Page 15 - Cover Letter and Medicare Evaluation (without Client's Name)
P. 15
Client Data Sheet
Client ID: 73335 November 19, 2020
Please verify the accuracy of the information below
Client's DOB: 02/24/49
Date that Medicare became or will become primary (when
client has both Part A & Part B): 03/01/21
Client's home zip code: 21117
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's Selection Criteria Does the Medicare
web site indicate that
this doctor accepts
Continue to see following physicians:
Medicare-approved
rates?
Dr. Nick Mellis Family practice Not listed
Dr. Frank Morris Cardiology Yes
Dr. Gregory Pokrywka Internal medicine Yes
Client wishes to compare both types of supplemental coverage
Prescription Drugs
Pharmacy Rite Aid
Refill schedule Both retail and mail-order
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