Required before we talk plans

Scope of Appointment

This is a short form CMS requires before any licensed agent can discuss specific Medicare plan options with you. It just confirms what you'd like to talk about — it does not enroll you in anything or obligate you in any way.

Why we ask for this: CMS requires a Scope of Appointment to be completed before a licensed agent can discuss specific Medicare plan options, so both sides are clear on what's being covered. Through September 30, 2026, that means this must be signed at least 48 hours before our appointment, with narrow exceptions for walk-ins or requests made during the last four days of a valid enrollment period. Starting October 1, 2026, CMS is removing that fixed advance-notice window — but it still must be completed before we discuss specific plans.

Trevor Snell Insurance · NPN 5457367 · Utah Lic. #131223 · 801-654-2313 · 4335 S Noal Dr, Millcreek, UT 84124. Records are retained for 10 years as required. This form is not an application for insurance and does not affect any current coverage.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Trevor Snell Insurance is not associated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS) or any other government agency. Medicare has neither reviewed nor endorsed this information. For a complete listing of plans in your area please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.