Compensated Research about Health Insurance Pre-screener to be considered Question Title * 1. Contact Information Name City State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Country Linkedin or social media link Email Phone Question Title * 2. Which county do you reside in? Alachua Baker Bay Bradford Brevard Broward Calhoun Citrus Lake Miami Dade Orange Osceola Seminole Polk Volusia Other (please specify) Question Title * 3. Do you, or does any member of your family, currently or formerly work for… A company that sells or manufactures appliances An agency offering or selling health insurance policies A food or beverage company A health insurance company Any healthcare provider, including a hospital, clinic, private practice, laboratory, managed care organization, health plan, etc A telecommunication firm A pharmaceutical company Other (please specify) Question Title * 4. What is your age? Question Title * 5. Are you … ? Male Female Non-binary or third gender Prefer not to say Prefer to self-describe Question Title * 6. Where were you born? USA Argentina Bolivia Brazil Chile Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Haiti Honduras Mexico Nicaragua Panama Paraguay Peru Puerto Rico Uruguay Venezuela Other (please specify) Question Title * 7. How long have you lived in the US? Question Title * 8. Which of the following best describes your ethnic background? American Indian or Native American Asian Black or African American Caribbean Hispanic or Latinx Middle Eastern or North African Native Hawaiian or Pacific Islander White or Caucasian Other (please specify) Question Title * 9. What languages were spoken in the household in which you grew up? Question Title * 10. What is your preferred language when interacting with healthcare providers? Spanish English Both English and Spanish Question Title * 11. The questions you will see next ask about your health insurance status, the name of your provider (if you are insured) and how you obtained coverage (if applicable). The purpose of these questions is to determine if you are a good fit for our research study. Any information obtained in this screening process is protected digitally and will only be shared with the research team and its client. If you qualify to participate in our research study, we will request you sign a formal confidentiality and HIPAA release form, fulfilling HIPAA privacy rules as well as the research team’s privacy policy. Personal information obtained under these forms is for the scope of the research project and nothing else. All information obtained from the screening process for this research is removed after 90 days but may be removed earlier upon your written request. Before proceeding with this questionnaire, please indicate “Yes” to indicate you understand we will be asking about this protected information. If you are not interested in applying, please indicate “No”. Yes No Question Title * 12. Which of the following best describes the type of health insurance you have? I have a Medicare plan through the government I have a Medicare Advantage plan through a private insurance company Dual Eligible Special Needs Plan I have health insurance through my employer or someone else's (e.g., spouse, domestic partner, parent) I have an individual plan with a private health insurance company I have Medicaid through the government I’m not sure I don’t have any health insurance Next