Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

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Box RX1

BOX RX1

4:27:17 PM Friday, January 08, 2010

Page Order # :

10

Page 1 of 104

Box RX1
BOX INSTRUCTIONS
( RXQ1005 )

BESIDES MEDICARE, IF TRICARE IS THE ONLY "CURRENT" PLAN, GO
TO BOX RXEND - (RXQ1455 ).
ELSE IF THE RESPONDENT IS A PROXY, GO TO RX1 - PDXHIDEC (
RXQ1010 ).
ELSE GO TO RXPD2 - PDEASY ( RXQ1015 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

355

TricareCurrent

There is a "current" Tricare plan =
There is a PLAN where PLAN.PLANTYPE = 6/Tricare &
PLRO where (PLRO.PLROPLAN = PLAN.PLANNUM &
PLRORND = current round & (PLRO.COVTIME =
1/WholeTime or PLRO.COVNOW = 1/Yes)).
Exclude Deleted Plans. See T.N. 52.

356

MHMONotCurrent

There is no "current" Medicare Managed Care plan
(Medicare Advantage plan) =
If there is a PLAN where PLANTYPE = 5/MHMO, there is
no PLRO where (PLROPLAN=PLANNUM &
PLRORND=current round and COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

357

MPDPNotCurrent

There is no "current" MPDP =
If there is a PLAN were PLAN.PLANTYPE = 7/MPDP,
there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

358

MedicaidNotCurrent

There is no "current" Medicaid Plan =
If there is PLAN where PLAN.PLANTYPE=2/Medicaid,
there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND = current round & (COVTIME =
1/WholeTime or COVNOW = 1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4:27:17 PM Friday, January 08, 2010

Page 2 of 104

Box RX1
359

PublicNotCurrent

There is no "current" Public Plan =
If there is a PLAN where PLAN.PLANTYPE =
3/PublicPlan, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

360

PrivateNotCurrent

There is no "current" Private Plan =
If there is PLAN where PLAN.PLANTYPE =
4/PrivatePlan, there is no PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
(COVTIME=1/WholeTime or COVNOW=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:17 PM Friday, January 08, 2010

Page 3 of 104

RX1

RX1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDXHIDEC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

20

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you help (SP) make decisions regarding (his/her) health

insurance coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:17 PM Friday, January 08, 2010

Page 4 of 104

RX1
PDXHIDEC

Field1:
Cheshire Name:

( RXQ1010 )

HRND.PDXHIDEC

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD2 - PDEASY ( RXQ1015 )

English text: YES
2

No

BOX RXEND - (RXQ1455 )

English text: NO
Attribute
Don't know

Route
BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:18 PM Friday, January 08, 2010

Page 5 of 104

RXPD2

RXPD2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDEASY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

30

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD PD1

Question Text:

Now I have a few questions regarding the Medicare Prescription
Drug benefit.
Overall, how easy or difficult do you think the Medicare Prescription
Drug benefit is to understand?
Would you say it is very easy to understand, somewhat easy,
somewhat difficult, or very difficult to understand?

Int. Instr II:

4:27:18 PM Friday, January 08, 2010

Page 6 of 104

RXPD2
INPUT FIELDS / ROUTING
PDEASY

Field1:
Cheshire Name:

( RXQ1015 )

PDRX.PDEASY

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TEasydiff
1
No
No

Number Label
1 VeryEasy

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD3 - PDKNOW ( RXQ1020 )

English text: VERY EASY
2

SomewhatEasy

3

SomewhatDifficult

RXPD3 - PDKNOW ( RXQ1020 )

English text: SOMEWHAT EASY
RXPD3 - PDKNOW ( RXQ1020 )

English text: SOMEWHAT DIFFICULT
4

VeryDifficult

RXPD3 - PDKNOW ( RXQ1020 )

English text: VERY DIFFICULT
Attribute
Don't know

Route
RXPD3 - PDKNOW ( RXQ1020 )

Refusal

RXPD3 - PDKNOW ( RXQ1020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:27:18 PM Friday, January 08, 2010

Page 7 of 104

RXPD2

4:27:18 PM Friday, January 08, 2010

Page 8 of 104

RXPD3

RXPD3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDKNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

40

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD PD2

Question Text:

How much do you think you know about the Medicare Prescription
Drug benefit?
Do you know just about everything you need to know, most of what
you need to know, some of what you need to know, a little of what
you need to know, or almost none of what you need to know about
the Medicare Prescription Drug benefit?

Int. Instr II:

4:27:19 PM Friday, January 08, 2010

Page 9 of 104

RXPD3
INPUT FIELDS / ROUTING
PDKNOW

Field1:
Cheshire Name:

( RXQ1020 )

PDRX.PDKNOW

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TKnow
1
No
No

Number Label
1 JustAboutEverythingYouNeedToKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD2 - (RXQ1025 )

English text: JUST ABOUT EVERYTHING YOU NEED TO KNOW
2

MostOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )
English text: MOST OF WHAT YOU NEED TO KNOW

3

SomeOfWhatYouNeedToKnow

BOX RXPD2 - (RXQ1025 )

English text: SOME OF WHAT YOU NEED TO KNOW
4

ALittleOfWhatYouNeedToKnow

BOX RXPD2 - (RXQ1025 )

5

AlmostNoneOfWhatYouNeedToKnow
BOX RXPD2 - (RXQ1025 )
English text: ALMOST NONE OF WHAT YOU NEED TO KNOW

English text: A LITTLE OF WHAT YOU NEED TO KNOW

Attribute
Don't know

Route
BOX RXPD2 - (RXQ1025 )

Refusal

BOX RXPD2 - (RXQ1025 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4:27:19 PM Friday, January 08, 2010

Page 10 of 104

RXPD3

DESIGN NOTES

4:27:19 PM Friday, January 08, 2010

Page 11 of 104

BOX RXPD2

BOX RXPD2

50

Page Order # :

BOX INSTRUCTIONS
( RXQ1025 )

IF SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN, GO TO
BOX RXPD3A - (RXQ1060 ).
ELSE IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT
HAS RX COVERAGE, GO TO RXPD9 - PDCONSDR ( RXQ1045 ).
ELSE IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX
COVERAGE, GO TO RXPD8A - PDCOMPPL ( RXQ1040 ).
ELSE GO TO RXPD20 - PDEXAPLY ( RXQ1140 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:19 PM Friday, January 08, 2010

Page 12 of 104

RXPD8A

RXPD8A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCOMPPL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

80

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "have".
Else display "has".
If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

Display report above question text.
Display all "current" private plans with RX coverage SP reported
being covered by in the current round.
Report header: PRIVATE PLANS WITH RX COVERAGE
Report layout:
Column 1, header="Plan Name", display PLAN.PLNAME.

TEXT:
Context Header:
Int. Instr I:

4:27:19 PM Friday, January 08, 2010

Page 13 of 104

RXPD8A
[You/(SP)] currently (have/has) drug coverage through [READ
PLAN(S) LISTED ABOVE].

Question Text:

Did [you/(SP), or someone for (SP),] compare the (CURRENT
YEAR) drug coverage offered by [READ PLAN(S) LISTED ABOVE]
with any Medicare Prescription Drug plans?
[EXPLAIN IF NECESSARY: A Medicare Prescription Drug plan
adds drug coverage to Original Medicare.]
Int. Instr II:
INPUT FIELDS / ROUTING
PDCOMPPL

Field1:
Cheshire Name:

( RXQ1040 )

PDRX.PDCOMPPL

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD9 - PDCONSDR ( RXQ1045 )

English text: YES
2

No

RXPD9 - PDCONSDR ( RXQ1045 )

English text: NO
Attribute
Don't know

Route
RXPD9 - PDCONSDR ( RXQ1045 )

Refusal

RXPD9 - PDCONSDR ( RXQ1045 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
4:27:19 PM Friday, January 08, 2010

Page 14 of 104

RXPD8A

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:27:19 PM Friday, January 08, 2010

Page 15 of 104

RXPD9

RXPD9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCONSDR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

90

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Advantage Plan that has RX
coverage, display "[You/(SP)] currently…"
Else do not display.
If SP is respondent, display "have".
Else display "has".
If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".
If Proxy is respondent and SP is male, display "him".
If Proxy is respondent and SP is female, display "her".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
4:27:20 PM Friday, January 08, 2010

Page 16 of 104

RXPD9
([You/(SP)] currently (have/has] drug coverage through (CURRENT
MEDICARE ADVANTAGE PLAN). Medicare calls this type of plan a
Medicare Advantage plan. Medicare also offers separate plans that
provide only drug coverage.)

Question Text:

Did [you/(SP), or someone for (SP),] consider enrolling (her/him) in a
separate Medicare Prescription Drug plan for (CURRENT YEAR)?
[EXPLAIN IF NECESSARY: A separate Medicare Prescription Drug
plan is typically used together with medical benefits from Original
Medicare.]
Int. Instr II:

INPUT FIELDS / ROUTING

PDCONSDR

Field1:
Cheshire Name:

( RXQ1045 )

PDRX.PDCONSDR

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD3 - (RXQ1050 )

English text: YES
2

No

BOX RXPD3 - (RXQ1050 )

English text: NO
Attribute
Don't know

Route
BOX RXPD3 - (RXQ1050 )

Refusal

BOX RXPD3 - (RXQ1050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:27:20 PM Friday, January 08, 2010

Page 17 of 104

RXPD9

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:20 PM Friday, January 08, 2010

Page 18 of 104

BOX RXPD3

BOX RXPD3

Page Order # :

100

BOX INSTRUCTIONS
( RXQ1050 )

IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO
TO BOX RX2 - (RXQ1215 ).
ELSE GO TO RXPD10 - PDMABENS ( RXQ1055 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:20 PM Friday, January 08, 2010

Page 19 of 104

RXPD10

RXPD10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDMABENS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

Did [you/(SP), or someone for (SP),] compare the (CURRENT
YEAR) drug coverage offered by [your/(SP's)] (CURRENT
MEDICARE ADVANTAGE PLAN) plan with any other Medicare
Advantage plans in [your/(SP's)] area?

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:20 PM Friday, January 08, 2010

Page 20 of 104

RXPD10
PDMABENS

Field1:
Cheshire Name:

( RXQ1055 )

PDRX.PDMABENS

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD4 - (RXQ1085 )

English text: YES
2

No

BOX RXPD4 - (RXQ1085 )

English text: NO
Attribute
Don't know

Route
BOX RXPD4 - (RXQ1085 )

Refusal

BOX RXPD4 - (RXQ1085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

4:27:20 PM Friday, January 08, 2010

Page 21 of 104

RXPD10
DESIGN NOTES

4:27:20 PM Friday, January 08, 2010

Page 22 of 104

BOX RXPD3A

BOX RXPD3A

Page Order # :

120

BOX INSTRUCTIONS
( RXQ1060 )

IF SP HAS REPORTED BEING AUTOMATICALLY ENROLLED IN A
MEDICARE PRESCRIPTION DRUG PLAN IN ANY PREVIOUS ROUND, GO
TO RXPD12 - PDAUTENR ( RXQ1070 ).
ELSE GO TO RXPD11 - PDEVROLL ( RXQ1065 ).

ASSIGNMENTS

TECHNICAL NOTES
431

PDAutoEnrollPrev

If SP has reported being automatically enrolled in a
Medicare Prescription Drug Plan in any previous round =
PDRX.PDEVROLL = /1Yes where HEST.HESTRND <
current round.

DESIGN NOTES

4:27:20 PM Friday, January 08, 2010

Page 23 of 104

RXPD11

RXPD11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDEVROLL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "by Medicare" and "ever" in bold.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Some people were automatically enrolled in a Medicare Prescription
Drug plan. By "automatically enrolled", I mean that the beneficiary
was assiged to a plan by Medicare, as opposed to selecting a plan
on his or her own.
[Were you/Was (SP)] ever automatically enrolled in a Medicare
Prescription Drug plan?

Int. Instr II:

4:27:20 PM Friday, January 08, 2010

Page 24 of 104

RXPD11
INPUT FIELDS / ROUTING
PDEVROLL

Field1:
Cheshire Name:

( RXQ1065 )

PDRX.PDEVROLL

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD12 - PDAUTENR ( RXQ1070 )

English text: YES
2

No

RXPD15 - PDCOMPRE ( RXQ1080 )

English text: NO
Attribute
Don't know

Route
RXPD15 - PDCOMPRE ( RXQ1080 )

Refusal

RXPD15 - PDCOMPRE ( RXQ1080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:20 PM Friday, January 08, 2010

Page 25 of 104

RXPD12

RXPD12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDAUTENR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "current" in bold.
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
If SP has reported being automatically enrolled in a Medicare
Prescription Drug Plan in any previous round, display "[EXPLAIN IF
NECESSARY: Some…"
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

4:27:21 PM Friday, January 08, 2010

[Were you/Was (SP)] automatically enrolled in (your/his/her) current
Medicare Prescription Drug plan - that is, (your/his/her) (CURRENT
MEDICARE PRESCRIPTION DRUG PLAN) plan?
Page 26 of 104

RXPD12
([EXPLAIN IF NECESSARY: Some people with Medicare were
automatically enrolled in a Medicare Prescription Drug plan. By
"automatically enrolled," I mean that the beneficiary was assigned to
a plan by Medicare as opposed to selecting a plan on his or her
own.])
Int. Instr II:
INPUT FIELDS / ROUTING
PDAUTENR

Field1:
Cheshire Name:

( RXQ1070 )

PDRX.PDAUTENR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD14 - PDSWITCH ( RXQ1075 )

English text: YES
No

RXPD14 - PDSWITCH ( RXQ1075 )

English text: NO
Attribute
Don't know

Route
RXPD14 - PDSWITCH ( RXQ1075 )

Refusal

RXPD14 - PDSWITCH ( RXQ1075 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:27:21 PM Friday, January 08, 2010

Page 27 of 104

RXPD12
TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

431

PDAutoEnrollPrev

If SP has reported being automatically enrolled in a
Medicare Prescription Drug Plan in any previous round =
PDRX.PDEVROLL = /1Yes where HEST.HESTRND <
current round.

DESIGN NOTES

4:27:21 PM Friday, January 08, 2010

Page 28 of 104

RXPD14

RXPD14

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDSWITCH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

150

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, did you know that people who are automatically
enrolled by Medicare in a Medicare Prescription Durg plan can
switch plans at any time without a penalty?

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:21 PM Friday, January 08, 2010

Page 29 of 104

RXPD14
PDSWITCH

Field1:
Cheshire Name:

( RXQ1075 )

PDRX.PDSWITCH

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TPDPNLTY
1
No
No

Number Label
1 YesDidKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD15 - PDCOMPRE ( RXQ1080 )

English text: YES DID KNOW
2

NoDidNotKnow

RXPD15 - PDCOMPRE ( RXQ1080 )

English text: NO DID NOT KNOW
Attribute
Don't know

Route
RXPD15 - PDCOMPRE ( RXQ1080 )

Refusal

RXPD15 - PDCOMPRE ( RXQ1080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:21 PM Friday, January 08, 2010

Page 30 of 104

RXPD15

RXPD15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDCOMPRE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

160

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you".
Else display "(SP), or someone for (SP),".
Display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

Did [you/(SP), or someone for (SP),] compare (CURRENT YEAR)
drug coverage offered by [your/(SP's) (CURRENT MEDICARE
PRESCRIPTION DRUG PLAN) plan with any other Medicare
Prescription Drug plans?

Int. Instr II:

4:27:21 PM Friday, January 08, 2010

Page 31 of 104

RXPD15
INPUT FIELDS / ROUTING
PDCOMPRE

Field1:
Cheshire Name:

( RXQ1080 )

PDRX.PDCOMPRE

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD4 - (RXQ1085 )

English text: YES
2

No

BOX RXPD4 - (RXQ1085 )

English text: NO
Attribute
Don't know

Route
BOX RXPD4 - (RXQ1085 )

Refusal

BOX RXPD4 - (RXQ1085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.

4:27:22 PM Friday, January 08, 2010

Page 32 of 104

RXPD15
MRES.RROSTNUM='01'.
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:22 PM Friday, January 08, 2010

Page 33 of 104

BOX RXPD4

BOX RXPD4

Page Order # :

170

BOX INSTRUCTIONS
( RXQ1085 )

IF (RXPD12 - PDAUTENR = 1/Yes) OR (RXPD15 - PDCOMPRE = 2/No, DK,
OR RF), GO TO BOX RX2 - (RXQ1215 ).
ELSE GO TO RXPD18 - PDOPTPRE ( RXQ1090 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:22 PM Friday, January 08, 2010

Page 34 of 104

RXPD18

RXPD18

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

PDOPTPRE

Field 2:

PDOPTDUC

Field 3:

PDOPTFOR

Field 4:

PDOPTVEN

Field 5:

PDOPTREC

Field 6:

PDOPTGAP

Field 7:

PDOPTPAY

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If proxy is respondent, display "you or (SP)".
Else display "you".
If SP has a "current" Medicare Advantage Plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Else display the name of the "current" Medicare Prescription Drug
plan, PLAN.PLNAME.
If proxy is respondent, display "for (SP)".
Else do not display.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:
4:27:22 PM Friday, January 08, 2010

Page 35 of 104

RXPD18
TEXT:
Context Header:
Int. Instr I:
The next questions are about different things [you or (SP)/you] may
have thought about when considering [your/(SP's)] options for
(CURRENT YEAR) drug coverage.

Question Text:

At the time that [you/(SP)] decided to have (CURRENT YEAR) drug
coverage through [(CURRENT MEDICARE ADVANTAGE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did
you consider [for (SP)]…
Int. Instr II:
INPUT FIELDS / ROUTING
PDOPTPRE

Field1:
Cheshire Name:

( RXQ1090 )

PDRX.PDOPTPRE

Item Text display:

Display "a." before the question text.

Item Text:

the cost of the plan's monthly premium?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTDUC ( RXQ1095 )

English text: YES
No

RXPD18 - PDOPTDUC ( RXQ1095 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTDUC ( RXQ1095 )

Refusal

RXPD18 - PDOPTDUC ( RXQ1095 )

4:27:22 PM Friday, January 08, 2010

Page 36 of 104

RXPD18
PDOPTDUC

Field2:
Cheshire Name:

( RXQ1095 )

PDRX.PDOPTDUC

Item Text display:

Display "b." before the question text.

Item Text:

the plan's deductible?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTFOR ( RXQ1100 )

English text: YES
No

RXPD18 - PDOPTFOR ( RXQ1100 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTFOR ( RXQ1100 )

Refusal

RXPD18 - PDOPTFOR ( RXQ1100 )

4:27:23 PM Friday, January 08, 2010

Page 37 of 104

RXPD18
PDOPTFOR

Field3:
Cheshire Name:

( RXQ1100 )

PDRX.PDOPTFOR

Item Text display:

Display "c." before the question text.

Item Text:

the plan's list of covered medicines, or formulary?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTVEN ( RXQ1105 )

English text: YES
No

RXPD18 - PDOPTVEN ( RXQ1105 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTVEN ( RXQ1105 )

Refusal

RXPD18 - PDOPTVEN ( RXQ1105 )

4:27:23 PM Friday, January 08, 2010

Page 38 of 104

RXPD18
PDOPTVEN

Field4:
Cheshire Name:

( RXQ1105 )

PDRX.PDOPTVEN

Item Text display:

Display "d." before the question text.

Item Text:

the convenience of the pharmacies that the plan allows

[you(SP)] to use?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTREC ( RXQ1110 )

English text: YES
No

RXPD18 - PDOPTREC ( RXQ1110 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTREC ( RXQ1110 )

Refusal

RXPD18 - PDOPTREC ( RXQ1110 )

4:27:24 PM Friday, January 08, 2010

Page 39 of 104

RXPD18
PDOPTREC

Field5:
Cheshire Name:

( RXQ1110 )

PDRX.PDOPTREC

Item Text display:

Display "e." before the question text.

Item Text:

someone's recommendation of the plan?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTGAP ( RXQ1115 )

English text: YES
No

RXPD18 - PDOPTGAP ( RXQ1115 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTGAP ( RXQ1115 )

Refusal

RXPD18 - PDOPTGAP ( RXQ1115 )

4:27:24 PM Friday, January 08, 2010

Page 40 of 104

RXPD18
PDOPTGAP

Field6:
Cheshire Name:

( RXQ1115 )

PDRX.PDOPTGAP

Item Text display:

Display "f." before the question text.

Item Text:

the gap in coverage or "donut hole"?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD18 - PDOPTPAY ( RXQ1120 )

English text: YES
No

RXPD18 - PDOPTPAY ( RXQ1120 )

English text: NO
Attribute
Don't know

Route
RXPD18 - PDOPTPAY ( RXQ1120 )

Refusal

RXPD18 - PDOPTPAY ( RXQ1120 )

4:27:24 PM Friday, January 08, 2010

Page 41 of 104

RXPD18
( RXQ1120 )

PDOPTPAY

Field7:

PDRX.PDOPTPAY

Cheshire Name:
Item Text display:

Display "g." before the question text.

Item Text:

the dollar amount [you/(SP)] would pay for prescribed

medicines (you use/he uses/she uses)?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD4A - (RXQ1125 )

English text: YES
No

BOX RXPD4A - (RXQ1125 )

English text: NO
Attribute
Don't know

Route
BOX RXPD4A - (RXQ1125 )

Refusal

BOX RXPD4A - (RXQ1125 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

4:27:24 PM Friday, January 08, 2010

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

Page 42 of 104

RXPD18
2

ManagedCarePlan

SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:25 PM Friday, January 08, 2010

Page 43 of 104

BOX RXPD4A

BOX RXPD4A

Page Order # :

190

BOX INSTRUCTIONS
( RXQ1125 )

IF RESPONDENT ANSWERED "YES" TO MORE THAN ONE QUESTION AT
RXPD18, GO TO RXPD18A - PDOPMOST ( RXQ1130 ).
ELSE GO TO BOX RXPD6 - (RXQ1135 ).

ASSIGNMENTS

TECHNICAL NOTES
434

RXPD18Yes

If respondent answered "YES" to more than one question
at RXPD18 =
More than one of the following fields = 1/Yes:
RXPD18 - PDOPTPRE
RXPD18 - PDOPTDUC
RXPD18 - PDOPTFOR
RXPD18 - PDOPTVEN
RXPD18 - PDOPTREC
RXPD18 - PDOPTGAP
RXPD18 - PDOPTPAY

DESIGN NOTES

4:27:25 PM Friday, January 08, 2010

Page 44 of 104

RXPD18A

RXPD18A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDOPMOST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If proxy is respondent, display "you or (SP)".
Else display "you".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

Which of these was the most important consideration when [you or
(SP)]/you] thought about [your/(SP's)] options for (CURRENT YEAR)
prescription drug coverage?
[READ ITEMS BELOW IF NECESSARY.]

Int. Instr II:

INPUT FIELDS / ROUTING

4:27:25 PM Friday, January 08, 2010

Page 45 of 104

RXPD18A

4:27:25 PM Friday, January 08, 2010

Page 46 of 104

RXPD18A
PDOPMOST

Field1:

Cheshire Name:

Item Text display:

( RXQ1130 )

PDRX.PDOPMOST
The response options for RXPD18A - PDOPMOST will be
displayed based on the responses to RXPD18.
For each question asked at RXPD18 where the response

equals "YES", display corresponding response option at

RXPD18A.

Else do not display response option.

See detailed instructions below.
If RXDP18 - PDOPTPRE = 1/Yes, display response option
1/CostOfMonthlyPremium .
If RXDP18 - PDOPTDUC = 1/Yes, display response option
2/PlansDeductible.
If RXDP18 - PDOPTFOR = 1/Yes, display response option
3/DrugsOnPlansList.
If RXDP18 - PDOPTVEN = 1/Yes, response option
4/ConvenienceOfThePharamacies.
If RXDP18 - PDOPTREC = 1/Yes, display response option
5/RecommendationOfPlan.
If RXDP18 - PDOPTGAP = 1/Yes, display response option
6/GapInCoverage.
If RXDP18 - PDOPTPAY = 1/Yes, display response option
7/WhatSPWouldPayForPMs.
If displaying response option 4 or 7, display SP's name as
part of the English Display Text.

Item Text:

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDopMost
1
No
No

Number Label
1 CostOfMonthlyPremium

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXPD6 - (RXQ1135 )

English text: THE COST OF THE PLANS MONTHLY PREMIUM
2

PlansDeductible

BOX RXPD6 - (RXQ1135 )

English text: THE PLANS DEDUCTIBLE
4:27:25 PM Friday, January 08, 2010

Page 47 of 104

RXPD18A

3

DrugsOnPlansList

BOX RXPD6 - (RXQ1135 )

English text: THE PLANS LIST OF MEDICINES OR FORMULARY
4

ConvenienceOfPharmacies

5

English text: CONVENIENCE OF THE PHARMACIES THAT THE PLAN ALLOWS (SP) TO USE
RecommendationOfPlan
BOX RXPD6 - (RXQ1135 )

BOX RXPD6 - (RXQ1135 )

English text: SOMEONES RECOMMENDATION OF THE PLAN
6

GapInCoverage

7

English text: THE GAP IN COVERAGE OR DONUT HOLE
WhatSPWouldPayForPMs
BOX RXPD6 - (RXQ1135 )

BOX RXPD6 - (RXQ1135 )

English text: THE DOLLAR AMOUNT (SP) WOULD PAY FOR PRESCRIBED MEDICINES
Attribute
Don't know

Route
BOX RXPD6 - (RXQ1135 )

Refusal

BOX RXPD6 - (RXQ1135 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:26 PM Friday, January 08, 2010

Page 48 of 104

BOX RXPD6

BOX RXPD6

Page Order # :

210

BOX INSTRUCTIONS
( RXQ1135 )

IF RXPD12 - PDAUTENR = 1/Yes, GO TO BOX RX2 - (RXQ1215 ).
ELSE GO TO RXPD18B - PDRECLIS ( RXQ1137 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:27:26 PM Friday, January 08, 2010

Page 49 of 104

RXPD18B

RXPD18B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDRECLIS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

215

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

As you may know, the government has programs that help
beneficiaries pay for the costs associated with a Medicare drug plan
and the purchase of prescription drugs. The help provided is
referred to as a "low-income subsidy" or "extra help".
[Are you/Is (SP)] receiving this type of help to pay for (your/his/her)
(CURRENT YEAR) Medicare prescription drug coverage?
[EXPLAIN IF NECESSARY: Beneficiaries who qualify for these
programs receive help paying for the Medicare drug plan's monthly
premium, help paying any yearly deductible, help paying

4:27:26 PM Friday, January 08, 2010

Page 50 of 104

RXPD18B
coinsurance and copayments for prescription drugs, and have no
coverage gap.]
Int. Instr II:

INPUT FIELDS / ROUTING

( RXQ1137 )

PDRECLIS

Field1:
Cheshire Name:

PDRX.PDRECLIS

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RX2 - (RXQ1215 )

English text: YES
2

No

RXPD20 - PDEXAPLY ( RXQ1140 )

English text: NO
Attribute
Don't know

Route
RXPD20 - PDEXAPLY ( RXQ1140 )

Refusal

RXPD20 - PDEXAPLY ( RXQ1140 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =

4:27:26 PM Friday, January 08, 2010

Page 51 of 104

RXPD18B
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:27:26 PM Friday, January 08, 2010

Page 52 of 104

RXPD20

RXPD20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDEXAPLY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

220

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Did [you/(SP)] apply to the Social Security Administration for extra

help with (CURRENT YEAR) drug coverage?

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:26 PM Friday, January 08, 2010

Page 53 of 104

RXPD20
PDEXAPLY

Field1:
Cheshire Name:

( RXQ1140 )

PDRX.PDEXAPLY

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RXPD21 - PDEXACCP ( RXQ1145 )

English text: YES
2

No

BOX RX2 - (RXQ1215 )

English text: NO
Attribute
Don't know

Route
BOX RX2 - (RXQ1215 )

Refusal

BOX RX2 - (RXQ1215 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:27 PM Friday, January 08, 2010

Page 54 of 104

RXPD21

RXPD21

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDEXACCP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Was [your/(SP's)] application for extra help accepted or denied?

Int. Instr II:

INPUT FIELDS / ROUTING

4:27:27 PM Friday, January 08, 2010

Page 55 of 104

RXPD21
PDEXACCP

Field1:
Cheshire Name:

( RXQ1145 )

PDRX.PDEXACCP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TPDExacp
1
No
No

Number Label
1 Accepted

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RX2 - (RXQ1215 )

English text: ACCEPTED
2

Denied

BOX RX2 - (RXQ1215 )

3

English text: DENIED
StillPending

BOX RX2 - (RXQ1215 )

English text: STILL PENDING/NO DECISION YET
Attribute
Don't know

Route
BOX RX2 - (RXQ1215 )

Refusal

BOX RX2 - (RXQ1215 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:27 PM Friday, January 08, 2010

Page 56 of 104

BOX RX2

BOX RX2

Page Order # :

300

BOX INSTRUCTIONS
( RXQ1215 )

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS
RX COVERAGE) OR (IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS
RX COVERAGE), GO TO RXINTRO - RXINTRO ( RXQ1220 ).
ELSE GO TO RX19 - PDNTENR ( RXQ1390 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:27 PM Friday, January 08, 2010

Page 57 of 104

RXINTRO

RXINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

RXINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

310

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you now receive".
Else display "(SP) now receives".
Display the word "now" in bold.
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE MANAGED CARE
PLAN NAME)".
Else if SP has a "current" Medicare Prescription Drug Plan, display
"(CURRENT MEDICARE PRESCRIPTION DRUG PLAN NAME)".
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
4:27:27 PM Friday, January 08, 2010

Page 58 of 104

RXINTRO
Context Header:
Int. Instr I:
I have a few questions regarding the prescribed drug coverage that
[you now receive/(SP) now receives] through [(CURRENT
MEDICARE MANAGED CARE PLAN NAME)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT
PRIVATE PLAN NAMES WITH RX)].

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
( RXQ1220 )

RXINTRO

Field1:
Cheshire Name:

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RX3 - (RXQ1222 )

English text: CONTINUE
Attribute
Empty

Route
BOX RX3 - (RXQ1222 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

4:27:27 PM Friday, January 08, 2010

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
Page 59 of 104

RXINTRO
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:27:27 PM Friday, January 08, 2010

Page 60 of 104

BOX RX3

BOX RX3

Page Order # :

313

BOX INSTRUCTIONS
( RXQ1222 )

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS RX
COVERAGE), GO TO RXPD23A - PDSATSFY ( RXQ1225 ).
ELSE GO TO RX2 - PDCONFID ( RXQ1227 ).

ASSIGNMENTS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:27 PM Friday, January 08, 2010

Page 61 of 104

RXPD23A

RXPD23A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDSATSFY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

317

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has a "current" Medicare Advantage Plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Else display the name of the "current" Medicare Prescription Drug
plan, PLAN.PLNAME.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

At the time that [you/(SP)] decided to have (CURRENT YEAR) drug
coverage through ([CURRENT MEDICARE ADVANTAGE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)],
how satisfied were you with the information that you had to make
that decision?

Int. Instr II:

4:27:27 PM Friday, January 08, 2010

Page 62 of 104

RXPD23A
INPUT FIELDS / ROUTING
( RXQ1225 )

PDSATSFY

Field1:
Cheshire Name:

PDRX.PDSATSFY

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSatsfya

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 VerySatisfied

Route
RX2 - PDCONFID ( RXQ1227 )

English text: VERY SATISFIED
2

Satisfied

3

Dissatisfied

RX2 - PDCONFID ( RXQ1227 )

English text: SATISFIED
RX2 - PDCONFID ( RXQ1227 )

English text: DISSATISFIED
4

VeryDissatisfied

RX2 - PDCONFID ( RXQ1227 )

English text: VERY DISSATISFIED
Attribute
Don't know

Route
RX2 - PDCONFID ( RXQ1227 )

Refusal

RX2 - PDCONFID ( RXQ1227 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

4:27:28 PM Friday, January 08, 2010

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
Page 63 of 104

RXPD23A
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65

MHMOCurrent

SP has a current Medicare Managed Care plan
(Medicare Advantage plan) =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:28 PM Friday, January 08, 2010

Page 64 of 104

RX2

RX2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDCONFID

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

320

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you now have".
Else display "(SP) now has".
Display the word "now" in bold.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD RX1

Question Text:

How confident are you that [you now have/(SP) now has] the drug
coverage that best meets (your/his/her) needs? Would you say you
are…

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:28 PM Friday, January 08, 2010

Page 65 of 104

RX2
PDCONFID

Field1:
Cheshire Name:
Item Text display:

( RXQ1227 )

PDRX.PDCONFID
Note to programmer: The English response text should be
displayed as Upper and Lower case as specified.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
Tconfidence
1
No
No

Number Label
1 ExConfident

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX3 - RXUSEPLN ( RXQ1230 )

English text: Extremely confident,
2

VeryConfident

RX3 - RXUSEPLN ( RXQ1230 )

English text: Very confident,
3

ModConfident

RX3 - RXUSEPLN ( RXQ1230 )

4

English text: Moderately confident,
SlConfident

RX3 - RXUSEPLN ( RXQ1230 )

English text: Slightly confident, or
5

NotConfident

RX3 - RXUSEPLN ( RXQ1230 )

English text: Not confident?
Attribute
Don't know

Route
RX3 - RXUSEPLN ( RXQ1230 )

Refusal

RX3 - RXUSEPLN ( RXQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:27:29 PM Friday, January 08, 2010

Page 66 of 104

RX2
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:27:29 PM Friday, January 08, 2010

Page 67 of 104

RX3

RX3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXUSEPLN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

330

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

4:27:29 PM Friday, January 08, 2010

Page 68 of 104

RX3
[Have you/Has (SP)] used (your/his/her) [(CURRENT MEDICARE
ADVANTAGE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION
DRUG PLAN NAME)/(CURRENT PRIVATE PLAN NAMES WITH
RX)] coverage when purchasing medicines since January 1 of this
year?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXUSEPLN

Field1:

( RXQ1230 )

PDRX.RXUSEPLN

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX4 - RXCOSTLY ( RXQ1235 )

English text: YES
2

No

RX18 - PDNOUSE ( RXQ1360 )

English text: NO
Attribute
Don't know

Route
RX18 - PDNOUSE ( RXQ1360 )

Refusal

RX18 - PDNOUSE ( RXQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4:27:29 PM Friday, January 08, 2010

Page 69 of 104

RX3
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:29 PM Friday, January 08, 2010

Page 70 of 104

RX4

RX4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXCOSTLY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

340

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Compared to last year, is the cost of the monthly premium for

[your/(SP's)] drug coverage more, less, or the same?

Int. Instr II:
INPUT FIELDS / ROUTING

4:27:29 PM Friday, January 08, 2010

Page 71 of 104

RX4
RXCOSTLY

Field1:
Cheshire Name:

( RXQ1235 )

PDRX.RXCOSTLY

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TMonthlyPremium
1
No
No

Number Label
1 MoreThanLastYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX5 - RXAMNTLY ( RXQ1240 )

English text: MORE THAN LAST YEAR
2

LessThanLastYear

RX5 - RXAMNTLY ( RXQ1240 )

3

English text: LESS THAN LAST YEAR
SameAsLastYear

RX5 - RXAMNTLY ( RXQ1240 )

English text: THE SAME AS LAST YEAR
4

NoDrugCovLastYear

RX5 - RXAMNTLY ( RXQ1240 )

English text: NO DRUG COVERAGE PREMIUM LAST YEAR
Attribute
Don't know

Route
RX5 - RXAMNTLY ( RXQ1240 )

Refusal

RX5 - RXAMNTLY ( RXQ1240 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:27:30 PM Friday, January 08, 2010

Page 72 of 104

RX5

RX5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXAMNTLY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

350

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you pay".
Else display "(SP) pays".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:

4:27:30 PM Friday, January 08, 2010

Page 73 of 104

RX5
Context Header:
Int. Instr I:
Are the amounts that [you pay/(SP) pays] for medicines at the
pharmacy using (your/his/her) [(CURRENT MEDICARE
ADVANTAGE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION
DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
coverage more, less, or the same compared to what (you/he/she)
paid last year?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXAMNTLY

Field1:
Cheshire Name:

( RXQ1240 )

PDRX.RXAMNTLY

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRXPayment
1
No
No

Number Label
1 MoreThanLastYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX7 - PDNOCVG ( RXQ1250 )

English text: MORE THAN LAST YEAR
2

LessThanLastYear

RX7 - PDNOCVG ( RXQ1250 )

English text: LESS THAN LAST YEAR
3

SameAsLastYear
English text: THE SAME AS LAST YEAR

RX7 - PDNOCVG ( RXQ1250 )

4

NoRXCostLastYear

RX7 - PDNOCVG ( RXQ1250 )

English text: NO COST FOR RX LAST YEAR
Attribute
Don't know

Route
RX7 - PDNOCVG ( RXQ1250 )

Refusal

RX7 - PDNOCVG ( RXQ1250 )

BACKGROUND VARIABLE ASSIGNMENTS

4:27:30 PM Friday, January 08, 2010

Page 74 of 104

RX5

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:27:30 PM Friday, January 08, 2010

Page 75 of 104

RX7

RX7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PDNOCVG

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

370

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "you regularly take".
Else display "(SP) regularly takes".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:

4:27:30 PM Friday, January 08, 2010

Page 76 of 104

RX7
Context Header:
Int. Instr I:
Are there any prescribed medicines that [you regularly take/(SP)
regularly takes] that are not covered by (your/his/her) (CURRENT
YEAR) [(CURRENT MEDICARE ADVANTAGE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
PDNOCVG

Field1:
Cheshire Name:

( RXQ1250 )

PDRX.PDNOCVG

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX8 - RXCHGMED ( RXQ1255 )

English text: YES
2

No

RX8 - RXCHGMED ( RXQ1255 )

English text: NO
Attribute
Don't know

Route
RX8 - RXCHGMED ( RXQ1255 )

Refusal

RX8 - RXCHGMED ( RXQ1255 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
4:27:31 PM Friday, January 08, 2010

Page 77 of 104

RX7

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =

Any PLAN where (PLAN.PLANDFLG=1/Yes or

PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or

PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =

There is a PLAN where PLAN.PLANTYPE=7/MPDP &

PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &

PLRO.PLRORND=current round &

PLRO.COVCURNT=1/Yes).

Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

6

SPFemale

SP is female =

ROST.ROSTSEX=2/Female on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

4:27:31 PM Friday, January 08, 2010

Page 78 of 104

RX8

RX8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXCHGMED

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

380

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

4:27:31 PM Friday, January 08, 2010

Page 79 of 104

RX8
[Have you/Has (SP)] had to change any of (your/his/her) prescribed
medicines from a brand name to a generic medicine because of
(your/his/her) (CURRENT YEAR) [(CURRENT MEDICARE
ADVANTAGE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION
DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXCHGMED

Field1:
Cheshire Name:

( RXQ1255 )

PDRX.RXCHGMED

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX9 - RXSWTCH ( RXQ1260 )

English text: YES
No

RX9 - RXSWTCH ( RXQ1260 )

English text: NO
Attribute
Don't know

Route
RX9 - RXSWTCH ( RXQ1260 )

Refusal

RX9 - RXSWTCH ( RXQ1260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:27:31 PM Friday, January 08, 2010

Page 80 of 104

RX8
TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =

Any PLAN where (PLAN.PLANDFLG=1/Yes or

PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or

PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =

There is a PLAN where PLAN.PLANTYPE=7/MPDP &

PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &

PLRO.PLRORND=current round &

PLRO.COVCURNT=1/Yes).

Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

4:27:31 PM Friday, January 08, 2010

Page 81 of 104

RX9

RX9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

RXSWTCH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

390

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

4:27:31 PM Friday, January 08, 2010

Page 82 of 104

RX9
[Have you/Has (SP)] had to switch to a different medication because
a drug (you/he/she) needed was not available through (your/his/her)
(CURRENT YEAR) [(CURRENT MEDICARE ADVANTAGE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXSWTCH

Field1:

( RXQ1260 )

PDRX.RXSWTCH

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX10 - RXPURCH ( RXQ1265 )

English text: YES
2

No

RX10 - RXPURCH ( RXQ1265 )

English text: NO
Attribute
Don't know

Route
RX10 - RXPURCH ( RXQ1265 )

Refusal

RX10 - RXPURCH ( RXQ1265 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4:27:32 PM Friday, January 08, 2010

Page 83 of 104

RX9
52

DeletedPlans

Deleted plans that are not valid for displays or checks =

Any PLAN where (PLAN.PLANDFLG=1/Yes or

PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or

PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =

There is a PLAN where PLAN.PLANTYPE=7/MPDP &

PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &

PLRO.PLRORND=current round &

PLRO.COVCURNT=1/Yes).

Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare

Advantage plan) with RX coverage=

There is a PLAN where PLANTYPE=5/MHMO & PLRO

where (PLROPLAN=PLANNUM & PLRORND=current

round & COVCURNT=1/Yes & MHMORX=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =

There is a PLAN where PLANTYPE=4/PrivatePlan &

PLRO where (PLROPLAN=PLAN.PLANNUM &

PLRORND=current round & (COVTIME=1/WholeTime or

COVNOW=1/Yes) & PRVRXCOV=1/Yes)).

Exclude Deleted Plans. See T.N. 52.

4

Respondent

On MRES where MRES.MRESRND = current round:

A Proxy interview (respondent is a proxy) =

MRES.SPPROXY=2/Proxy.

MRES.RROSTNUM=ROST.ROSTNUM of respondent.

An SP interview (respondent is the SP) =

MRES.SPPROXY=1/SP.

MRES.RROSTNUM='01'.

5

SPMale

SP is male =

ROST.ROSTSEX=1/Male on ROST where

ROST.ROSTNUM='01'.

6

SPFemale

SP is female =

ROST.ROSTSEX=2/Female on ROST where

ROST.ROSTNUM='01'.

DESIGN NOTES

4:27:32 PM Friday, January 08, 2010

Page 84 of 104

RX10

RX10

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXPURCH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

400

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)
drug coverage".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME and "plan".
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "(PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN) plan(s)". Always
display "plan(s)" with the "(s)" in parentheses.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
4:27:32 PM Friday, January 08, 2010

Page 85 of 104

RX10
When purchasing prescribed medicines through [your/(SP's)]
[(CURRENT MEDICARE ADVANTAGE PLAN) drug
coverage/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)
plan/(CURRENT PRIVATE PLAN NAMES WITH RX) plan(s)] in
(CURRENT YEAR), [do you/does (SP)] pay more than you expected,
about as much as expected, or less than expected?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXPURCH

Field1:
Cheshire Name:

( RXQ1265 )

PDRX.RXPURCH

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRXPurch
1
No
No

Number Label
1 MoreThanExpected
2

English text: MORE THAN EXPECTED
AboutAsMuchAsExp

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX16 - RXPARTIC ( RXQ1350 )
RX16 - RXPARTIC ( RXQ1350 )

English text: ABOUT AS MUCH AS EXPECTED
3

LessThanExpected

RX16 - RXPARTIC ( RXQ1350 )

English text: LESS THAN EXPECTED
Attribute
Don't know

Route
RX16 - RXPARTIC ( RXQ1350 )

Refusal

RX16 - RXPARTIC ( RXQ1350 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:27:32 PM Friday, January 08, 2010

Page 86 of 104

RX10
HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:32 PM Friday, January 08, 2010

Page 87 of 104

RX16

RX16

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

RXPARTIC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

470

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you generally prefer".
Else display "(SP) generally prefers".
If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

4:27:32 PM Friday, January 08, 2010

Page 88 of 104

RX16
Int. Instr I:
Does the [(CURRENT MEDICARE ADVANTAGE PLAN)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE
PLAN NAMES WITH RX)] drug plan network include the pharmacy
that [you generally prefer/(SP) generally prefers] to use?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
RXPARTIC

Field1:

( RXQ1350 )

PDRX.RXPARTIC

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRXPartIC
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
RX17 - PDRXRATE ( RXQ1355 )

English text: YES
No

RX17 - PDRXRATE ( RXQ1355 )

English text: NO
3

OnlyUsesNetMailOrder
DO NOT DISPLAY. DATA EDITING ONLY.
English text: ONLY USES NETWORK MAIL ORDER PHARMACY

Attribute
Don't know

Route
RX17 - PDRXRATE ( RXQ1355 )

Refusal

RX17 - PDRXRATE ( RXQ1355 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:27:33 PM Friday, January 08, 2010

Page 89 of 104

RX16
HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:33 PM Friday, January 08, 2010

Page 90 of 104

RX17

RX17

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PDRXRATE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

480

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD RX2

Question Text:

Overall, how satisfied are you with [your/(SP's)] drug plan through

4:27:33 PM Friday, January 08, 2010

Page 91 of 104

RX17
[(CURRENT MEDICARE ADVANTAGE PLAN)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE
PLAN NAMES WITH RX)]?
Int. Instr II:
INPUT FIELDS / ROUTING
PDRXRATE

Field1:
Cheshire Name:

( RXQ1355 )

PDRX.PDRXRATE

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSatsfya
1
No
No

Number Label
1 VerySatisfied

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXEND - (RXQ1455 )

English text: VERY SATISFIED
2

Satisfied

BOX RXEND - (RXQ1455 )

3

English text: SATISFIED
Dissatisfied

BOX RXEND - (RXQ1455 )

4

VeryDissatisfied

English text: DISSATISFIED
BOX RXEND - (RXQ1455 )

English text: VERY DISSATISFIED
Attribute
Don't know

Route
BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
4:27:33 PM Friday, January 08, 2010

Page 92 of 104

RX17

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:33 PM Friday, January 08, 2010

Page 93 of 104

RX18

RX18

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PDNOUSE

Field 2:

PDNOOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

490

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has "current" Medicare Managed Care plan that has RX
coverage, display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Else if SP has a "current" Medicare Prescription Drug Plan,
display the name of the "current" Medicare Prescription Drug plan,
PLAN.PLNAME.
Else if SP has at least one "current" Private plan that has RX
coverage, display up to 4 "current" Private plans that have RX
coverage in the following format "PRIVATE PLAN 1, PRIVATE
PLAN 2, PRIVATE PLAN 3, AND PRIVATE PLAN 4".

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
4:27:33 PM Friday, January 08, 2010

Page 94 of 104

RX18
Question Text:

Why [haven't you/hasn't (SP)] used (your/his/her) [(CURRENT
MEDICARE ADVANTAGE PLAN)/(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN
NAMES WITH RX)] coverage in (CURRENT YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:27:34 PM Friday, January 08, 2010

Page 95 of 104

RX18
PDNOUSE

Field1:
Cheshire Name:

( RXQ1360 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=PDRX.PDNOPCHS
2=PDRX.PDNOCARD
3=PDRX.PDNOMEDC
4=PDRX.PDNOEXPS
5=PDRX.PDNOCOVD
91=PDRX.PDNOOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDNOUSE
6
No
No

Number Label
1 HaveNotPurchasedMedicine

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX RXEND - (RXQ1455 )

English text: HAVE NOT PURCHASED MEDICINE
2

DontHaveCard

BOX RXEND - (RXQ1455 )

3

English text: DON'T HAVE CARD OR OTHER ENROLLMENT VERIFICATION/NOT ABLE
DUE TO PLAN PROBLEM
PharmacyWouldntGiveMedicine
BOX RXEND - (RXQ1455 )
English text: PHARMACY WOULDN'T GIVE MEDICINE

4

CostOfRxTooHigh

BOX RXEND - (RXQ1455 )

5

DrugsNeededNotCovered
BOX RXEND - (RXQ1455 )
English text: DRUG(S) NEEDED NOT COVERED BY PLAN

English text: COST OF RX TOO HIGH/EXPENSIVE

91

Other

RX18 - PDNOOTHOS ( RXQ1388 )

English text: OTHER
Attribute
Don't know

Route
BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

4:27:34 PM Friday, January 08, 2010

Page 96 of 104

RX18
PDNOOTHOS

Field2:
Cheshire Name:

( RXQ1388 )

PDRX.PDNOOS

Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer

instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
52

DeletedPlans

Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.

342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

344

MHMOCurrWithRx

SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

4:27:34 PM Friday, January 08, 2010

Page 97 of 104

RX18
354

PrivPlanCurrWithRx

SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.

DESIGN NOTES

4:27:34 PM Friday, January 08, 2010

Page 98 of 104

RX19

RX19

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PDNTENR

Field 2:

PDNTOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

500

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

You said that [you are/(SP) is] not enrolled in a Medicare

Prescription Drug plan. What is the reason (you are/he is/she is) not
enrolled in such a plan?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:27:35 PM Friday, January 08, 2010

Page 99 of 104

RX19

4:27:35 PM Friday, January 08, 2010

Page 100 of 104

RX19
PDNTENR

Field1:
Cheshire Name:

( RXQ1390 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=PDRX.PDNTRXCV
2=PDRX.PDNTPRES
3=PDRX.PDNTCOVR
4=PDRX.PDNTENRL
5=PDRX.PDNTPLAN
6=PDRX.PDNTEXPS
7=PDRX.PDNTCONF
8=PDRX.PDNTMANY
9=PDRX.PDNTBEFT
10=PDRX.PDNTPDP
11=PDRX.PDNTINTL
91=PDRX.PDNTOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TPDNTENR
12
No
No

FieldSize:
Min Value:
Max Value:
Mask:

Number Label
Route
1 HaveRxCoverageThroughNonPdp
BOX RXEND - (RXQ1455 )
English text: HAVE RX COVERAGE THROUGH A NON-PDP PLAN/SOURCE
2

DontTakeEnoughPrescriptions

BOX RXEND - (RXQ1455 )

3

English text: DON'T TAKE ENOUGH PRESCRIPTIONS TO NEED IT
PlansDontCoverPrescriptions
BOX RXEND - (RXQ1455 )

4

English text: PLANS DON'T COVER PRESCRIPTIONS SP TAKES
DontKnowHowToEnroll
BOX RXEND - (RXQ1455 )
English text: DON'T KNOW HOW TO ENROLL

5

DontKnowEnoughAboutPlans

BOX RXEND - (RXQ1455 )

6

TooExpensive

7

English text: TOO EXPENSIVE OR CAN'T AFFORD
TooConfusing
BOX RXEND - (RXQ1455 )

English text: DON'T KNOW ENOUGH ABOUT PLANS
BOX RXEND - (RXQ1455 )

English text: TOO CONFUSING OR TOO COMPLICATED
8

TooManyPlansToChooseFrom

BOX RXEND - (RXQ1455 )

English text: TOO MANY PLANS TO CHOOSE FROM OR CAN'T DECIDE ON ONE PLAN
4:27:36 PM Friday, January 08, 2010

Page 101 of 104

RX19

9

WontBenefitOrSaveMoney

BOX RXEND - (RXQ1455 )

English text: WON'T BENEFIT OR WON'T SAVE MONEY
10

HadAPdpDidntLike

11

English text: HAD A PDP, DIDN'T LIKE IT OR WASN'T USEFUL
SpBuysMedicineOutsideUS
BOX RXEND - (RXQ1455 )

BOX RXEND - (RXQ1455 )

English text: SP BUYS MEDICINE OUTSIDE OF THE U.S.
91

OtherReason

RX19 - PDNTOTHOS ( RXQ1395 )

English text: OTHER REASON
Attribute
Don't know

Route
BOX RXEND - (RXQ1455 )

Refusal

BOX RXEND - (RXQ1455 )

Field2:

PDNTOTHOS

( RXQ1395 )

PDRX.PDNTOS

Cheshire Name:
Item Text display:

Display "(SPECIFY)" in same blue font used for interviewer
instructions.

Item Text:

OTHER REASON (SPECIFY)

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TOthrspec

1

No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX RXEND - (RXQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4:27:36 PM Friday, January 08, 2010

Page 102 of 104

RX19

DESIGN NOTES

4:27:36 PM Friday, January 08, 2010

Page 103 of 104

BOX RXEND

BOX RXEND

Page Order # :

510

BOX INSTRUCTIONS
( RXQ1455 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:27:36 PM Friday, January 08, 2010

Page 104 of 104