Medicare Clarity Score

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Medicare Clarity Score Diagnostic

Who are you filling this out for today?

Myself

My spouse/partner

A parent or other loved one

Where are you in the Medicare timeline?

I’m already on Medicare

I turn 65 in the next 6 months

I turned 65 in the last 12 months

I’m over 65 and stayed on employer/group coverage

I’m not sure

Are you worried about paying a penalty for enrolling in Medicare later than required?

Yes, very worried

Somewhat concerned

Not worried

How is your Medicare set up right now?

Original Medicare only (no other coverage)

Original Medicare + a Medigap (supplement) + a separate Part D plan

A Medicare Advantage (all‑in‑one) plan

Employer or retiree coverage is my main coverage

I honestly don’t know what I have

Have your current Medicare costs (premiums, deductibles, prescriptions) risen significantly in the last 12 months?

Yes, lots

Slightly

No

Do you have prescription drug coverage that you know is Medicare-creditable?

Yes, I have a Part D plan

Yes, my employer/retiree plan told me it’s “creditable”

I’m not sure

No, I don’t have separate drug coverage

In a typical year, how many medications do you take regularly?

None or only 1

2–4

5 or more

It changes a lot / not sure

Have you checked that your doctors and hospitals are covered by your Medicare plan this year?

Yes, I checked this year and I’m confident

I checked before, but not this year

I haven’t checked

I don’t know how to check

How confident are you that you’re not overpaying for your Medicare coverage?

Very confident – I review it every year

Somewhat confident – I’ve looked at it once or twice

Not confident – I’ve never really compared plans

I’m worried I’m overpaying

Do you know your maximum out-of-pocket (MOOP) limit for medical expenses this year?

Yes, I know exactly what it is

I have a general idea, but not the exact number

No, I have no idea what my limit is

I don't think my plan has a limit

Have you received unexpected medical bills in the last year?

Yes

Sometimes

No

Has anyone clearly explained late enrollment penalties and how your income can affect what you pay (IRMAA)?

Yes, and I feel like I understand it

It’s been mentioned, but I’m still not clear

No, no one has walked me through it

I’ve already been hit with penalties or higher costs

What worries you most about your Medicare right now?

Getting hit with penalties for doing something wrong

Not having the coverage I need when something happens

Paying more than I should for what I have

Just making sure I’m truly on the right path

Do you feel your current Medicare coverage meets your budget and health needs?

Yes

Somewhat

No

Does your coverage change each year (e.g., pharmacy networks or doctor networks)?

Yes

Not sure

No

Full Name

Email

Mobile

Total Risk Score

Risk Band

High Risk

Medium Risk

Low Risk

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Trusted SR Solutions is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

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