Healthcare Insurance Coverage

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* 1. Which age group are you a part of?

Under 18

18 - 29

30 - 39

40 - 49

50 - 59

60 - 64

65+

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* 2. Do you currently have health insurance coverage?

Yes

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* 3. How long have you been on the plan you are currently covered by?

Less than 6 months

6 months to 1 year

1 year to 1.5 years

1.5 years to 2 years

2 years to 3 years

3 years or more

Not Applicable

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* 4. Are you the parent or caregiver for someone who has health insurance?

Yes

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* 5. How long has the person you are caring for been on the plan they are covered by?

Less than 6 months

6 months to 1 year

1 year to 1.5 years

1.5 years to 2 years

2 years to 3 years

3 years or more

Not Applicable

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* 6. Which of the following best describes your role in making healthcare-related decisions including which insurance plan to choose?

	For yourself	For someone you are the parent or caregiver of
I make the decision alone	I make the decision alone For yourself	I make the decision alone For someone you are the parent or caregiver of
I share the decisions with someone else	I share the decisions with someone else For yourself	I share the decisions with someone else For someone you are the parent or caregiver of
Someone else makes the decisions	Someone else makes the decisions For yourself	Someone else makes the decisions For someone you are the parent or caregiver of

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* 7. Which one of the following best describes your current health insurance coverage? (For yourself, please only select your primary insurance. For someone you are the parent or caregiver of, select all that apply.)

	For yourself	For someone you are the parent or caregiver of
Insured by own employer or union	Insured by own employer or union For yourself	Insured by own employer or union For someone you are the parent or caregiver of
Insured through spouse or partner's employer or union	Insured through spouse or partner's employer or union For yourself	Insured through spouse or partner's employer or union For someone you are the parent or caregiver of
Receive Medicare	Receive Medicare For yourself	Receive Medicare For someone you are the parent or caregiver of
Receive Medicaid	Receive Medicaid For yourself	Receive Medicaid For someone you are the parent or caregiver of
Buy coverage directly (through the Federal Marketplace, an insurance agent, or directly from an insurance company, but not through an employer)	Buy coverage directly (through the Federal Marketplace, an insurance agent, or directly from an insurance company, but not through an employer) For yourself	Buy coverage directly (through the Federal Marketplace, an insurance agent, or directly from an insurance company, but not through an employer) For someone you are the parent or caregiver of
Coverage by TRICARE, CHAMPUS, CHAPVA, VA, military health care, or Indian Health Service	Coverage by TRICARE, CHAMPUS, CHAPVA, VA, military health care, or Indian Health Service For yourself	Coverage by TRICARE, CHAMPUS, CHAPVA, VA, military health care, or Indian Health Service For someone you are the parent or caregiver of
Uninsured	Uninsured For yourself	Uninsured For someone you are the parent or caregiver of
Not sure	Not sure For yourself	Not sure For someone you are the parent or caregiver of

Other (please specify)