Evaluation of Selected Aspects of the National Medicare Education Program: Final Design Report. Appendix B

01/10/2008

Final Design Report B-1

Appendix B: MCBS Survey Questions

KN3. In the past year, have you tried to find out how much [you/(SP)] needed to pay for a particular medical service?
MCBS Survey Questions
         
  KPYFIND YES 1 (KN4)
    NO 2 (KN6)
    NEVER CONTACTED ANYONE FOR ANY INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 (KN6)
    DON’T KNOW -8 (KN6)
         
KN4. How did you find out about what [you/(SP)] needed to pay for a particular medical service? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KPYNOFND R DID NOT FIND INFORMATION  THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 (KN6)
  KPYINSCO MEDICARE CLAIMS 1  
  KPYMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KPYMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KPYSSOFF SOCIAL SECURITY OFFICE 4  
  KPYAARP AARP/SENIOR CITIZENS ORGS 5  
  KPYFAMLY FAMILY OR FRIENDS 6  
  KPYSRCTR LOCAL SENIOR CENTER 7  
  KPYHOSP LOCAL HOSPITAL 8  
  KPYDOCTR DOCTOR’S OFFICE   MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KPYCOUN ASSISTANCE PRGM. 10  
  KPYPUBL MEDICARE PUBLICATIONS 11  
  KPYZINE NEWSPAPERS OR MAGAZINES 13  
  KPYOGOVT OTHER GOVERNMENT AGENCY 14  
  KPYEMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KPYHMO HMO 16  
  KPYINET THE INTERNET 17  
  KPYSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KPYOSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO 19  
  KPYTV TV 20  
  KPYRADIO RADIO 21  
  KPYOTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KPYOTHOS REFUSED -7  
  KPYMCBS DON’T KNOW -8  
         
KN6. In the past year, have you tried to find information [for (SP)] about any new benefits or changes in the Medicare program?
  KWBFIND YES 1 (KN7)
    NO 2 (KN9)
    NEVER CONTACTED ANYONE FOR ANY INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 (KN9)
    DON’T KNOW -8 (KN9)
         
KN7. Where did you find the information about new benefits or changes in the Medicare program? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KWBNOFND R DID NOT FIND INFORMATION   THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 (KN9)
  KWBINSCO MEDICARE CLAIMS 1  
  KWBMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KWBMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KWBSSOFF SOCIAL SECURITY OFFICE 4  
  KWBAARP AARP/SENIOR CITIZENS ORGS. 5  
  KWBFAMLY FAMILY OR FRIENDS 6  
  KWBSRCTR LOCAL SENIOR CENTER 7  
  KWBHOSP LOCAL HOSPITAL 8  
  KWBDOCTR DOCTOR’S OFFICE   MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KWBCOUN ASSISTANCE PRGM. 10  
  KWBPUBL MEDICARE PUBLICATIONS 11  
  KWBZINE NEWSPAPERS OR MAGAZINES 13  
  KWBOGOVT OTHER GOVERNMENT AGENCY 14  
  KWBEMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KWBHMO HMO 16  
  KWBINET THE INTERNET 17  
  KWBSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KWBOSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO. 19  
  KWBTV TV 20  
  KWBRADIO RADIO 21  
  KWBOTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KWBOTHOS REFUSED -7  
  KWBMCBS DON’T KNOW -8  
         
KN9. In the past year, have you tried to find information about what medical services Medicare covers and does not cover?
  KVRFIND YES 1 (KN10)
    NO 2 (KN12)
    NEVER CONTACTED ANYONE FOR ANY INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 (KN12)
    DON’T KNOW -8 (KN12)
         
KN10. Where did you find the information about what medical services Medicare covers and does not cover? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KVRNOFND R DID NOT FIND INFORMATION THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 (KN12)
  KVRINSCO MEDICARE CLAIMS 1  
  KVRMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KVRMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KVRSSOFF SOCIAL SECURITY OFFICE 4  
  KVRAARP AARP/SENIOR CITIZENS ORGS. 5  
  KVRFAMLY FAMILY OR FRIENDS 6  
  KVRSRCTR LOCAL SENIOR CENTER 7  
  KVRHOSP LOCAL HOSPITAL 8  
  KVRDOCTR DOCTOR’S OFFICE MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KVRCOUN ASSISTANCE PRGM. 10  
  KVRPUBL MEDICARE PUBLICATIONS 11  
  KVRZINE NEWSPAPERS OR MAGAZINES 13  
  KVROGOVT OTHER GOVERNMENT AGENCY 14  
  KVREMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KVRHMO HMO 16  
  KVRINET THE INTERNET 17  
  KVRSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KVROSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO. 19  
  KVRTV TV 20  
  KVRRADIO RADIO 21  
  KVROTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KVROTHOS REFUSED -7  
  KVRMCBS DON’T KNOW -8  
         
KN12. In the past year, have you tried to find out about the availability and benefits of Medicare managed care plans, such as HMOs?
  KVLFIND YES 1 (KN13)
    NO 2 BOX KN2
    NEVER CONTACTED ANYONE FOR ANY INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 BOX KN2
    DON’T KNOW -8 BOX KN2
         
KN13. How did you find out about the availability and benefits of Medicare managed care plans, such as HMOs? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KVLNOFND R DID NOT FIND INFORMATION THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 BOX KN2  
  KVLINSCO MEDICARE CLAIMS 1  
  KVLMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KVLMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KVLSSOFF SOCIAL SECURITY OFFICE 4  
  KVLAARP AARP/SENIOR CITIZENS ORGS. 5  
  KVLFAMLY FAMILY OR FRIENDS 6  
  KVLSRCTR LOCAL SENIOR CENTER 7  
  KVLHOSP LOCAL HOSPITAL 8  
  KVLDOCTR DOCTOR’S OFFICE MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KVLCOUN ASSISTANCE PRGM. 10  
  KVLPUBL MEDICARE PUBLICATIONS 11  
  KVLZINE NEWSPAPERS OR MAGAZINES 13  
  KVLOGOVT OTHER GOVERNMENT AGENCY 14  
  KVLEMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KVLHMO HMO 16  
  KVLINET THE INTERNET 17  
  KVLSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KVLOSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO. 19  
  KVLTV TV 20  
  KVLRADIO RADIO 21  
  KVLOTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KVLOTHOS REFUSED -7  
  KVLMCBS DON’T KNOW -8  
         
KN15. In the past year, have you tried to find information about what (your/SP’s) Medigap or supplemental insurance policy covers? [PROBE IF NECESSARY: That is, information about what (your/SP’s) (READ PLAN NAMES BELOW) policy covers?]
  KGPFIND YES 1 (KN16)
    NO 2 BOX KN3
    NEVER CONTACTED ANYONE FOR ANY    
    INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 BOX KN3
    DON’T KNOW -8 BOX KN3
         
KN16. Where did you find the information about what (your/SP’s) Medigap or supplemental insurance policy covers? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KGPNOFND R DID NOT FIND INFORMATION THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 BOX KN3
  KGPINSCO MEDICARE CLAIMS 1  
  KGPMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KGPMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KGPSSOFF SOCIAL SECURITY OFFICE 4  
  KGPAARP AARP/SENIOR CITIZENS ORGS. 5  
  KGPFAMLY FAMILY OR FRIENDS 6  
  KGPSRCTR LOCAL SENIOR CENTER 7  
  KGPHOSP LOCAL HOSPITAL 8  
  KGPDOCTR DOCTOR’S OFFICE MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KGPCOUN ASSISTANCE PRGM. 10  
  KGPPUBL MEDICARE PUBLICATIONS 11  
  KGPZINE NEWSPAPERS OR MAGAZINES 13  
  KGPOGOVT OTHER GOVERNMENT AGENCY 14  
  KGPEMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KGPHMO HMO 16  
  KGPINET THE INTERNET 17  
  KGPSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KGPOSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO. 19  
  KGPTV TV 20  
  KGPRADIO RADIO 21  
  KGPOTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KGPOTHOS REFUSED -7  
  KGPMCBS DON’T KNOW -8  
         
KN18. In the past year, have you tried to find information about (your/SP’s) Medicaid plan, such as how it works with Medicare?
  KCDFIND YES 1 (KN19)
    NO 2 (KN22)
    NEVER CONTACTED ANYONE FOR ANY    
    INFORMATION ON ANY TOPIC 3 (KN21)
    REFUSED -7 (KN22)
    DON’T KNOW -8 (KN22)
         
KN19. Where did you find the information? [CODE ALL THAT APPLY.] [PRESS CTRL/L TO LEAVE SCREEN.]
  KCDNOFND R DID NOT FIND INFORMATION THE INSURANCE COMPANY THAT PROCESSES (SP’S) 96 (KN22)
  KCDINSCO MEDICARE CLAIMS 1  
  KCDMEDGP MEDIGAP/SUPPLEMENTAL INS. COMPANY 2  
  KCDMCOFF MEDICARE OFFICE INCLUDING THE TELEPHONE HOTLINE 3  
  KCDSSOFF SOCIAL SECURITY OFFICE 4  
  KCDAARP AARP/SENIOR CITIZENS ORGS. 5  
  KCDFAMLY FAMILY OR FRIENDS 6  
  KCDSRCTR LOCAL SENIOR CENTER 7  
  KCDHOSP LOCAL HOSPITAL 8  
  KCDDOCTR DOCTOR’S OFFICE MEDICARE COUNSELING PROGRAM, E.G., STATE HEALTH INS. 9  
  KCDCOUN ASSISTANCE PRGM. 10  
  KCDPUBL MEDICARE PUBLICATIONS 11  
  KCDZINE NEWSPAPERS OR MAGAZINES 13  
  KCDOGOVT OTHER GOVERNMENT AGENCY 14  
  KCDEMPLR EMPLOYER OR FORMER EMPLOYER 15  
  KCDHMO HMO 16  
  KCDINET THE INTERNET 17  
  KCDSEMNR HEALTH FAIR/SEMINAR AT AN HMO OR INSURANCE COMPANY 18  
  KCDOSMNR HEALTH FAIR/SEMINAR OTHER THAN HMO/INSURANCE CO. 19  
  KCDTV TV 20  
  KCDRADIO RADIO 21  
  KCDOTHER ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  KCDOTHOS REFUSED -7  
  KCDMCBS DON’T KNOW -8  
         
KN27. Did [you/(SP)] receive a copy of this book, called Medicare and You 2004, which gives an overview of the Medicare program? *SHOW CARD KN7*
  KBOKRECD YES 1 (KN28)
    NO 2 BOX KN4B
    REFUSED -7 BOX KN4B
    DON’T KNOW -8 BOX KN4B
         
KN29. How easy to understand did you find (this book/the parts you looked at) – would you say (it was/they were) very easy to understand, somewhat easy to understand, somewhat difficult to understand, or very difficult to understand? *SHOW CARD KN1*
  KBOKUNDR VERY EASY 1  
    SOMEWHAT EASY 2  
    SOMEWHAT DIFFICULT 3  
    VERY DIFFICULT 4  
    REFUSED -7  
    DON’T KNOW -8  
         
KN29b. In general, how easy did you find the plan information chart to understand – would you say it was very easy to understand, somewhat easy to understand, somewhat difficult to understand, or very difficult to understand? *SHOW CARD KN1*
  KBOKUNST VERY EASY 1  
    SOMEWHAT EASY 2  
    SOMEWHAT DIFFICULT 3  
    VERY DIFFICULT 4  
    REFUSED -7  
    DON’T KNOW -8  
         
KN30. [Do you/Do you or (SP)] still have this Medicare and You 2004 book? *SHOW CARD KN7*
  KBOKHAVE YES 1  
    NO 2  
    REFUSED -7  
    DON’T KNOW -8  
         
KN37. Most people covered by Medicare can select among different kinds of health plan options within Medicare. [PROBE: Do you think this is true or false, or are you not sure?]
  KNPLNCHC TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
KN42. Medicare managed care plans (HMOs) often cover more health services, like prescribed medicines, than Medicare without a supplemental insurance policy. [PROBE: Do you think this is true or false, or are you not sure?]
  KNHMOCOV TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
KN43. With a Medicare HMO, people can go to any doctor or hospital in the United States for routine care and the visit will be covered. [PROBE: Do you think this is true or false, or are you not sure?]
  KNANYDOC TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
KN44. If your Medicare HMO stops serving people with Medicare in your area, you can join another HMO if one is available. [PROBE: Do you think this is true or false, or are you not sure?]
  KNJOIHMO TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
KN45. If your Medicare HMO leaves the Medicare program and you do not choose another one, you will be covered by the Original Medicare plan. [PROBE: Do you think this is true or false, or are you not sure?]
  KNCOVORG TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
KN46. A Medicare HMO can raise its fees or change its benefits each year. [PROBE: Do you think this is true or false, or are you not sure?]
  KNRAISE TRUE 1  
    FALSE 2  
    NOT SURE 3  
    REFUSED -7  
         
PD16. Please look at this card and tell me which of these sources, if any, you used to find information regarding (your/SP’s) prescription drug coverage options. [CODE ALL THAT APPLY. PRESS CTRL/L TO LEAVE SCREEN.] *SHOW CARD PD3*
  PDNOTLOK R DID NOT LOOK FOR INFORMATION 96  
  PDINFMED MEDICARE 1  
  PDSOSEC SOCIAL SECURITY OFFICE 2  
  PDSTMAGC STATE MEDICAID AGENCY 3  
  PDOTHRGV OTHER GOVERNMENT AGENCY 4  
  PDINFINS INSURANCE CO (PDP, MEDICARE ADVANTAGE, MEDIGAP, SUPPLEMENTAL) 5  
  PDEMPLYR CURRENT OR FORMER EMPLOYER OR UNION 6  
  PDINFFML FAMILY, FRIENDS, CO-WORKERS 7  
  PDINFPCY PHARMACY 8  
  PDINFPRV HEALTH CARE PROVIDER (DR, HOSP, LAB) 9  
  PDINFMDA MEDIA (TV, RADIO, NEWSPAPER, MAGAZINE) 10  
  PDINFORG SENIOR COUNSELOR OR ORGANIZATION (AARP,SR CENTER, ETC.) 11  
  PDNFOTHR ANY OTHER PERSON OR PLACE (SPECIFY)___________________ 91  
  PDNFOS REFUSED -7  
    DON’T KNOW -8  
         
BK30. Would you say you have read this (book/bulletin) thoroughly, that you have read parts of it, or that you haven’t read it at all?
  BOOKREAD READ IT THOROUGHLY 1  
    READ PARTS OF IT 2  
    HAVEN’T READ IT AT ALL 3  
    REFUSED -7  
    DON’T KNOW -8  
         
BK31. Have you ever used this (book/bulletin) to look up a telephone number?
  BOOKTELE YES 1  
    NO 2  
    REFUSED -7  
    DON’T KNOW -8  
         
         
BK32. *Display “book” if SP resides in Arizona, Florida, Ohio, Oregon, Washington, or the Kansas City MSA. Residence in Arizona, Florida, Ohio, Oregon, or Washington should be determined by the state code of the SP’s primary address. Residence in the Kansas City MSA should be determined by the ZIP code of the SP’s primary address; ZIP codes included in the MSA are listed in Attachment BK1. Otherwise, display “bulletin.”*
         
BK32. Have you ever used this (book/bulletin) to find information about health plan options available to [you / (SP)], such as Medicare managed care plans, HMO or supplemental plans?
  BOOKOPT YES 1  
    NO 2  
    REFUSED -7  
    DON’T KNOW -8  
     
 

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