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  • Medicare Health Screener

    When completing this health screener, the information you share is exclusively used within our office to assist us in preparing the best and most accurate Medicare policy recommendations.

  • Medical Questions Part A:
    Please answer Yes or No to the best of your Knowledge & Belief.

  • This question applies to the following 3A - 3G questions:

    Have You been medically diagnosed with, treated for, or had a surgery for any of the following?

  • Medical Questions Part B:
    This question applies to the following 8A - 8G questions:

    Within the past two years, have you been treated for, or been advised by a physician to have treatment for:

  • Please provide us with additional information for each question you answered "YES."

    1. State the name or type of condition and the approximate month and year it began.
    2. How is the medical condition being managed? (i.e., Surgery, Medications, Physical, or another form of therapy.)
    3. What is the current medical status? (i.e., On-going, Maintenence Checkups, Remission, or Resolved.)
    4. List all of the medications for treating your medical condition.

     

    Here is an example.

    "Diagnosed with Prostate Cancer in July 2020. Radiation and Surgery were completed in September 2020. Yearly recheck with Urologist but no reoccurrence. No medications."

     

    Your answers will help us make the best recommendations for your current and unique health scenario. We serve you best when we can quickly and accurately get you the proper guidance. Depending on your responses, Some, None, or All carriers may be available for you to consider. Thank you, and we will be in touch soon!

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