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2026 AEP
Contact Us

Home
About
- Meet Jenell
- Testimonials
Get Started
ABCs of Medicare
- The ABCs of Medicare
- FAQs
Forms
2026 AEP
Contact Us

2026 AEP

Please complete and submit by SEPTEMBER 26, 2025
Sharing this information with us is strictly voluntary. The information is used to create a more accurate
plan analysis based on your specific needs.

PLEASE NOTE: If you leave the page before submitting the form your progress will NOT be saved.

You can view 2026 Medicare Changes packet for Medicare Advantage plans by clicking here

You can view 2026 Medicare Changes packet for Medicare Part D Drug plans by clicking here

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This field is for validation purposes and should be left unchanged.

Agent Name:

Client Name:(Required)

DOB:(Required)

Month

Day

Year

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

County (not COUNTRY)(Required)

Tobacco Use Last 12 Months?(Required)

Yes

Are you a current client?(Required)

Yes

Please select your current coverage(Required)

Medicare Supplement (Medigap) and Part D Drug Plan (Complete Sections A and B below)

Medicare Advantage (Complete Section C below)

SECTION A: If you have a MEDICARE SUPPLEMENT (MEDIGAP) Plan fill out this section

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SECTION A: If you have a MEDICARE SUPPLEMENT (MEDIGAP) Plan fill out this section

Medicare Supplement Company Name (on your Insurance Card)

Type: (F/G/Other)

Prescription Drug Coverage Plan Name (on your Insurance Card)

Are you considering changing to a Medicare Advantage Plan?

Yes

Please tell us why?

Next: Proceed to Section B

SECTION B: Prescription Drug Coverage Plan (DO NOT complete if you have Medicare Advantage)

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SECTION D: Fill out this section ONLY if you want to change Medicare Advantage plans OR move from your Medicare Supplement (Medigap) to Medicare Advantage

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Current doctors will be provided online in my PlanEnroll account

Yes

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SECTION B: Prescription Drug Coverage Plan (DO NOT complete if you have Medicare Advantage)

Current Pharmacy Name

Select all that apply:

Mark here if you take NO medications

Mark here if you've reviewed your Annual Notice of Change (ANOC) and wish to STAY on your current Prescription Drug plan for 2026

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Please select an option

Mark here if you take NO medications

Mark here if you've reviewed your Annual Notice of Change (ANOC) and wish to STAY on your current Prescription Drug plan for 2026

Next: Review Important Message below and then Submit form

SECTION C: If you have a MEDICARE ADVANTAGE Plan fill out this section

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SECTION C: If you have a MEDICARE ADVANTAGE Plan fill out this section

Medicare Advantage Plan Name (on your Insurance Card)

Please select an option

I’ve reviewed my Annual Notice of Change (ANOC) and wish to STAY on my current plan for 2026

I would like to change Medicare Advantage Plans for 2026

Please tell us why?

Are you okay with changing doctors?

Yes

Next: Review Important Message below and then Submit form

IMPORTANT MESSAGE:

NEXT STEP is providing medication and doctor information (if needed). This will be done on our new PlanEnroll platform. Please look for two emails that you will receive within 72 hours explaining this next step.

1. FROM: [email protected] / SUBJECT: 2026 AEP next steps (read this email FIRST)
2. FROM: [email protected] / SUBJECT: Invitation to PlanEnroll Profile Sync

BE SURE TO WATCH YOUR SPAM OR JUNK FOR THESE EMAILS

Additional Notes (provide any other information you think will be helpful in reviewing your 2026 Medicare Plan needs)

Section Break

Unlocking The Right Medicare Plan For You

Are you ready for the next step?

Get Started

Jenell Sobas, FPQP®

303-484-1763

[email protected]

10268 West Centennial Road, Suite 200K Littleton CO 80127

*Not affiliated with or endorsed by the government or federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.