By submitting your information, you agree to a have your benefit options reviewed and discussed with a sales agent. Please note, the person who will discuss your options would be contracted with several Medicare plans. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan. Signing this form does NOT obligate you to enroll in a plan, affect your current or future enrollment status, or enroll you in a Medicare plan. Scope of Appointment documentation is subject to CMS record retention requirements.