ATTACHMENT 1 Pre-Note and Cover Letters

ATTACHMENT 1

DRAFT MAIL SURVEY LETTERS

DRAFT PRE-NOTIFICATION LETTER

Dear {Mr./Ms.} LAST NAME:

As a person with Medicare, you deserve to get the highest quality medical care when you need it, from doctors that you trust. The Centers for Medicare & Medicaid Services (CMS) is the Federal Agency that administers the Medicare program and our responsibility is to ensure that you get high quality care at a reasonable price. One of the ways we can fulfill that responsibility is to find out directly from you about the care you are currently receiving under the Medicare program.

CMS is conducting a survey of people with Medicare in managed care plans to learn more about the care you receive. This survey is called the “Medicare Satisfaction Survey.” Your name was selected at random by CMS from among the Medicare enrollees in your health plan. We would appreciate it if you would take the time, about 20 minutes, to fill out this questionnaire and then return it in the enclosed postage-paid envelope. The accuracy of the results depends on getting answers from you and other people with Medicare selected for this survey. This is your opportunity to help us, and your health plan, serve you better.

All information you provide will be held in confidence by CMS and is protected by the Privacy Act. You do not have to participate in this survey. Your help is voluntary, and your decision to participate or not to participate will have no effect on your Medicare benefits.

We hope that you will take the opportunity to answer the questionnaire and help us to ensure that you get the highest quality care. Your knowledge and experiences could help other people with Medicare make more informed health plan choices.

[VENDOR NAME] is a survey research organization working with CMS and your Medicare plan to carry out this survey. If you have any questions about the survey, please feel free to call [CONTACT NAME] of [VENDOR NAME] at 1-800-XXX-XXXX.

Thank you for your help with this important survey.

Sincerely,

Walter Stone

Privacy Officer

Centers for Medicare & Medicaid Services

Enclosures

DRAFT COVER LETTER

Dear Medicare Beneficiary:

As a person with Medicare, you deserve to get the highest quality medical care when you need it, from doctors that you trust. The Centers for Medicare & Medicaid Services (CMS), is the federal agency that administers the Medicare program and our responsibility is to ensure that you get that high quality care at a reasonable price. One of the ways we can fulfill that responsibility is to find out directly from you about the care you are currently receiving under the Medicare program and your Medicare health plan.

CMS is conducting a survey of people in Medicare health plans to learn more about the health care services you receive. Your name was selected at random by CMS from among the enrollees in your health plan. We would greatly appreciate it if you would take the time, about 20 minutes, to fill out this questionnaire. The accuracy of the results depends on getting answers from you and other people with Medicare selected for this survey. This is your opportunity to help us, and your health plan, serve you better.

All information you provide will be held in confidence and is protected by the Privacy Act. The information you provide will not be shared with anyone other than authorized persons at CMS and [VENDOR NAME], the survey research organization assisting us in this survey. You do not have to participate in this survey. Your help is voluntary, and your decision to participate or not to participate will not affect your Medicare benefits in any way. However, your knowledge and experiences will help other people with Medicare make more informed choices about their health plan, so we hope you will choose to help us.

If you have any questions about the survey or would like to find out how to complete the survey by phone, please call [VENDOR NAME] toll-free at 1-XXX XXXX, Monday through Friday, between XX:XX a.m. and XX:XX p.m.

Thank you in advance for your participation.

Sincerely,

Walter Stone

Privacy Officer