Do you live in Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga or Oswego County?

Are you eligible for Medicare?

Do you or your spouse currently work or have you or your spouse worked at some time within the last 12 months?

Do you currently have comprehensive health insurance coverage or have you had it at some time in the last 12 months?

Are you currently eligible for comprehensive health insurance through your job?

Did you lose coverage or are you going to lose coverage due to any of the following?

Loss of employment, discontinuation of a group health plan, legal separation, or aging off a parent's insurance policy.

Does your employer contribute to the cost of insurance?

How many people in your household?

Is your current monthly income at or below $2,257.00?

Is your current monthly income at or below $3,036.00?

Is your current monthly income at or below $3,815.00?

Is your current monthly income at or below $4,594.00?

Is your current monthly income at or below $5,373.00?

Is your current monthly income at or below $6,153.00?

Multiply $780.00 by the total number of people greater than 6 in your household. Add this amount to $6,153.00? Is your current monthly income at or below this amount?