Page 13 - Cover Letter and Evaluation for Mr. Fred Falten

Client Data Sheet

Client ID: 11419354 March 29, 2021

Please verify the accuracy of the information below and let us know if changes need to
be made.

Client's DOB: 04/02/51

Date that Medicare became or will become primary (when
client has both Part A & Part B): TBD*
Client's home zip code: 03801

Has client started receiving Social Security or SSDI payments? Yes

After client retires, will he or she have access to health
insurance through a spouse's or ex-spouse's employer plan? No

Client wants to see a comparison of both types of coverage --
Advantage plans and Medigap polices/stand-alone drug plans

Prescription Drugs Client's pharmacy: CVS

90-day refills at retail
Refill Schedule:
pharmacy

*Although client has Parts A&B, he is still working and uses his employer's group plan
for hisprimary health coverage

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