Medical Expenses

You told us that someone in your home pays medical bills. Please answer the questions to tell us more about the medical expenses.


Select the type of medical expense.


Enter the name of medical care provider.


Enter the date of service in the following format: MM/DD/YYYY. Be sure to use slashes (/).


Select how frequently the of medical expense is paid.


Enter the amount paid.


If the medical bill is paid in full, please choose Yes.


Enter the amount pending on the bill.


If the person listed on the page pays other medical bills, select Yes.  If they don't, select No.


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