Hep Health Care Survey

Covering Costs
For people living with hepatitis, access to affordable care and treatment is essential for survival. Hep wants to know about your health care coverage and concerns.
1) What type of health insurance do you currently have?

Employer-based private insuranceIndividual-based private insuranceMedicaidMedicareNoneOther
2) Do you use any of the following programs to help with your health care costs? (Check all that apply.)

Pharmaceutical assistance program (PAP)Pharmaceutical copay programOther
3) On average, how much do you spend on your health insurance coverage each month?

NoneLess than $100$100–$299$300–$499$500 or more
4) On average, how much do you spend each month on out-of-pocket costs for your health care (for example, copays and deductibles)?

NoneLess than $100$100–$299$300–$499$500 or more
5) How satisfied are you with your current health care coverage?

Very satisfiedSomewhat satisfiedNot at all satisfied
6) How satisfied are you with your current health care costs?

Very satisfiedSomewhat satisfiedNot at all satisfied
7) Have you skipped or delayed any care or treatment in the past year because of the cost?

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

A lotA littleNot at all
9) Are you concerned about the repeal of the Affordable Care Act?

YesNo
10) What year were you born?
11) What is your gender?

MaleFemaleTransgenderOther
12) What is your sexual orientation?

StraightGay/lesbianBisexualOther
13) What is your ethnicity? (Check all that apply.)

American Indian or Alaska NativeArab or Middle EasternAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
14) What is your current level of education?

Some high schoolHigh school graduateSome collegeBachelor’s degree or higher
15) What is your zip code?
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Covering Costs