Optional worksheet

Medicare Worksheet

List your doctors, prescriptions, and contact details for your own records. A consult is optional.

Name and contact

Full legal name *Preferred namePhone *EmailDate of birthPart B effective date (if known)

Street addressApt / suite

CityStateZIP *County

For official information and to compare all plans in your area, visit Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048). Related: Medicare Plan Finder.

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IEP Timeline

Pin your 7-month Initial Enrollment Period to your birthday.

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Educational estimates only—not Medicare, CMS, or Social Security advice. Figures use published 2026 reference amounts and can change. A licensed agent can review your situation before you choose or change coverage.