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Advantage Plan Switch Eligibility

Advantage Plan Switch Eligibility

Advantage Plan Switch EligibilityCareTech2025-09-24T20:45:10+00:00

Medicare Coverage Eligibility Questionaire

Step 1 of 6

16%
Are you currently bedridden, confined to a wheelchair, or do you require the assistance of a motorized mobility device?(Required)
Are you currently hospitalized, in a nursing home or assisted living facility, using the services of a home healthcare agency or have you been hospitalized two or more times in the past year?(Required)
In the past two years, have you been advised to have surgery (including cataract or joint replacement surgery), injections in a physician's office, infusions, or therapy that has not been performed?(Required)
Have you ever had, been medically diagnosed with, or treated for any of the following: * Parkinson's disease, multiple or amyotrophic lateral sclerosis, muscular dystrophy, Alzheimer's disease, dementia, or any other cognitive disorder?(Required)
Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex (ARC), or tested positive for the Human Immunodeficiency Virus (HIV)?(Required)
Chronic kidney disease or insufficiency, or renal failure requiring dialysis?(Required)
Do you have Systemic Lupus, scleroderma, myasthenia gravis, or Crohn's Disease or Ulcerative Colitis?(Required)
Have you had n organ transplant, stem cell transplant or been advised to have an organ transplant (excluding cornea transplants)?(Required)
Cardiac defibrillator implanted?(Required)
Chronic hepatitis or cirrhosis of the liver?(Required)
Cardiac defibrillator implanted?(Required)
Chronic hepatitis or cirrhosis of the liver?(Required)
Osteoporosis with fractures?(Required)
Aortic or cardiac aneurysm that has not been surgically repaired?(Required)
Within the past twelve (12) months have you had or been treated for or been advised by a physician to have treatment of the following:(Required)

Within the past two (2) years, have you had any of the following:

Vascular angioplasty, endarterectomy, or implantation of a pacemaker?(Required)
A stroke or transient ischemic attack (TIA)?(Required)

Within the past two (2) years have you had or been treated for or been advised by a physician to have treatment for:

Alcoholism or drug abuse?(Required)
Any mental or nervous disorder requiring inpatient treatment by a psychiatrist?(Required)
Degenerative bone disease, Heart valve disorder, Spinal stenosis, Atrial fibrillation, Rheumatoid arthritis, Heart rhythm disorder, or Pancreatitis(Required)

Within the past twelve (12) months have you had or been treated for or been advised by a physician to have treatment of the following:

Coronary artery disease, Peripheral artery disease, Cardiomyopathy, Peripheral vascular disease, Congestive heart failure, Peripheral venous thrombotic disease, Angina, Carotid artery disease, or Neuropathy?(Required)
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