MEDICARE
Enrollment Resources
MEDICARE Enrollment Resources
2026 promises to be a busy medicare open enrollment. We appreciate your cooperation in providing as much information as possible so we can provide you with your best options.
Let’s get started working on your Medicare Health care needs for 1/1/26. To assist you we will need some additional information.
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To get started securing your Medicare quotes, click the button below.
Please help us by providing as much information as possible when you complete the questionnaire:
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DOCTOR INFO: When adding your doctors, include the office address you visit in the field “Doctor’s Office City.”
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RX INFO: Click “Add a Prescription.” Type in your prescription and select your dosage from the drop-down list provided. Under Quantity, indicate the actual number of pills, syringes, or amount of cream/gel you use in a month.
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SCOPE OF APPOINTMENT FORM: This form is required by the Centers for Medicare & Medicaid Services (CMS). It protects Medicare beneficiaries from scams and high-pressure tactics. Follow the prompts to complete it.
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When you’re ready to proceed, click the “Get Started with Leslie” button. The link will take you to our survey. To begin, enter your name, and the survey questions will load.
Once we receive notification that you’ve completed the survey, we’ll reach out to schedule a next-steps meeting with you.
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Medicare Documents You May Need
Medicare CMS-40B: Application for Medicare Part A and B
Use this form when you are turning 65 and want to enroll in Medicare. This is called an Initial Enrollment Period (IEP).
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Medicare CMS-L564: Request for Employment Information
Use this form to apply for a Special Enrollment Period (SEP) if you are over 65 and are leaving an employer health plan. Please submit both the CMS-40B and the CMS-L564 60 days prior to the date you want Medicare coverage to start. Please note that you must enroll in Medicare Part B before you can sign up for Medicare health plan coverage.
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Both forms need to be delivered or sent by certified mail to your local Social Security office.
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Scope of Appointment Form (LSM Insurance Scope of APT)
This form must be completed 48 hours before any Medicare discussions with Leslie McMillan. It is required by the Centers for Medicare & Medicaid Services (CMS) and protects Medicare beneficiaries from scams and high-pressure tactics. Please note that if you complete the online survey, the SOA form is included.
