www.medicare.gov Open in urlscan Pro
23.221.21.195  Public Scan

Form analysis
2 forms found in the DOM

GET /search/medicare

<form action="/search/medicare" method="get" id="search-block-form" accept-charset="UTF-8" role="search" class="search-form search-block-form" aria-hidden="true">
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    <input title="Enter the terms you wish to search for." data-drupal-selector="edit-keys" class="form-autocomplete form-search ui-autocomplete-input" data-autocomplete-path="/vertex_autocomplete/vertex_ai_search" type="search" id="edit-keys"
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</form>

POST /

<form class="medicare-email-signup-form" data-drupal-selector="medicare-email-signup-form-2" action="/" method="post" id="medicare-email-signup-form--2" accept-charset="UTF-8">
  <input data-drupal-selector="edit-prod" type="hidden" name="prod" value="prod">
  <input data-drupal-selector="edit-state-question-id" type="hidden" name="state_question_id" value="65497">
  <input data-drupal-selector="edit-group-question-id" type="hidden" name="group_question_id" value="74299">
  <input data-drupal-selector="edit-email" type="hidden" name="email" value="">
  <fieldset role="group" aria-label="Signup form for email updates" class="ds-c-fieldset ds-u-margin-top--0 js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-step1" id="edit-step1--2">
    <legend>
      <span class="fieldset-legend"></span>
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    <div class="fieldset-wrapper">
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        <label for="edit-step1-email--2" class="m-evo-label ds-c-label js-form-required form-required"><span>Enter your email address</span></label>
        <input class="ds-c-field form-email required" autocomplete="off" data-drupal-selector="edit-step1-email" type="email" id="edit-step1-email--2" name="step1[email]" value="" size="60" maxlength="254" placeholder="name@example.com"
          required="required">
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      <div class="m-evo-form-item js-form-item form-item js-form-type-checkbox form-type-checkbox js-form-item-step1-consent form-item-step1-consent">
        <input class="ds-c-choice form-checkbox required" data-drupal-selector="edit-step1-consent" type="checkbox" id="edit-step1-consent--2" name="step1[consent]" value="1" required="required">
        <label for="edit-step1-consent--2" class="m-evo-label ds-c-label option js-form-required form-required"><span><span> By checking this box, you consent to our <a href="/privacy-policy">data privacy policy</a>. </span></span></label>
      </div>
    </div>
  </fieldset>
  <input autocomplete="off" data-drupal-selector="form-43bq4nylgobvsboix3fgw0otelntdqhje7m9ii0fpzq" type="hidden" name="form_build_id" value="form-43bq4NyLGobvSboiX3FGW0otelntDqHJe7m9II0FpzQ">
  <input data-drupal-selector="edit-medicare-email-signup-form-2" type="hidden" name="form_id" value="medicare_email_signup_form">
  <div data-drupal-selector="edit-emailsignup-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-emailsignup-actions--2">
    <input data-drupal-selector="edit-emailsignup-actions-next1" type="submit" id="edit-emailsignup-actions-next1--2" name="op" value="Next Step" class="button button--primary js-form-submit form-submit ds-c-button ds-c-button--solid"
      data-once="drupal-ajax">
  </div>
</form>

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Versionreact-global-header:release-2.27.3Hashreact-global-header:d832ea8

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