How this works

Fill out the sections below on any phone, tablet, or computer. You don't need a PDF reader or any special software—just type your answers right into the boxes. When you're finished, tap Print / Save as PDF at the bottom to save a copy, then email it to David.Ion@insuranceonramp.com, print it, or bring it to your appointment.

Use Part 1 if you're approaching Medicare and comparing your working-years benefits to retirement. Use Part 2 if you're already enrolled in Medicare and comparing your current plan. Fill out whichever applies to you—you don't have to complete both.

Prefer a PDF? You can also open the fillable PDF version in your browser.

Your Information

Part 1 — New to Medicare

Compare your working years benefits to your retirement years benefits. For each section, note whether the benefit transitions with you and whether it's important to have.

Health Insurance

Working Years
/
Retirement Years (Medicare Supplement)
/

Dental Insurance

Working Years
Retirement Years

Extended Cancer Protection

Working Years
Retirement Years

Life Insurance

Working Years
Retirement Years

Other Benefits

Working Years
Retirement Years

Income

Working Years
Retirement Years

Retirement Accounts

Working Years
Retirement Years

Part 2 — Enrolled in Medicare

Which type of plan do you currently have? Compare a Medicare Supplement to a Medicare Advantage (MA) Plan, and note whether each benefit is important to have.

Your Current Plan

Medicare Supplement
/
MA Plan
/

Dental Insurance

Medicare Supplement
MA Plan

Extended Cancer Protection

Medicare Supplement
MA Plan

Life Insurance

Medicare Supplement
MA Plan

Other Health Benefits

Medicare Supplement
MA Plan

Income

Medicare Supplement
MA Plan

Retirement Accounts

Medicare Supplement
MA Plan

Tip: in the print dialog, choose "Save as PDF" as the destination to keep a digital copy you can email to David.