MEDICARE ANALYSIS

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Medicare Analysis form

Has anyone explained your Medicare options lately?

Do you want any prescriptions checked?

How often do you go to the doctor or see a specialist?

Do you have a particular doctor, hospital or pharmacy that you want to use?

Do you have End Stage Renal Disease or any other chronic conditions?

Do you know anyone who has been in an assisted living, long-term care or skilled nursing facility?

Do you live part-time in another state or travel frequently?

Do you currently receive health coverage through a former employer or organization?

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