Medicare Appointment Preparation

Set The Scope For Your Appointment

Choose the coverage topics you want to discuss and complete your appointment-scope details in one clear step.

One Beneficiary Per Form

Scope Of Appointment

Tell me which products you want to discuss. Our appointment will stay focused on the choices you select below.

This form does not enroll you in a plan.
Signing does not affect your current or future Medicare enrollment and does not obligate you to enroll. Do not enter Medicare numbers, Social Security numbers, prescription details, or health information.

Products To Discuss

Select every product you would like to discuss with the Licensed Sales Representative.

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Beneficiary Details

Appointment Date

Authorized Representative

Your Electronic Signature

By signing, you agree to meet with a Licensed Sales Representative to discuss only the selected products. The representative may be employed or contracted by a Medicare plan and may be paid based on enrollment. They do not work directly for the federal government.

Licensed Sales Representative

NameDavid de Jonge
Phone(352) 212-8411
Representative ID20488263

Advisor signature and plans represented during the meeting are completed through the secure advisor workflow.

Appointment details are completed by the Licensed Sales Representative after secure receipt and review of the signed Scope Of Appointment. A reviewed, secure submission connection is required before this form can store or transmit visitor information.

Plan descriptions

Stand-alone Medicare Prescription Drug Plans (Part D)

  • Medicare Prescription Drug Plan (PDP)

    A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Medicare Advantage Plans (Part C) and Cost Plans

  • Medicare Health Maintenance Organization (HMO)

    A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies).

  • Medicare Preferred Provider Organization (PPO) Plan

    A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals but you can also use out-of-network providers, usually at a higher cost.

  • Medicare Private Fee-For-Service (PFFS) Plan

    A Medicare Advantage Plan in which you may go to any Medicare-approved doctor, hospital and provider that accepts the plan’s payment, terms and conditions and agrees to treat you – not all providers will. If you join a PFFS Plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You will usually pay more to see out-of-network providers.

  • Medicare Point of Service (POS) Plan

    A type of Medicare Advantage Plan available in a local or regional area which combines the best feature of an HMO with an out-of-network benefit. Like the HMO, members are required to designate an in-network physician to be the primary health care provider. You can use doctors, hospitals, and providers outside of the network for an additional cost.

  • Medicare Special Needs Plan (SNP)

    A Medicare Advantage Plan that has a benefit package designed for people with special health care needs. Examples of the specific groups served include people who have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain chronic medical conditions.

  • Medicare Medical Savings Account (MSA) Plan

    MSA Plans combine a high deductible health plan with a bank account. The plan deposits money from Medicare into the account. You can use it to pay your medical expenses until your deductible is met.

  • Medicare Cost Plan

    In a Medicare Cost Plan, you can go to providers both in and out of network. If you get services outside of the plan's network, your Medicare-covered services will be paid for under Original Medicare but you will be responsible for Medicare coinsurance and deductibles.

Hospital Indemnity Products

  • Plans offering additional benefits; payable to consumers based upon their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or connected to Medicare.

Medicare Supplement (Medigap) Products

  • Plans offering a supplemental policy to fill “gaps” in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Medicare.

Ancillary Products

  • Plans offering additional benefits for consumers who are looking to cover needs for dental, vision or hearing. These plans are not affiliated or connected to Medicare.

BRIGHT LIFE

Insurance Consultants

David de Jonge

Licensed Independent Insurance Agent

Serving Florida Residents

📞 (352) 212-8411

📧  david.dj@brightlifeics.com

Coverage

MedicarePrescription DrugsLife InsuranceDentalVisionHearing

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Insurance plans presented on this site are offered by licensed insurance agents. Plan pricing, availability, and benefits vary by state, age, health status, and individual circumstances. Not all applicants will qualify for all plans.

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We do not offer every Medicare plan available. We currently represent 11 Medicare organizations. Plan and product availability varies by county and service area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) for information about all Medicare options available in your area.

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