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Are you new to Medicare?
Yes
No
I know a little about medicare
Are you 65 years old or over?
Yes
I will be 65 this year
I will be 65 next year
I will be 65 in 2 - 3 years
Are you qualified for disability?
Yes
No
Not sure
Do you travel out of your home state often?
Yes
No
Occasionally
Do you take more than 5 prescriptions?
Yes
No
Do you have a critical illness?
Yes
No
Do you need dental or vision coverage?
No
I need dental coverage
I need vision coverage
I need both dental and vision coverage
What is your gender?
Male
Female
Other
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