Medicare Self-Audit Worksheet
Gather the facts before you compare a single plan.
The inventory every Clearing tool reads from — your coverage, dates, doctors, medications, and questions, in one place.
You don't need to finish this before using the Blueprint. It simply helps you move faster and feel more prepared. Fill in what you know now; the rest can wait until you gather paperwork. It saves as you go, right on this device.
Your answers stay on your device. The Clearing does not receive or store what you type here. If you email the worksheet to yourself, we use your address only to send it — nothing more unless you separately opt in. We never share your information with insurance agents.
About this worksheet
- What it is: A one-time inventory of the facts every Medicare decision depends on — coverage, doctors, drugs, pharmacy, budget, timing.
- Why: Every Clearing tool reads from what you gather here. Fill it out once, bring it to every tool.
- Time: About 15 minutes if you have your documents handy.
- You can start without everything. Sections A and B are the essentials. The rest can wait.
- Three ways to use it: fill it out on this page · download the PDF · email it to yourself.
- Filling this out for someone else? Use their information throughout. Wherever this worksheet says you or your, read it as them and theirs.
Where you are right now
The moment you're in shapes everything else.
EssentialYour Medicare dates
Timing drives penalties and windows — even a rough date helps.
EssentialYour doctors
Who you want to keep — and how much it matters.
Your medications
The list that decides whether a drug plan actually fits.
Your pharmacy
A blind spot most people don't know to check.
Budget & cost concerns
What kind of cost you'd rather live with.
EssentialYour biggest questions
The things you actually want answered.
Your summary
Your Medicare starting point.
In one sentence, write what you need your Medicare coverage to help you do. This keeps you focused as you use the Blueprint.
Keep this worksheet
Download the PDF, email it to yourself, or print this page — then bring it to the Blueprint.
Now what?
Save it — download the PDF, email it to yourself, or print this page. Then take it to the Blueprint.
That's fine — you already have what you need for the Blueprint. Save what you have and come back to the rest when documents are in reach.
Saved locally. The Clearing does not receive your answers.
Now use what you built
Your Self-Audit is the inventory every Clearing tool reads from. Save it — download the PDF, email it to yourself, or print this page — and keep it nearby for the tools that come next.
Ready to turn your situation into specific answers? Every decision tool reads from what you just gathered.
See all Decision ToolsKeep this worksheet nearby
It can help during any of these conversations:
About this document
This worksheet is orientation, not advice. The Clearing does not receive, store, or transmit your answers. We don't sell plans and earn nothing from what you choose. Rules and costs change; verify your specifics with a licensed professional or your State Health Insurance Assistance Program (SHIP). Not affiliated with Medicare, CMS, or SSA.
Self-Audit Worksheet v1.2 · July 2026 · joinclearing.com