USA Medicare Program

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Are you currently enrolled in both Medicare Parts A & B?

Part A covers hospital care. Part B covers medical care.

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Medicaid provides coverage for some limited-income people.

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Zip Code

Are you currently enrolled in both Medicare Parts A & B?

Do any of these apply to you?

Are you receiving benefits from California Medicaid (MediCal?)

Date of Birth

What is your email?

What is your name?

Telephone Number

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