our next meeting.

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James Beckstrom | Secure Investors Group INC | (248) 414-1529

Scope of Appointment

Scope of Appointment

Hi —, James Beckstrom at Secure Investors Group INC has sent you this Scope of Appointment, which lets you select the topics covered in your upcoming meeting. Please review the information below, make any edits needed, and complete the digital signature.

Beneficiary details

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Agent details

James Beckstrom
Secure Investors Group INC
(248) 414-1529

The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by the person signing up for Medicare, or their authorized representative.

Products to discuss

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan. Signing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or enroll you in a Medicare plan.

Beneficiary or authorized representative signature

Type your full name and click “Sign & submit” to complete your signature.

Please type your full name to sign.

All set — thank you.

Your intake and Scope of Appointment have been sent to Jim. Keep a copy below for your own records.

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