Scope of Appointment

Submission Form

If you have an appointment or have requested to be contacted by a MedicareCompareUSA Affiliate Agent, it is required that a Scope of Appointment form be completed. Completing this form will take you less than three minutes. See below for additional information about the Scope of Appointment process.

Click Here to complete the Scope of Appointment – Be sure to click “FINISH” after you sign

If you have questions about the Scope of Appointment or submission process, please contact us at:

MedicareCompareUSA Customer Service: (855) 256-1505

Scope of Appointment – Frequently Asked Questions

What is the purpose of a Scope of Appointment?

The Scope of Appointment is a federally required form used to document an appointment between an insurance agent and a Medicare beneficiary to ensure that no other types of products are discussed outside of what the beneficiary originally requested. Your completion of a Scope of Appointment does not require, imply or suggest that you intend to purchase a Medicare plan from an insurance agent. The form protects the beneficiary from being solicited for a product that he/she did not originally express interest.

What are the different “plan types” the beneficiary can specify they want to discuss?

MedicareCompareUSA Affiliated Agents represent a variety of different Medicare plan types. When completing the Scope of Appointment, please initial the Medicare plan types you wish to discuss with the agent. If you are considering all of your Medicare options, you may want to initial each of the following on the Scope of Appointment:

  • Stand-alone Medicare Prescription Drug Plans (Part D)
  • Medicare Advantage Plans (Part C) and Cost Plans
  • Medicare Supplements (Medigap) Products