Quick Medicare Check-Up

Welcome

Please spare a few minutes to share your valuable opinions and feedback with us.

Quick Medicare Check-Up

We like to check in with our clients each year to make sure your Medicare plan is still working well for you. Your answers help us identify any benefits you may be missing or improvements we can help with.

What's your name?

First Name *

Last Name *

What's your phone number?

Phone *

How confident are you that your Medicare coverage actually fits your needs?

How confident are you that your current coverage protects you from unexpected medical expenses? *

Very confident

Somewhat confident

Not sure

Not very confident

Medical Costs: Have you had any unexpected medical bills or hospital costs in the past year? *

If you were hospitalized for several days, would you feel financially prepared for hospital copays and related expenses? *

Yes

Somewhat

Not sure

If you needed several weeks of help at home after a hospital stay, would you feel financially prepared to cover recovery expenses? Examples may include caregiving, transportation, meals, or household assistance. *

Yes

Somewhat

I would like more information about options

If you needed temporary help at home due to illness or surgery, would you feel financially prepared to cover in-home care? *

Yes

Somewhat

Not sure

Have you or has anyone in your immediate family experienced cancer? *

Yes

Not sure

If you were diagnosed with cancer, would you feel financially prepared for expenses such as treatment, travel, or recovery support? *

Yes

Somewhat

I'm not sure

If you needed help during recovery after cancer treatment, who would most likely assist you? *

Family or friends

Paid caregivers

I'm not sure

I would need additional support

If you experienced a serious condition such as a heart attack or stroke, would your current coverage help with recovery expenses and time away from normal activities? *

Yes

Somewhat

Not sure

Before today, were you aware that some insurance plans provide cash benefits to help cover expenses during illness, hospitalization, or recovery? *

Yes

Not sure

Which of the following topics would you like to learn more about? (Check all that apply) *

Would you like a quick coverage review to see if any of these protections may make sense for your situation? *

Yes, please contact me

Maybe later

No review needed

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