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Are you currently enrolled in Medicare?
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Which parts are you enrolled in?
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Do you have health insurance through an employer or spouse’s employer?
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Are you receiving Social Security or Railroad Retirement benefits?
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Have you been diagnosed with End-Stage Renal Disease (ESRD) or ALS?
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Are you interested in Original Medicare or a Medicare Advantage Plan?
Do you take any regular prescription medications?
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Please list your medications and dosages:
Are you interested in additional benefits like dental, vision, hearing, or fitness programs?
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When do you plan to enroll or make changes to your Medicare plan? (e.g., Turning 65, Open Enrollment, Losing Employer Coverage, etc.)
Do you need help comparing different Medicare plans?
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Is there anything else you'd like us to know about your health needs or preferences?
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