The Medicare Mentors

What Brought You Here Today?

Book

Billboard

Facebook

Friend/ Advisor

Oprah

Other

Where Do You Live? ( Resident Status)

Pennsylvania

Ohio

Florida

None of the Above

Are You Currently On Medicare? (Both Part A and Part B)

Yes

No

Do You Have Benefits Available Through You/Your Spouses Employer (or Former Employer)?

Yes

No

Will You Be Eligible For Medicare Within the Next 6 Months?

Yes

No

Where Are You Benefits From?

State Teachers Retirement

Union

Federal or State Retiree

None of the Above

Do You Have Veteran Administration Benefits Available?

Yes

No

What Coverage Do You Currently Have?

Medicare Advantage Plan (Ex. HMO, PPO, PFFS, MSA)

Medicare Supplemental Plan (Ex. Plan F, Plan G, Plan N)

Affordable Care Act Plan (ObamaCare)

Original Medicare (Part A and Part B Only)

Group Health Coverage

I Don't Know

What Plan Do You Have?

Plan F

Plan G

Plan C

Plan N

None of the Above

What Type Of Plan Do You Have?

HMO (Health Maintenance Organization)

PPO (Preferred Provider Organization)

PFFS (Private Fee For Service)

MSA (Medical Savings Account)

I Don't Know

Are You a Diabetic?

Yes (No Insulin)

Yes (Insulin Dependant)

No

Have You Been Admitted To The Hospital In The Past 12 Months? (Overnight Stay)

Yes

No

Are You Currently Prescribed More Than 5 Medications?

Yes

No

Do You Currently Get Any Extra Help Paying Your Prescription Drug Costs?

Yes

No

I Don't Know

Is Your Income Less Than $31,500 (Married) or $23,500 (Single)?

Yes

No

Do You Travel For Extended Periods Of Times Throughout The Year? ( More than 2 Weeks at a Time?

Yes

No

Where Do You Travel Most Often?

Florida

North Carolina

Arizona

None of the above

What Is Your Biggest Concern?

Cancer

Home Health Care

Long Term Care

Hospitalization

Prescription Drug Costs

All Of The Above

Do You Currently Carry Any Home Health Care Coverage? (Medicare Does Not Provide Home Health Care Services for Daily Activities Of Living. Ex. Cooking, Cleaning, Bathing, Toileting)

Yes

No

I Don't Know

Do You Currently Carry Any Cancer Coverage? ( Beyond What Medicare Covers)

Yes

No

I Don't Know

Do You Currently Carry Any Additional Hospital Coverage? (Beyond Medicare- Ex. Hospital Indemnity Plan)

Yes

No

I Don't Know

Do You Currently Carry Any Long Term Care Coverage? (Medicare Does Not Pay For Long Term Care)

Yes

No

I Don't Know

What Is Your Total Current Monthly Premium? (Medical and Prescription-Not Including Your Part B Premium)

$0-50

$51-100

$101-150

$150-200

Over $201

What Information Are You Looking For?

General Information

Options

Enrollment

Cost

Eligibility

Do You Currently Carry Any Home Health Care Coverage? (Medicare Does Not Provide Home Health Care Services for Daily Activities Of Living. Ex. Cooking, Cleaning, Bathing, Toileting)

Yes

No

I Don't Know

Do You Currently Carry Any Cancer Coverage? ( Beyond What Medicare Covers)

Yes

No

I Don't Know

Do You Currently Carry Any Additional Hospital Coverage? (Beyond Medicare- Ex. Hospital Indemnity Plan)

Yes

No

I Don't Know

Do You Currently Carry Any Long Term Care Coverage? (Medicare Does Not Pay For Long Term Care)

Yes

No

I Don't Know

What Were You Looking For Today?

I Need To Make A Change

I Am Confused

I Want A Full Assessment Of My Needs

Curiosity

None Of The Above

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