Health | Protection | Wellness | Legacy

Annual review · AEP 2027

Already on Medicare? Let’s review your 2027 options.

A few quick questions so we can make the most of our time together. No Social Security or Medicare numbers needed.

About you

About you

Layla is licensed in the states listed.

For example: Mecklenburg

How should we reach you?
Your current coverage

Your current coverage

What kind of coverage do you have now?

For example, the name on your plan card.

What's changed since your last review?

What's changed since your last review?

Have your doctors changed?
Have your prescriptions changed?
Has your preferred pharmacy changed?
Are you seeing any new specialists?
What matters to you

What matters to you

What matters most this year?Choose all that apply.

The next sections are optional.

These questions help prepare your review. They do not confirm eligibility, coverage, doctor participation, or prescription coverage. Please don't share Medicaid, Medicare, or Social Security numbers.

Your doctors and providers (optional)

Your doctors and providers (optional)

Would you like to list your doctors now?
Your prescriptions (optional)

Your prescriptions (optional)

Type what's on the bottle label, or upload a medication list.

Would you like to list your prescriptions now?

City, or street and city

How do you like to get your prescriptions?
Help with coverage and costs (optional)

Help with coverage and costs (optional)

Answer only what you're comfortable with. "Not sure" and "Prefer to discuss" are always fine.

Are you enrolled in Medicare Part A?
Are you enrolled in Medicare Part B?

Medicaid

Do you currently have Medicaid?

Medicaid is a state program, separate from Medicare.

Plans for people with Medicare and Medicaid (D-SNP)

Do you already have a Dual Eligible Special Needs Plan (D-SNP)?
Would you like Layla to check D-SNP options for you?

D-SNPs are for people who have both Medicare and Medicaid. Your Medicaid level, Part A and B, where you live, enrollment rules, and plan requirements all need to be verified. Extra Help alone does not make someone eligible for a D-SNP. About Special Needs Plans on Medicare.gov (opens in a new tab)

Plans for certain chronic conditions (C-SNP)

Has a healthcare provider diagnosed you with an ongoing (chronic) condition?
Would you like a review of Chronic Condition Special Needs Plans (C-SNPs)?

About Special Needs Plans on Medicare.gov (opens in a new tab)

Extra Help with drug costs (LIS)

Extra Help is a Medicare program that helps pay Part D drug costs. About Extra Help on Medicare.gov (opens in a new tab)

Do you currently get Extra Help with Part D drug costs?
Does your state help pay your Part B premium (a Medicare Savings Program)?
Do you get Supplemental Security Income (SSI)?

SSI is different from Social Security retirement or SSDI.

Do you have an Extra Help application that is pending or was recently denied?
Would you like help applying for Extra Help?
Interested in additional protection?

Interested in additional protection?

These are separate insurance products, not Medicare plans. Requesting information is optional and does not affect your Medicare review. This is not a Medicare Supplement (Medigap) plan, and choosing an option here is not an enrollment, a Scope of Appointment, or permission to discuss these products during your Medicare appointment.

Would you like information about coverage that may help with expenses related to a hospital stay, an accident, or cancer? (optional)
How did you hear about us? (optional)

How did you hear about us? (optional)

Meeting time

Meeting time

Are you comfortable meeting by RingCentral Video?

Meetings are held by RingCentral Video (video on your phone, tablet, or computer) — or by phone if you prefer. Please note: your meeting will be recorded, as Medicare (CMS) rules require agents to record appointments with clients.

For example: Tuesday or Thursday mornings.

Permission to Contact

Permission to Contact

Questions or to withdraw your permission, call Layla at 980-254-6887. This permission covers your Medicare information request only — not life insurance or other products. Layla does not use automated or prerecorded calls or marketing texts.