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Plaza Research is recruiting a project on behalf of UnitedHealthcare. We would like to assure you at the outset that we are not selling anything now – nor will you be solicited at any time in the future. We are conducting a research project with people from across the country on the topic of Medicare, and we would like to invite you to participate. We would value your opinions and input – plus, if you qualify, you will be compensated for taking the time to participate.

We have just a few introductory questions to ensure you qualify. If you qualify for this survey, we would invite you to participate in the study and will give you the details of what that would entail.

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* 1. What is your full name? (First and last)

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* 2. What is your phone number? (Area-code included)

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* 3. In which city and state do you currently reside?

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* 4. Can you please tell me how old you are?

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* 5. Do you currently have health care insurance?

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* 6. What company provides your current health insurance coverage?

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* 7. Overall, how satisfied have you been with your current insurance plan?

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* 8. What is your current employment status?

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* 9. How would you describe the size of the company you work for?

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* 10. How do you currently get your health care insurance?

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* 11. Which of the following best describes your plan for retirement?

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* 12. When you retire, what are your plans for your health care coverage?

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* 13. At the time when you leave your current health insurance plan, do you expect to be eligible for Medicaid - health insurance that is partially or fully funded by your state at a reduced cost to you?

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* 14. Do you intend to apply for Medicare at some point in the near future?

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* 15. When do you expect to apply for Medicare?

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* 16. Which of the following best describes your current status when it comes to selecting a Medicare plan?

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* 17. Which of the following best describes your marital status?

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* 18. Do you regularly use a computer at home?

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* 19. Do you have Internet access at home?

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* 20. What kind of Internet access do you have at home?

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* 21. How comfortable do you feel when you're using the computer?

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* 22. Which of the following activities do you feel comfortable doing on a computer?

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* 23. What is the last level of education that you completed?

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* 24. What of the following best describes your household's total yearly income for 2010, before taxes?

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