Calendar for Supplemental Samples

MCBS Planner 2006-2007
Supplemental

Sample

Because we care...
Your answers are confidential
All information you provide will be kept in strict confidence under the laws prescribed by the Privacy Act of 1974.
Information cannot be disclosed in any form that would permit identification of an individual in this study.

OMB # 0938-0568 Expiration 03/31/2008

20240.0606.788904

Organizing your medical papers and bills can be
very time consuming. Using this MCBS Respondent
Planner will help! The handy calendar will keep
track of your appointments, important dates and
bills right where you can find them.

Current
Beneficiary
Survey

Message from

T

hank you for participating in the Medicare
Current Beneficiary Survey (MCBS).
With your help, we are working to make Medicare
a more cost-effective purchaser of high-quality
health care that meets the needs of all beneficiaries.

Message from

Y

our participation in the MCBS provides
valuable information to both researchers and
policymakers about the needs of Americans who
have Medicare health insurance.
CMS collects large amounts of information about
hospitals, doctors, and other medical professionals.
They can tell how Medicare works for those groups.
But the only way to learn about how the Medicare
program works for people like you, is to ask.
AARP supports this survey because we think it
is important. Please take part, and help improve
your Medicare program. Whether you take part in
the survey is entirely your choice. Your Medicare
benefits will not be affected by the answers that
you give, or by whether or not you participate.
Also, your answers must be kept private and
confidential. There is a law – the federal Privacy
Act – that requires this.

Using Your Planner

I

t is helpful to use the separate folder to store
Medicare/insurance statements, canceled checks,
medical bills/receipts and RX labels/receipts.
A convenient way you may choose to keep track
of your health care events is to write down the
following items in your planner.
* Doctor and dentist appointments.
* 
Prescribed medicines you obtained,
including refills.
* 
If you do not have a bill or receipt,
record the total cost and what was paid.
* 
Hospital visits including the emergency room
(ER) and outpatient department (OPD).
* Labs, x-rays, or other tests.
* Nursing home stays.
* 
Home Visits by a medical professional,
family, or friend.
* 
Eyeglasses, diabetic equipment, ambulance
services, or other medical items.

Important
Numbers & Websites
MCBS Respondent Hotline: 1-800-937-8286
Medicare Hotline: 1-800-633-4227
Medicare Fraud Hotline: 1-800-447-8477
Social Security Administration: 1-800-772-1213
www.cms.hhs.gov/mcbs
www.aarp.org

Sunday

Monday

Tuesday

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Saturday

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31

August
2006

Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

Wednesday

September
2006

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

1

2

Yom
Kippur

3

4

5

6

7

3

Columbus
Day

10

11

12

13

14

5

6

7

8

9

8

9

10 Grandparents
Day 11

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28

24

25

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30

30

31

4

Labor Day

Medicare Current Beneficiary Survey  •  1-800-937-8286

Rosh
Hashanah;
First Day
of Autumn

29

Daylight
Savings
Time Ends

Halloween

October
2006

Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

November
2006

Wednesday

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

December
2006

Thursday

Friday

Saturday

1

2

11 Veterans Day

3

17

18

22

23 Thanksgiving
Day 24

25

29

30

1

2

3

5

6

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28

29

Christmas
Day

First Day
of Winter

31
Medicare Current Beneficiary Survey  •  1-800-937-8286

Medicare Current Beneficiary Survey  •  1-800-937-8286

23

30

Hanukkah

Sunday

Monday

Tuesday

1 New Year’s
2
Day

7

8

Wednesday

Thursday

Friday

Saturday

3

4

5

6

9

10

11

12

14

Luther
15 Martin
King, Jr. Day 16

17

18

21

22

23

24

25

28

29

30

31

(observed)

Sunday

Monday

Tuesday

Wednesday

Thursday

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Saturday

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13

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8

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20

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12

15

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26

27

18

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22

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26

January
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

6

7

Lincoln’s
Birthday

13

14

President’s
Day

20

21

27

28

Valentine’s
Day

February
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

March
2007

Wednesday

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

1

2

3

1

Daylight
Savings
Time Begins

2

3

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5

4

5

6

7

8

9

10

8

Easter

9

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11

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17 St. Patrick’s
Day

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29

First Day
of Spring

Medicare Current Beneficiary Survey  •  1-800-937-8286

Earth Day

30

Saturday

6 Good Friday 7

14

Passover

April
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

21

28

Sunday

Monday

Tuesday

Wednesday

Thursday

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Saturday

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11

13 Mother’s Day 14

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27

28

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30

31

Memorial
Day

Sunday

Monday

Tuesday

Wednesday

June
2007

Thursday

Friday

Saturday

1

2

12

3

4

8

9

18

19 Armed Forces
Day

10

25

26

May
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

5

6

7

11

12

13

14

Flag Day

15

16

17 Father’s Day 18

19

20

21

First Day
of Summer

22

23

24

26

27

28

29

30

25

Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

1

2

3

8

9

10

15

16

22

29

Wednesday

4 Independence
Day

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

August
2007

Wednesday

Thursday

Friday

Saturday

1

2

3

4

14

5

20

21

27

28

5

6

7

11

12

13

17

18

19

23

24

25

26

30

31

July
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

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Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

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Thursday

September
2007

Friday

Saturday

Sunday

Monday

Tuesday

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Thursday

Friday

Saturday

2

3

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5

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9

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11

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13

1

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31

4

5

6

9 Grandparents
Day 10

11

12

13

16

17

18

19

20

21

22

24

25

26

27

28

29

23

3

First Day
of Autumn

Labor Day

Rosh
Hashanah;
First Day
of Autumn

30
Medicare Current Beneficiary Survey  •  1-800-937-8286

Yom
Kippur

28

Daylight
Savings
Time Ends

Columbus
Day

Halloween

October
2007

Medicare Current Beneficiary Survey  •  1-800-937-8286

Sunday

Monday

Tuesday

Wednesday

November
2007

Thursday

Friday

Saturday

1

2

3

4

Sunday

Wednesday

December
2007

Thursday

Friday

Saturday

1

6

7

8

9

10

2

11 Veterans Day 12

13

14

15

16

17

19

19

20

21

22 Thanksgiving
Day 23

24

25

26

27

29

29

Medicare Current Beneficiary Survey  •  1-800-937-8286

Tuesday

5

30

Monday

3

4

5

9

10

11

16

17

18

23

24

25

30

31

Christmas
Day

6

7

8

12

13

14

15

19

20

21

22

26

27

28

29

Hanukkah

Medicare Current Beneficiary Survey  •  1-800-937-8286

First Day
of Winter

MCBS 2008
Januar y 2008

Februar y 2008

S M

T W

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F

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F

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March 2008

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30 31

Sunday

Monday

6

Tuesday

1

7

8

New Year’s
Day

Wednesday

2

9

Thursday

3

10

Friday

4

11

Saturday

5

A pri l 2008

Ma y 2008

S M

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T W

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T W

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Luther
21 Martin
King, Jr. Day 22
(observed)

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A ugu st 2008

Sep tem ber 2008

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January
2008

Medicare Current Beneficiary Survey  •  1-800-937-8286

7

15 16 17 18 19 20 21

S M

28

6

1 1 12 13 14 15 16 17

Oc to ber 2008

27

5

4

13 14 15 16 17 18 19

Jul y 2008

13

June 2008

T W

5

6

7

No ve m ber 2008

T

F

S

S M

F

S

S M

T W

T

F

S

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1

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T W
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T

December 2008

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30

Medicare Current Beneficiary Survey  •  1-800-937-8286