Lee Funke Medicare Review – Medicare Review

MEDICARE REVIEW

Lee Funke | 217-671-3749

Medicare has several parts and multiple plan options to choose from. In order to avoid higher costs and/or complications, a little up-front planning is necessary.

Our Medicare Review will help you gather the information that I need when determining your right Medicare options.

First & Last Name

Date of Birth

What is your home address?

What COUNTY do you live in?

What's your Medicare Number?

What is your Part A date?

What is your Part B date?

Phone number

May I text you at this number

Yes No

What is your current coverage?

Medicare Supplement Plan Carrier

Medicare Supplement Plan

Medicare Supplement Premium

Stand-Alone Prescription Drug Plan

Stand-Alone Prescription Drug Plan Premium

Medicare Advantage Plan Carrier

Group/Individual Coverage

Do you have a Medicare.gov account?

Yes No

Medicare.gov username

Medicare.gov password

I understand that I am supplying my Medicare.gov account information so my plan can be reviewed and that no information is stored in the account that I have not already shared.

I understand

Mother's maiden name?

Preferred pharmacy #1

Preferred pharmacy #2

Current Prescription Medications

Primary Care Physician

Specialists

What other services would you like more information on?

Locking in market gains Eliminating or reducing market risk Tax-Free retirement Increasing retirement income Getting above average returns with less risk for your investments Estate, Will, and Trust services Reducing taxes in retirement Retirement income planning Long term care planning Final expense/life insurance

Do you know anyone else that may be able to use my services? If so, list their name and email below.

A Free Review Could Save You Thousands