CMS-10441 Attachment J - post survey conditions 3 and 4 - 100112

ID: ________________
Post-Exposure Survey for Medicare Plan Finder Study
Conditions 3 and 4
1. How easy or difficult was it for you to use the website in general?

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Very easy.
Somewhat easy.
Neither easy nor difficult.
Somewhat difficult.
Very difficult.

2. How easy or difficult was it for you to find information that you were looking for?

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Very easy.
Somewhat easy.
Neither easy nor difficult.
Somewhat difficult.
Very difficult.

3. How easy or difficult was it for you to understand the information that was provided about
the prescription drug plans?

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Very easy.
Somewhat easy.
Neither easy nor difficult.
Somewhat difficult.
Very difficult.

4. How easy or difficult was it for you to do what was required to get from the home page to a
table with information about plan benefits, cost, and quality?

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Very easy.
Somewhat easy.
Neither easy nor difficult.
Somewhat difficult.
Very difficult.
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5. How satisfied or dissatisfied were you with the information you were given about each
prescription drug plan?

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Very satisfied.
Somewhat satisfied.
Neither satisfied nor dissatisfied.
Somewhat dissatisfied.
Very dissatisfied.

6. How did you feel about the amount of information you were given about each prescription
drug plan? Would you say that it was . . .

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Not enough information (I would have liked more).
About the right amount of information for me to handle.
More information than I could handle.

7. How easy or difficult was it for you to choose a prescription drug plan?

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Very easy.
Somewhat easy.
Neither easy nor difficult.
Somewhat difficult.
Very difficult.

8. How confident are you that you made a good choice?

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Extremely confident.
Somewhat confident.
Not at all confident.

9. To what extent did making a choice make you feel each of the following ways . . .

Confused
Confident
Overwhelmed
Intimidated

Not at all

Very little

Somewhat

Extremely

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Capable
Annoyed
Relaxed
Content
Doubtful
Calm
Frustrated
Assured
Anxious
Certain

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10. If you could have free access to a website like this one when you need to choose a
prescription drug plan in real life, how likely would you be to use this website?

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Definitely would use.
Probably would use.
Not sure.
Probably would not use.
Definitely would not use.

11. Would you recommend that your friends and family use a website like this one when they
make their own choices about a prescription drug plan?

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Definitely recommend.
Probably recommend.
Not sure.
Probably not recommend.
Definitely not recommend.

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12. We’re interested in knowing what you remember about the website and how useful the information was. This question is about some of the
types of information that were shown about each prescription drug plan.

Types of Information about
Prescription Drug Plans

Do you
remember
seeing this
information?
No

Yes 

If you remember seeing the information:

If you remember seeing the information:

How easy or difficult was it to tell which plans
were better or worse using this information?

How much did this information influence your
choice of a plan?

Very
easy

Somewhat
easy

Somewhat
difficult

Very
difficult

Not at
all

Very little

Somewhat

A great
deal

a. Total estimated annual costs

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b. Monthly premium

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c. Annual deductible

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d. Whether the drugs you
entered were on the plan’s
formulary

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e. Pharmacy status

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f. Overall plan quality

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13. Looking at the table on the following page, which plan has the highest monthly premium?
Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

Plan E.

Plan F.

14. Looking at the table on the following page, which plan has the highest estimated annual
health and drug costs? Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

Plan E.

Plan F.

15. Looking at the table on the following page, which plan has the lowest overall quality
rating? Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

Plan E.

Plan F.

16. Looking at the table on the following page, which plan has the lowest total estimated
annual costs? Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

Plan E.

Plan F.

17. If you wanted a plan that is above average quality and has no monthly premium, which plan
would be your best choice? Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

Plan E.

Plan F.

18. If you wanted a plan that is above average quality and includes all your drugs on its
formulary, which plan would you choose? Circle one answer only.
Plan A.

Plan B.

Plan C.

Plan D.

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Plan E.

Plan F.

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19. Below is a picture of the first page you saw on the Plan Finder website. Thinking about
when you first saw that web page, how good an idea did the page give you about what
information was available on the Plan Finder website?

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No idea at all.
Very little idea.
Some idea.
A very clear idea.

20. How good an idea did this page give you about what you might be able to do on the
website?

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No idea at all.
Very little idea.
Some idea.
A very clear idea.

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Finally, we’d like to ask you some questions about risk. Please choose the best answer possible
by checking the appropriate box or writing in an answer on the line provided.
21. Which of the following numbers represents the biggest risk of getting a disease?

□ 1 in 100.
□ 1 in 1000.
□ 1 in 10.
22. Which of the following numbers represents the biggest risk of getting a disease?

□ 1%.
□ 10%.
□ 5%.
23. If Person A’s risk of getting a disease is 1% in ten years, and person B’s risk is double that of
A’s, what is B’s risk?
_______%.
24. If Person A’s risk of getting a disease is 1 in 100 in ten years, and person B’s risk is double
that of A’s, what is B’s risk?
_______ in 100.
25. If the chance of getting a disease is 10%, how many people would be expected to get the
disease:
a. Out of 100?
b. Out of 1000?

_______ out of 100.
_______ out of 1000.

26. If the chance of getting a disease is 20 out of 100, this would be the same as having a
______% chance of getting the disease.

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