Medicare Enrollment Checklist

MEDICARE OPTIONS FOR YOU

Contact Trout Insurance for a complete review of Your Medicare Options. Agents are standing by.
Call 828.279.4681 today.

• Are you eligible for enrollment in 2023/2024? We can review guidelines for enrollment with you. Click Here.

• The Annual Enrollment Period (AEP) begins October 15, 2023 for members already enrolled in Medicare. Please contact us for exceptions.

Turning 65 - New to Medicare

• You may enroll in a Medicare plan three months before the month you turn 65, the month of your birthday, and 3 months after.

• All plans including Medicare Supplements are guarantee issue during this enrollment period (IEP).

We represent Medicare Advantage HMO, PPO and PFFs organizations with a Medicare contract. Enrollment in any plan depends on contract renewal. You must continue to pay your Medicare Part B premium.

Complete this form so we may get started to review your Medicare medical and Rx Prescription plan options for 2024.

2023/2024 Medicare Enrollment Form for Over 65

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Date of Birth *

Address *

City *

State *

My Current Agent Is: *

Zip *

County *

Medicare Part B eligibility date (on your Medicare Card) *

My Current Plan *

My Current Insurance Company *

Primary Care Doctor *

Specialist 1 *

Specialist 2 *

Have you been diagnosed with Heart Disease or Diabetes? *

Yes No

Your Preferred Local Pharmacy *

Prescriptions Taken Regularly:

Rx 1 Name *

Rx 1 Dosage *

Rx 1 How Often *

Rx 2 Name *

Rx 2 Dosage *

Rx 2 How Often *

Rx 3 Name *

Rx 3 Dosage *

Rx 3 How Often *

Rx 4 Name *

Rx 4 Dosage *

Rx 4 How Often *

Rx 5 Name *

Rx 5 Dosage *

Rx 5 How Often *

Rx 6 Name *

Rx 6 Dosage *

Rx 6 How Often *

Questions/ Comments/ Notes *

If you were referred to Trout Insurance, whom should we thank? *

Submit

Trout Insurance Services
Visit: 29 N Main St
Weaverville, NC 28787

Mail: PO Box 1414
Weaverville, NC 28787

Ph: 828.279.4681
Fax: 1-888-221-4842
[email protected]

Privacy Notice | Privacy Policy

Not affiliated with the U.S. Government or Federal Medicare Program.

Stay current with relevant insurance news. Newsletters usually send out about once per month. We will never share your address.

Trout Insurance is a full line insurance agency based in WNC. We serve clients in North and South Carolina as well as national companies. Trout Insurance offers life, health, disability, Medicare supplement, Medicare Health Plans, Medicare Prescription Plans, Long term care insurance, Home and Auto insurance for individuals. For businesses we offer group health & benefits, commercial liability, property & worker's compensation as well as plans for business owners.

Dave Trout, David Hanson and Idelle Davids are independent insurance agents with Trout Insurance.

We do not offer every plan available in your area. Currently we represent at least 8 organizations which offer at least 57 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Effective June 28, 2024 ; Jessica Cody & Jeremy Sheridan are no longer associated or appointed with or through Trout Insurance Services, Inc.

They may be reached at:
828-713-8640 – Cody
828-606-7994 – Sheridan

This is an amiable separation and they have the our confidence they will continue to act as the professional agents they have demonstrated over the years with TIS. Our agreement includes provisions that they will retain the agreed policies which they previously directly managed under the Trout Insurance agency license. They will be initiating “Agent of Record Transfers “ to their new agency and /or insurance companies and we will honor those requests. Until those transfers are effective, Trout Insurance retains the fiduciary responsibility under our North Carolina Department of Insurance license & obligations to service your policy. Our commitment is to do so in a polite, effective and efficient manner.
Please send any and all requests and questions to this designated email address: [email protected] or call 828 – 519-5218. these are monitored daily. Please allow three working days for our response and resolution.
And, please note policy changes may not be changed or bound via voicemail or merely email. Per insurance regulations, a licensed agent appointed by that company must make the change.

Enroll for 2023/2024

2023/2024 Medicare Enrollment Form for Over 65

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