CH_December_2017

For people living with cancer, access to affordable care and treatment is essential for survival. Cancer Health wants to know about your health care coverage and concerns.

1) What type of health insurance do you currently have?

2) On average, how much do you spend on your health insurance coverage each month?

3) On average, how much do you spend each month on out-of-pocket costs for your health care (for example, copays and deductibles)?

4) How satisfied are you with your current health care coverage?

5) How satisfied are you with your current health care costs?

6) Have you skipped or delayed any care or treatment in the past year because of the cost?

7) How much do you worry about the cost of your health care?

8) Are you concerned about the repeal of the Affordable Care Act?

9) What year were you born?

10) What is your gender?

Other

11) What is your sexual orientation?

Other

12) What is your ethnicity? (Check all that apply.)

13) What is your current level of education?

14) What is your zip code?

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