Needs Assessment | meandmedicare

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MEDICARE NEEDS ASSESSMENT

This short needs assessment helps me understand your current Medicare coverage and what is important to you. We will review your answers together before considering specific Medicare plan options.

Your Current Coverage Check all that apply.

Original Medicare & PDP (Only)

Medicare Advantage

Medicare Supplement (Medigap)

Medicaid

What is the name of your plan

What is important to you? Check all that apply.

I have an ongoing health condition or treatment that should be considered when reviewing my coverage needs

Part B Give Back - Part B premium reduction

Keeping my costs low when I receive healthcare (deductables, copays, coinsuraces or max out of pocket cost)

Keeping doctors, specialists, hospitals, or other providers that are important to me

Prescription drug coverage and costs

Dental, vision, or hearing benefits

Coverage for medical equipment, therapy, rehabilitation, or home health services

Transportation or other healthcare-access needs

Coverage that works when I travel or live away from home

Specific Concerns:

How do you feel about your current Medicare coverage?

I'm satisfied

It's okay, but I would like to review my options

I'm not satisfied

What do you particularly want to keep, change, or improve about your coverage?

Acknowledgment:

I have completed the information above, and it reflects my current Medicare coverage needs and preferences.

*Client's First Name

*Client's last name

*Phone

Self-Guided Tools & Forms

Find a Medicare Advantage Plan
Add you Medical Information
Dental/Vision/Hearing
Hospital Indemnities
Under 65 Health Insurance (ACA)

Business Info

Me and Medicare LLC

South Dakota
(971) 366-2500
Hello@MeandMedicare.com

Support@MeandMedicare.com

Disclaimer: The information provided on this website is for general educational purposes about Medicare Advantage (Part C), Medicare Part D, and related services. Costs, copays, coinsurance, benefits, and coverage rules vary by plan, provider network, and service area. You must continue to pay your Medicare Part B premium.

Me and Medicare LLC is a privately owned and operated insurance agency and is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

We do not offer every plan available in your area: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MEDICARE NEEDS ASSESSMENT

This short needs assessment helps me understand your current Medicare coverage and what is important to you. We will review your answers together before considering specific Medicare plan options.

Acknowledgment:

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