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Section 14, Part C covers participation in health insurance plans for which the consumer unit does not pay directly, such as Medicare, Medicaid, and military health care plans.
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How many members of your CU are covered by Medicare? [enter value] ______________
Who is enrolled in a Medicare Prescription Drug plan? [enter text] ______________
In what month and year did you or CU member(s) enroll in the prescription drug plan?
* Enter month of enrollment [enter value] ______________
* Enter year of enrollment [enter value] ______________
What is the monthly premium for you or CU member(s) Medicare Prescription Drug plan?
* Do not include any monthly co-payments paid by the CU. [enter value] ______________
Is the monthly premium deducted from a Social Security payment?
How many members of your CU are covered by Medicaid? [enter value] ______________
How many members of your CU are covered by Medicare? [enter value] ______________
Who is enrolled in a Medicare Prescription Drug plan? [enter text] ______________
In what month and year did you or CU member(s) enroll in the prescription drug plan?
* Enter month of enrollment [enter value] ______________
* Enter year of enrollment [enter value] ______________
What is the monthly premium for you or CU member(s) Medicare Prescription Drug plan?
* Do not include any monthly co-payments paid by the CU. [enter value] ______________
Is the monthly premium deducted from a Social Security payment?
Are you or any members of your CU enrolled in Medicaid?
How many members of your CU are covered by Medicaid? [enter value] ______________
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Last Modified Date: November 8, 2007