Refer to "States with Medicare Managed Care Plan" card and the address on the cover of the HIS-1. (Resident of State with Medicare Managed care plans)
1[] Resident of state on card (1h)
2[] Other (1d for NP with 1b, or 2)
1h. Can -- go to ANY doctor who will accept Medicare or must -- choose from a specific group or list of doctors?
If doctor was assigned by the plan, mark box 2.
1[] Any doctor (1d for NP with 1b, or 2)
2[] Select from list/group (1i)
9[] DK (1d for NP with 1b, or 2)
i. What is the specific name if -- Medicare health plan?
___________
___________
___________
(1d for NP with 1b,or 2)