Beware of deceptive sales practices during Medicare's 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Primary Applicant section. Enter your first name, middle initial, last name, and suffix. Ensure that you provide your Social Security Number and date of birth accurately.
3. In Section 2, provide information for any dependents. Include their names, ages, and relationships to you. Make sure to indicate if they require dental coverage.
4. Select your desired coverage in Section 3 by checking the appropriate box for either HMO or EPO plans.
5. Review the Dental Acknowledgment section in Section 4 and confirm whether you want dental coverage for dependents under 18.
6. Complete Sections 5 through 8 regarding replacement coverage information, agent details (if applicable), certification, and billing information. Ensure all signatures are provided where required.

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