(303) 973-6636

(800) 295-5860

6638 W. Ottawa Ave, #120

Littleton, Colorado

info@hbsltc.com

www.medicarehbs.com

How to Get Started

To request your Medicare Planning Options Analysis, please complete the 3-step form on this page. Please be advised if you leave the page before finishing the final step, your progress will not be saved.
If you would prefer to download fillable forms click here.

2026 AEP

Annual Enrollment Period Personal Information Sheet

Please complete and submit the form below. If you would prefer to download a fillable form, click here.

    Complete the Following:
    Please select your current coverage
    Agent's Name:
    Client Name:
    DOB:
    Phone:
    Address:
    City:
    County:
    State:
    ZIP:
    Email:
    Tobacco Use Last 12 Months?
    Are you a current client?
    If not, how did you hear about us?

    SECTION A: This section ONLY applies if you have a Medicare Supplement (Medigap) and plan on moving to a Medicare Advantage plan

    Read notice in Section C

    SECTION B: Fill Out This Section ONLY if you have a Medicare Advantage Plan

    Medicare Advantage Plan Name (on your Insurance Card)
    Please select an option
    Please tell us why?
    Are you okay with changing doctors?
    Please tell us why?

    SECTION C: Doctors and Medications

    You will receive an email or text from "Plan Enroll". Please follow the link and complete steps to input Doctors and Medications.

    LAST STEPS: Please Read

    Please submit responses at the bottom of the page. Completing the Scope of Appointment will allow us to schedule an appointment.
    Disclaimer: Sharing this information with us is strictly voluntary. The information is used to create a more accurate plan analysis based on your specific needs as presented by Medicare’s Official Website.

    Scope of Sales Appointment Confirmation Form

    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...

    Please initial below beside the type of product(s) you want the agent to discuss.
    Product type descriptions can be found at the bottom of this page.

    Standalone Medicare Prescription Drug Plans (Part D)
    Medicare Advantage Plans (Part C) and Cost Plans
    Dental/Vision/Hearing Products
    Hospital Indemnity Products
    Medicare Supplement (Medigap) Products

    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...

    Signing this form does NOT obligate you to enroll in a plan...

    Beneficiary or Authorized Representative Signature and Signature Date:
    Signature - Sign Below with Cursor Or Touch (Touch Screen Devices)
    Signature Date
    If you are the authorized representative, please sign above and print below:
    Representative's Name
    Your Relationship to the Beneficiary
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