Scope of Appointment Form

A form that gives permission for a licensed insurance agent to discuss specific Medicare options that you choose. You are NOT enrolling in a plan when you fill this out.

The Scope of Appointment is required by the Centers for Medicare & Medicaid Services (CMS).
It protects you by making sure the agent only talks about the types of Medicare plans you agree to discuss—such as Medicare Advantage (Part C), Prescription Drug Plans (Part D), and/or Medicare Supplement (Medigap) coverage.

In most cases, the form must be completed at least 48 hours before your scheduled appointment.
This gives you time to review the form and prepare any questions.

Think of it like a restaurant menu: you tell the agent which “menu items” you want to hear about, and they must stick to those topics - the agent can’t bring up other products like life insurance or dental-only plans.
This keeps your meeting focused and ensures your privacy and preferences are respected.

The Scope of Appointment keeps your meeting organized and follows Medicare’s consumer protection rules.
It ensures that the information shared is limited to what you want to know and helps prevent unwanted sales discussions.