Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Medicare FFS Survey (CMS-R-246)

2011 FFS Survey (April)	2011 FFS Survey Revised
Our records show that you are now in Medicare, the health insurance program for people 65 years old or older or persons with certain disabilities. Please answer the following questions in this survey as fully as possible regardless of whether you consider yourself in Medicare. Some people who have Medicare also have other insurance to help pay for some of the costs of their health care. Do you have any other insurance that pays at least some of the cost of your health care?  Yes If Yes, Go to Question 3  No	1.. Our records show that you are now in Medicare, the health insurance program for people 65 years old or older or persons with certain disabilities. Please answer the following questions in this survey as fully as possible regardless of whether you consider yourself in Medicare. Some people who have Medicare also have other insurance to help pay for some of the costs of their health care. Do you have any other insurance that pays at least some of the cost of your health care?  Yes If Yes, Go to Question 3  No
Please mark the box below for each type of health insurance that you have.  Medigap, which may be identified on the front of your policy as “Medicare Supplemental Insurance”  Employer, Union, or Retiree Health Coverage (insurance)  Veteran’s Benefits, also known as VA benefits  Military Retiree Benefits, also known as Tricare  Medicaid, also known as State medical assistance, which is for some persons with limited income and resources  Any Prescription Drug Plan  Other (Please write the name of the other health insurance you currently have on the line below.) ____________________________________________  I don’t have health insurance other than Medicare.	Please mark the box below for each type of health insurance that you have.  Medigap, which may be identified on the front of your policy as “Medicare Supplemental Insurance”  Employer, Union, or Retiree Health Coverage (insurance)  Veteran’s Benefits, also known as VA benefits  Military Retiree Benefits, also known as Tricare  Medicaid, also known as State medical assistance, which is for some persons with limited income and resources  Any Prescription Drug Plan  Other (Please write the name of the other health insurance you currently have on the line below.) ____________________________________________  I don’t have health insurance other than Medicare.
YOUR HEALTH CARE IN THE LAST 6 MONTHS	YOUR HEALTH CARE IN THE LAST 6 MONTHS
4. In the last 6 months, did you have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor’s office?  Yes  No → If No, Go to Question 5	4. In the last 6 months, did you have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor’s office?  Yes  No → If No, Go to Question 6
5. In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed?  Never  Sometimes  Usually  Always	5. In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed?  Never  Sometimes  Usually  Always
6. In the last 6 months, not counting the times you needed care right away, did you make any appointments for your health care at a doctor’s office or clinic?  Yes  No → If No, Go to Question 8	6. In the last 6 months, not counting the times you needed care right away, did you make any appointments for your health care at a doctor’s office or clinic?  Yes  No → If No, Go to Question 8
7. In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor’s office or clinic as soon as you thought you needed?  Never  Sometimes  Usually  Always	7. In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor’s office or clinic as soon as you thought you needed?  Never  Sometimes  Usually  Always
8. In the last 6 months, not counting the times you went to an emergency room, how many times did you go to a doctor’s office or clinic to get health care for yourself?  None → If None, Go to Question 10  1  2  3  4  5 to 9  10 or more	8. In the last 6 months, not counting the times you went to an emergency room, how many times did you go to a doctor’s office or clinic to get health care for yourself?  None → If None, Go to Question 11  1  2  3  4  5 to 9  10 or more
9. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?  Never  Sometimes  Usually  Always	9. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?  Never  Sometimes  Usually  Always
10. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months?  0 Worst health care possible  1  2  3  4  5  6  7  8  9  10 Best health care possible	10. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months?  0 Worst health care possible  1  2  3  4  5  6  7  8  9  10 Best health care possible
11. In the last 6 months, did you have a health problem for which you needed special medical equipment, such as a cane, a wheelchair, oxygen equipment, or diabetic supplies and equipment?  Yes  No → If No, Go to Question 13	11. In the last 6 months, did you have a health problem for which you needed special medical equipment, such as a cane, a wheelchair, oxygen equipment, or diabetic supplies and equipment?  Yes  No If No, Go to Question 13
12. In the last 6 months, how often was it easy to get the medical equipment you needed through Medicare?  Never  Sometimes  Usually  Always	12. In the last 6 months, how often was it easy to get the medical equipment you needed through Medicare?  Never  Sometimes  Usually  Always
Your Personal Doctor	Your Personal Doctor
13. A personal doctor is the one you would see if you need a check-up, want advice about a health problem, or get sick or hurt. Do you have a personal doctor?  Yes  No → If No, Go to Question 23	13. A personal doctor is the one you would see if you need a check-up, want advice about a health problem, or get sick or hurt. Do you have a personal doctor?  Yes  No → If No, Go to Question 23
14. In the last 6 months, how many times did you visit your personal doctor to get care for yourself?  None → If None, Go to Question 23  1  2  3  4  5 to 9  10 or more	14. In the last 6 months, how many times did you visit your personal doctor to get care for yourself?  None → If None, Go to Question 23  1  2  3  4  5 to 9  10 or more
15. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?  Never  Sometimes  Usually  Always	15. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?  Never  Sometimes  Usually  Always
16. In the last 6 months, how often did your personal doctor listen carefully to you?  Never  Sometimes  Usually  Always	16. In the last 6 months, how often did your personal doctor listen carefully to you?  Never  Sometimes  Usually  Always
17. In the last 6 months, how often did your personal doctor show respect for what you had to say?  Never  Sometimes  Usually  Always	17. In the last 6 months, how often did your personal doctor show respect for what you had to say?  Never  Sometimes  Usually  Always
18. In the last 6 months, how often did your personal doctor spend enough time with you?  Never  Sometimes  Usually  Always	18. In the last 6 months, how often did your personal doctor spend enough time with you?  Never  Sometimes  Usually  Always
19. Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?  0 Worst personal doctor possible  1  2  3  4  5  6  7  8  9  10 Best personal doctor possible	19. Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?  0 Worst personal doctor possible  1  2  3  4  5  6  7  8  9  10 Best personal doctor possible
20. In the last 6 months, did you see your personal doctor for a specific illness or for any health conditions? Yes No → If No, Go to Question 22	20. In the last 6 months, did you see your personal doctor for a specific illness or for any health conditions? Yes No If No, Go to Question 22
21. In the last 6 months, how often did your personal doctor give you easy to understand instructions about what to do to take care of this illness or health condition?  Never  Sometimes  Usually  Always	21. In the last 6 months, how often did your personal doctor give you easy to understand instructions about what to do to take care of this illness or health condition?  Never  Sometimes  Usually  Always
22. In the last 6 months, how often did your personal doctor ask you to describe how you were going to follow these instructions?  Never  Sometimes  Usually  Always	22. In the last 6 months, how often did your personal doctor ask you to describe how you were going to follow these instructions?  Never  Sometimes  Usually  Always
This question was moved from Specialist section to Personal Doctor Session	23. How satisfied are you with the help you received to coordinate your care in the last 6 months?  Very dissatisfied  Somewhat dissatisfied  Neither dissatisfied nor satisfied  Somewhat satisfied  Very satisfied
Getting Health Care From Specialists	Getting Health Care From Specialists
23. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 6 months, did you try to make any appointments to see a specialist?  Yes  No → If No, Go to Question 28	24. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 6 months, did you try to make any appointments to see a specialist?  Yes  No → If No, Go to Question 29
24. In the last 6 months, how often was it easy to get appointments with specialists?  Never  Sometimes  Usually  Always	25. In the last 6 months, how often was it easy to get appointments with specialists?  Never  Sometimes  Usually  Always
25. How many specialists have you seen in the last 6 months?  None → If None, Go to Question 28  1 specialist  2  3  4  5 or more specialists	26. How many specialists have you seen in the last 6 months?  None → If None, Go to Question 29  1 specialist  2  3  4  5 or more specialists
26. We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?  0 Worst specialist possible  1  2  3  4  5  6  7  8  9  10 Best specialist possible	27. We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?  0 Worst specialist possible  1  2  3  4  5  6  7  8  9  10 Best specialist possible
27. In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from specialists?  Never  Sometimes  Usually  Always  I do not have a personal doctor  I did not visit my personal doctor in the last 6 months	28. In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from specialists?  Never  Sometimes  Usually  Always  I do not have a personal doctor  I did not visit my personal doctor in the last 6 months
xx. How satisfied are you with the help you received to coordinate your care in the last 6 months?  Very dissatisfied  Somewhat dissatisfied  Neither dissatisfied nor satisfied  Somewhat satisfied  Very satisfied	This question was moved to the primary doctor section of the survey
Medicare Experience	Medicare Experience
28. In the last 6 months, did you try to get any kind of care, tests, or treatment through your health plan?  Yes  No → If No, Go to Question 30	29. In the last 6 months, did you try to get any kind of care, tests, or treatment through your health plan?  Yes  No → If No, Go to Question 31
29. In the last 6 months, how often was it easy to get the care, tests, or treatment you thought you needed through Medicare?  Never  Sometimes  Usually  Always	30. In the last 6 months, how often was it easy to get the care, tests, or treatment you thought you needed through Medicare?  Never  Sometimes  Usually  Always
30. In the last 6 months, did you try to get information or help from Medicare’s customer service?  Yes  No → If No, Go to Question 34	31. In the last 6 months, did you try to get information or help from Medicare’s customer service?  Yes  No → If No, Go to Question 35
31. In the last 6 months, how often did Medicare’s customer service give you the information or help you needed?  Never  Sometimes  Usually  Always	32. In the last 6 months, how often did Medicare’s customer service give you the information or help you needed?  Never  Sometimes  Usually  Always
32. In the last 6 months, how often did your health plan’s customer service staff treat you with courtesy and respect?  Never  Sometimes  Usually  Always	33. In the last 6 months, how often did Medicare’s customer service staff treat you with courtesy and respect?  Never  Sometimes  Usually  Always
33. In the last 6 months, did your Medicare give you any forms to fill out?  Yes  No → If No, Go to Question 35	34. In the last 6 months, did Medicare give you any forms to fill out?  Yes  No → If No, Go to Question 36
34. In the last 6 months, how often were the forms from your health plan easy to fill out?  Never  Sometimes  Usually  Always	35. In the last 6 months, how often were the forms from Medicare easy to fill out?  Never  Sometimes  Usually  Always
35. Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate Medicare?  0 Worst health plan possible  1  2  3  4  5  6  7  8  9  10 Best health plan possible	36. Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate Medicare?  0 Worst health plan possible  1  2  3  4  5  6  7  8  9  10 Best health plan possible
36. Each fall your health plan sends you a notice that describes any changes in covered services. Since September 2010, has your health plan sent you this kind of notice?  Yes  No  Don’t know	This question was dropped in revised survey
37. When you sign up for a health plan, you are given a document that describes your specific benefits under the plan. This document also describes whether there are any limits on how much or what type of care you can have in a year, what care or treatment is included in your health plan, and your rights as a plan member. Has your health plan ever given you a document with this kind of information?  Yes  No  Don’t know	This question was dropped in revised survey
38. An insurance agent or broker sells insurance for your health, your home, or your car. Did an insurance agent or broker ever call you without your asking them to, to tell you about insurance for health care or prescription medicines?  Yes  No	This question was dropped in revised survey
39. Did an insurance agent or broker ever visit your home you without your asking them to, to tell you about insurance for health care or prescription medicines?  Yes  No	This question was dropped in revised survey
40. Did an insurance agent or broker ever switch you to a different health care plan without your permission?  Yes  No	This question was dropped in revised survey
Your Medicare Rights	Your Medicare Rights
41. Was there ever a time when you believed you needed care or services that your health plan decided not to give you?  Yes  No → If No, Go to Question 44	37. Was there ever a time when you believed you needed care or services that your health plan decided not to give you?  Yes  No → If No, Go to Question 43
42. Have you ever asked anyone at your health plan to reconsider a decision not to provide or pay for health care or services?  Yes  No → If No, Go to Question 47  Don’t know → If Don't know, Go to Question 47	38. Have you ever asked anyone at your health plan to reconsider a decision not to provide or pay for health care or services?  Yes  No → If No, Go to Question 43  Don’t know → If Don't know, Go to Question 43
43. When you spoke to your health plan about the decision not to provide care or services, did they… Please mark one or more.  Tell you that you can file an appeal  Offer to send you forms that you need to file an appeal  Suggest how to resolve your complaint  Listen to your complaint but did not help resolve it  Discourage you from taking action  Do none of these things	39. When you spoke to your health plan about the decision not to provide care or services, did they… Please mark one or more.  Tell you that you can file an appeal  Offer to send you forms that you need to file an appeal  Suggest how to resolve your complaint  Listen to your complaint but did not help resolve it  Discourage you from taking action  Do none of these things
44. In the last 6 months, have you called or written your health plan with a complaint or problem?  Yes  No →If No, Go to Question	40. In the last 6 months, have you called or written your health plan with a complaint or problem?  Yes  No → If No, Go to Question 43
45. How long did it take for your health plan to resolve your complaint?  Same day  1 week  2 weeks  3 weeks  4 or more weeks  I am still waiting for it to be settled	41. How long did it take for your health plan to settle your complaint?  Same day  1 week  2 weeks  3 weeks  4 or more weeks  I am still waiting for it to be settled
46. Was your complaint or problem settled to your satisfaction?  Yes  No  I am still waiting for it to be settled	42. Was your complaint or problem settled to your satisfaction?  Yes  No  I am still waiting for it to be settled
About You	About You
47. In general, how would you rate your overall health?  Excellent  Very good  Good  Fair  Poor	43. In general, how would you rate your overall health?  Excellent  Very good  Good  Fair  Poor
48. In general, how would you rate your overall mental health?  Excellent  Very good  Good  Fair  Poor	44. In general, how would you rate your overall mental health?  Excellent  Very good  Good  Fair  Poor
49. In the past 12 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem?  Yes  No → If No, Go to Question 51	45. In the past 12 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem?  Yes  No → If No, Go to Question 47
50. Is this a condition or problem that has lasted for at least 3 months?  Yes  No	46. Is this a condition or problem that has lasted for at least 3 months?  Yes  No
51. Do you now need or take medicine prescribed by a doctor?  Yes  No → If No, Go to Question 53	47. Do you now need or take medicine prescribed by a doctor?  Yes  No → If No, Go to Question 49
52. Is this to treat a condition that has lasted for at least 3 months?  Yes  No	48. Is this to treat a condition that has lasted for at least 3 months?  Yes  No
53. In the last 6 months, how often was it easy to get the medicines your doctor prescribed?  Never  Sometimes  Usually  Always  My doctor did not prescribe any medicines for me in the last 6 months.	49. In the last 6 months, how often was it easy to get the medicines your doctor prescribed?  Never  Sometimes  Usually  Always  My doctor did not prescribe any medicines for me in the last 6 months.
54 Do you have insurance that pays part or all of the cost of your prescription medicines?  Yes  No  Don’t know	50. Do you have insurance that pays part or all of the cost of your prescription medicines?  Yes  No  Don’t know
55. In the last 6 months, did you ever delay or not fill a prescription because you felt that you could not afford it?  Yes  No  My doctor did not prescribe any medicines for me in the last 6 months	51. In the last 6 months, did you ever delay or not fill a prescription because you felt that you could not afford it?  Yes  No  My doctor did not prescribe any medicines for me in the last 6 months
56. How confident are you that you can identify when it is necessary for you to get medical care?  Very confident  Confident  Somewhat confident  Not at all confident	This question was dropped in revised survey
57. Because of any impairment or health problem, do you need the help of other persons with your personal care needs, such as eating, dressing, or getting around the house?  Yes  No	This question was dropped in revised survey
58. Because of any impairment or health problem, do you need help with your routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?  Yes  No	This question was dropped in revised survey
59. Do you have a physical or medical condition that seriously interferes with your independence, participation in the community, or quality of life?  Yes  No	This question was dropped in revised survey
60. Has a doctor ever told you that you had any of the following conditions? Yes No a. A heart attack? b. Angina or coronary heart disease? c. A stroke? d. Cancer, other than skin cancer? e. Emphysema, asthma or COPD (chronic obstructive pulmonary disease)? f. Any kind of diabetes or high blood sugar?	52. Has a doctor ever told you that you had any of the following conditions? Yes No a. A heart attack? b. Angina or coronary heart disease? c. A stroke? d. Cancer, other than skin cancer? e. Emphysema, asthma or COPD (chronic obstructive pulmonary disease)? f. Any kind of diabetes or high blood sugar?
61. Did you get a flu shot since September 1, 2010?  Yes  No  Don’t know	53. Have you had a flu shot since September 1, 2010?  Yes  No  Don’t know
62. Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person’s lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.  Yes  No  Don’t know	54. Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person’s lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.  Yes  No  Don’t know
63. Do you now smoke cigarettes or use tobacco every day, some days, or not at all?  Every day  Some days  Not at all →If No, Go to Question 68  Don’t know →If Don’t know, Go to Question 68	55. Do you now smoke cigarettes or use tobacco every day, some days, or not at all?  Every day  Some days  Not at all →If No, Go to Question 57  Don’t know →If Don’t know, Go to Question 57
64. In the last 6 months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider?  Never  Sometimes  Usually  Always  I had no visits in the last 6 months.	56. In the last 6 months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider?  Never  Sometimes  Usually  Always  I had no visits in the last 6 months.
65. What is your age?  18 to 24  25 to 34  35 to 44  45 to 54  55 to 64  65 to 69  70 to 74  75 to 79  80 to 84  85 or older	57. What is your age?  18 to 24  25 to 34  35 to 44  45 to 54  55 to 64  65 to 69  70 to 74  75 to 79  80 to 84  85 or older
66. Are you male or female?  Male  Female	58. Are you male or female?  Male  Female
67. What is the highest grade or level of school that you have completed?  8th grade or less  Some high school, but did not graduate  High school graduate or GED  Some college or 2-year degree  4-year college graduate  More than 4-year college degree	59. What is the highest grade or level of school that you have completed?  8th grade or less  Some high school, but did not graduate  High school graduate or GED  Some college or 2-year degree  4-year college graduate  More than 4-year college degree
68. Are you of Hispanic or Latino origin or descent?  Yes, Hispanic or Latino  No, not Hispanic or Latino	60. Are you of Hispanic or Latino origin or descent?  Yes, Hispanic or Latino  No, not Hispanic or Latino
69. What is your race? Please mark one or more.  White  Black or African-American  Asian  Native Hawaiian or other Pacific Islander  American Indian or Alaska Native	61. What is your race? Please mark one or more.  White  Black or African-American  Asian  Native Hawaiian or other Pacific Islander  American Indian or Alaska Native
70. Did someone help you complete this survey?  Yes  No → If No, Go to Question 72	62. Did someone help you complete this survey?  Yes  No → If No, Go to Question 64
71. How did that person help you? Please mark one or more.  Read the questions to me  Wrote down the answers I gave  Answered the questions for me  Translated the questions into my language  Helped in some other way	63. How did that person help you? Please mark one or more.  Read the questions to me  Wrote down the answers I gave  Answered the questions for me  Translated the questions into my language  Helped in some other way
72. Do you live alone?  Yes, I live alone  No, I live with others	64. Do you live alone?  Yes, I live alone  No, I live with others
73. The Medicare Program is trying to learn more about the health care or services provided to people with Medicare. May we contact you again about the health care services that you received?  Yes  No	65. The Medicare Program is trying to learn more about the health care or services provided to people with Medicare. May we contact you again about the health care services that you received?  Yes  No

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