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Crosswalk - PDP
ICR 201307-0938-003 · OMB 0938-1113 · Object 40814501.
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Crosswalk - PDP |
| Author | RAND Authorized User |
| Last Modified By | Calc |
| File Modified | 2013-07-08 |
| File Created | 2026-09-16 |
| Conversion State | complete |
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Disenrollee Survey Comparison PDP Only Question Number 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Heading YOUR FORMER PRESCRIPTION DRUG PLAN Heading YOUR FORMER PRESCRIPTION DRUG PLAN We are sending you this survey We are sending you this survey because we believe you because we believe you recently recently left, switched or were left or were dropped by a Directions dropped by a prescription drug Directions prescription drug plan, or plan. switched prescription drug plans. Our records show that you used to belong to [PLAN NAME], but no longer belong to that plan. Is that right? Yes No If No, go to #3 1 1 Our records show that you used to belong to [PLAN NAME], but no longer belong to that plan. Is that right? Yes If Yes, go to Question 2 I left or was dropped by a plan but it was not [PLAN NAME] Go to Question 2 No, I did not belong to [PLAN NAME] No, I still belong to [PLAN NAME] If you answered No to Question 1, please stop and return the survey. You DO NOT have to complete the survey. 1 of 38 09/16/20261 Disenrollee Survey Comparison PDP Only Question Number 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Did you move outside of the area where [PLAN NAME] was available? Yes If Yes, Please stop and return the survey No If No, go to #6 2 2 Do you still belong to [PLAN NAME]? Yes 3 Did you have to leave or switch [PLAN NAME] for any of the following reasons? I moved outside of the area where the plan was available I was dropped by the plan The plan was cancelled or discontinued in my area The plan was changed by the organization that provides my insurance (such as an employer or a union) PLEASE READ: If you checked any of the reasons above, please stop and return the survey. You DO NOT have to complete the survey. o None of the above --> If you did not choose any of the reasons in Question 2 please continue to Question 3 Dropped If Yes, Please stop and return this survey No Dropped 4 Did you recently leave, switch, or were you dropped by a prescription drug plan? Yes No Dropped If No, Please stop and return this survey 2 of 38 09/16/20262 Disenrollee Survey Comparison PDP Only Question Number 5 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number What is the name of the prescription drug plan you recently left, switched or were dropped by? (Please print) __________________________ __ Please think of this plan as you answer the questions in this survey. Dropped GETTING INFORMATION OR Heading HELP FROM YOUR FORMER PRESCRIPTION DRUG PLAN These questions ask about your experience with your former prescription drug plan. Directions 6 7 GETTING INFORMATION OR HELP Heading FROM YOUR FORMER PRESCRIPTION DRUG PLAN These questions ask about your experience with your former prescription drug plan. As you answer the rest of the questions in this survey, please think only of your former plan. Customer service is information Customer service is information you get from staff about what is you get from staff about what is covered and how to use the covered and how to use the plan. plan. Did you ever try to get Did you ever try to get information or help from [PLAN information or help from [PLAN NAME]’s customer service? NAME]’s customer service? Yes Yes 3 No No If No, go to #5 If No, go to #8 How often did the plan’s customer service give you the information or help you needed? Never Sometimes Usually Always I did not try to get information or help from the plan’s customer service 4 How often did the plan’s customer service give you the information or help you needed? Never Sometimes Usually Always I did not try to get information or help from the plan’s customer service 3 of 38 09/16/20263 Disenrollee Survey Comparison PDP Only Question Number 8 2010 Version: PDP_Pilot Did you ever try to get information from the plan about which prescription medicines were covered? Yes No Question 2013 Version: 2PDP Survey Number 5 Did you ever try to get information from the plan about which prescription medicines were covered? Yes No If No, go to #7 If No, go to #10 9 10 How often did the plan give you all the information you needed about which prescription medicines were covered? Never Sometimes Usually Always I did not try to get information about which prescription medicines were covered Did you ever try to get information from the plan about how much you would have to pay for a prescription medicine? Yes No 6 7 How often did the plan give you all the information you needed about which prescription medicines were covered? Never Sometimes Usually Always I did not try to get information about which prescription medicines were covered Did you ever try to get information from the plan about how much you would have to pay for a prescription medicine? Yes No If No, go to #9 If No, go to #12 4 of 38 09/16/20264 Disenrollee Survey Comparison PDP Only Question Number 11 12 13 2010 Version: PDP_Pilot How often did the plan give you all the information you needed about how much you would have to pay for a prescription medicine? Never Sometimes Usually Always I did not try to get information about how much I would have to pay for a prescription medicine Did you ever need written information from the plan in a language other than English? Yes No If No, go to #14 How often did the plan give you written information in a language other than English? Never Sometimes Usually Always I did not need written information in a language other than English GETTING INFORMATION OR Heading HELP FROM YOUR FORMER PRESCRIPTION DRUG PLAN Did a doctor ever prescribe a medicine for you that the plan did not cover? 14 Yes No Question 2013 Version: 2PDP Survey Number 8 9 10 How often did the plan give you all the information you needed about how much you would have to pay for a prescription medicine? Never Sometimes Usually Always I did not try to get information about how much I would have to pay for a prescription medicine Did you ever need written information from the plan in a language other than English? Yes No If No, go to #11 How often did the plan give you written information in a language other than English? Never Sometimes Usually Always I did not need written information in a language other than English GETTING INFORMATION OR HELP Heading FROM YOUR FORMER PRESCRIPTION DRUG PLAN Did a doctor ever prescribe a medicine for you that the plan did not cover? 11 Yes No 5 of 38 09/16/20265 Disenrollee Survey Comparison PDP Only Question Number 15 16 17 18 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number How often was it easy to use the plan to get the medicines your doctor prescribed? Never Sometimes Usually Always I did not use the plan to get any prescription medicines How often was it easy to use the plan to get the medicines your doctor prescribed? Never Sometimes Usually Always I did not use the plan to get any prescription medicines Did you ever use the plan to fill a prescription at a local pharmacy? Yes No If No, go to #18 How often was it easy to use the plan to fill a prescription at a local pharmacy? Never Sometimes Usually Always I did not use the plan to fill a prescription at a local pharmacy Did you ever use the plan to fill any prescriptions by mail? Yes No 12 13 14 15 Did you ever use the plan to fill a prescription at a local pharmacy? Yes No If No, go to #15 How often was it easy to use the plan to fill a prescription at a local pharmacy? Never Sometimes Usually Always I did not use the plan to fill a prescription at a local pharmacy Did you ever use the plan to fill a prescription at a local pharmacy? Yes No If No, go to #15 If No, go to #20 19 How often was it easy to use the plan to fill prescriptions by mail? Never Sometimes Usually Always I did not use the plan to fill a prescription by mail 16 How often was it easy to use the plan to fill prescriptions by mail? Never Sometime Usually Always I did not use the plan to fill a prescription by mail 6 of 38 09/16/20266 Disenrollee Survey Comparison PDP Only Question Number 20 2010 Version: PDP_Pilot Using any number from 0 to 10, where 0 is the worst prescription drug plan possible and 10 is the best prescription drug plan possible, what number would you use to rate the plan? 0 Worst prescription drug plan 1 possible 2 3 4 5 6 7 8 9 10 Best prescription drug plan possible Question 2013 Version: 2PDP Survey Number 17 Using any number from 0 to 10, where 0 is the worst prescription drug plan possible and 10 is the best prescription drug plan possible, what number would you use to rate the plan? 0 Worst prescription drug plan 1 possible 2 3 4 5 6 7 8 9 10 Best prescription drug plan possible REASONS YOU LEFT YOUR REASONS YOU LEFT YOUR Heading FORMER PRESCRIPTION DRUG Heading FORMER PRESCRIPTION DRUG PLAN PLAN People leave, switch or drop a People leave, drop, or switch prescription drug plan for prescription drug plans for different reasons. These different reasons. These questions are about reasons questions are about reasons you you may have had for may have had for switching, switching, leaving, or dropping leaving, or dropping [PLAN Directions: Directions: [PLAN NAME]. In this survey NAME]. we use the words “did you leave” to ask about why you left, dropped. or switched from your former prescription drug plan. Did you leave the plan because Did you leave the plan because you found out that someone you found out that someone had had signed you up for the plan signed you up for the plan without your permission? without your permission? 21 18 Yes Yes No No 7 of 38 09/16/20267 Disenrollee Survey Comparison PDP Only Question Number 22 23 24 2010 Version: PDP_Pilot Did you leave the plan because you were accidentally taken off the plan (or because of some other paperwork or clerical error)? Yes No A premium is the amount that you pay to have prescription medicine coverage from a prescription drug plan. Some prescription drug plans charge a premium to people on Medicare who are enrolled in that prescription drug plan. Did you leave the plan because the monthly premium for prescription medicine coverage went up? Yes No Did you leave the plan because you stopped paying the monthly premium for the plan? Yes No Question 2013 Version: 2PDP Survey Number 19 20 21 Did you leave the plan because you were accidentally taken off the plan (or because of some other paperwork or clerical error)? Yes No Some Medicare beneficiaries have to pay their prescription drug plan a monthly fee out of their own pocket for coverage for prescription medicines. Did you leave the plan because the monthly fee that the plan charges to provide coverage for prescription medicines went up? Yes No Did you leave the plan because you stopped paying the monthly fee for coverage for prescription medicines? Yes No If No, go to #26 If No, go to #23 25 Why did you stop paying the monthly premium for the plan? I stopped paying the monthly premium because I could not afford it I stopped paying the monthly premium because I was unhappy with the plan I stopped paying the monthly premium for some other reason 22 Why did you stop paying the the plan’s monthly fee? I stopped paying the monthly fee because I could not afford it I stopped paying the monthly fee because I was unhappy with the plan I stopped paying the monthly fee for some other reason 8 of 38 09/16/20268 Disenrollee Survey Comparison PDP Only Question Number 26 27 28 29 30 2010 Version: PDP_Pilot A formulary is the list of prescription medicines covered by a prescription drug plan. Did you leave the plan because of a change in the formulary? Yes No Question 2013 Version: 2PDP Survey Number 23 Did you leave the plan because you hit the temporary limit (also called the “coverage gap” or “donut hole”) when you had to pay all of the costs of your prescription medicines up to a yearly limit? Yes No Did you leave the plan because the dollar amount you had to pay each time you filled or refilled a prescription went up? Yes No Did you leave the plan because you found a prescription drug plan that costs less? Yes No Did you leave the plan because a change in your personal finances meant you could no longer afford the plan? Yes No Prescription drug plans have a list of the prescription medicines that the plan will cover. Did you leave the plan because they changed the list of prescription medicines they cover? Yes No Dropped 24 25 26 Did you leave the plan because the dollar amount you had to pay each time you filled or refilled a prescription went up? Yes No Did you leave the plan because you found a prescription drug plan that costs less? Yes No Did you leave the plan because a change in your personal finances meant you could no longer afford the plan? Yes No 9 of 38 09/16/20269 Disenrollee Survey Comparison PDP Only Question Number 31 32 33 34 35 2010 Version: PDP_Pilot Did you leave the plan because the plan refused to pay for a medicine your doctor prescribed? Yes No Did you leave the plan because you had problems getting the medicines your doctor prescribed? Yes No Did you leave the plan because it was difficult to get brand name medicines? Yes No Did you leave the plan because you were frustrated by the plan’s approval process for medicines your doctor prescribed that were not on their formulary? Yes No Did you leave the plan because you did not know whom to contact when you had a problem filling or refilling a prescription? Yes No Question 2013 Version: 2PDP Survey Number 27 28 29 Did you leave the plan because the plan refused to pay for a medicine your doctor prescribed? Yes No Did you leave the plan because the plan refused to pay for a medicine your doctor prescribed? Yes No Did you leave the plan because it was difficult to get brand name medicines? Yes No 30 31 Did you leave the plan because you were frustrated by the plan’s approval process for medicines your doctor prescribed that were not on the plan’s list of medicines that the plan covers? Yes No Did you leave the plan because you did not know whom to contact when you had a problem filling or refilling a prescription? Yes No 10 of 38 09/16/202610 Disenrollee Survey Comparison PDP Only Question Number 36 37 38 39 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Did you leave the plan because it was hard to get information from the plan -- like which prescription medicines were covered or how much a specific medicine would cost? Yes No Did you leave the plan because it was hard to get information from the plan -- like which prescription medicines were covered or how much a specific medicine would cost? Yes No Did you leave the plan because you were unhappy with how the plan handled a question or complaint? Yes No Did you leave the plan because you could not get the information or help you needed from the plan? Yes No Did you leave the plan because their customer service staff did not treat you with courtesy and respect? Yes No 32 33 34 35 Did you leave the plan because you were unhappy with how the plan handled a question or complaint? Yes No Did you leave the plan because you could not get the information or help you needed from the plan? Yes No Did you leave the plan because their customer service staff did not treat you with courtesy and respect? Yes No OTHER REASONS FOR LEAVING YOUR FORMER PRESCRIPTION Heading Heading DRUG PLAN OTHER REASONS FOR LEAVING YOUR FORMER PRESCRIPTION DRUG PLAN Directions Every year Medicare evaluates all Medicare prescription drug plans and gives each plan a quality rating. The ratings are referred to as the Medicare star or plan ratings. The ratings provide Medicare beneficiaries information on the quality of services a plan provides. Not included. 11 of 38 09/16/202611 Disenrollee Survey Comparison PDP Only Question Number 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Did you leave the plan because it got a low Medicare star rating? Not included. Not included. 36 37 Yes No Did you leave the plan because you found another plan with a higher Medicare star rating? Yes No Not included. 38 In the past year, did you think about the Medicare star or plan ratings when making a decision about enrolling in a prescription drug plan? Yes No 40 41 42 Did you leave [PLAN NAME] because it wasn’t what you expected? Yes No Dropped Did you leave the plan because a doctor or pharmacist told you that another plan had better benefits or coverage for prescription medicines? Yes No Dropped Did you leave the plan because a family member or friend told you that another prescription drug plan was a better plan? Yes No Did you leave the plan because a family member or friend told you that another prescription drug plan was a better plan? Yes No 39 12 of 38 09/16/202612 Disenrollee Survey Comparison PDP Only Question Number 43 44 45 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Did you leave the plan because you saw a commercial or advertisement for a prescription drug plan you thought you would like better? Yes No Did you leave the plan because you saw a commercial or advertisement for a prescription drug plan you thought you would like better? Yes No Did you leave the plan because you found another plan that better met your prescription needs? Yes No Did you leave the plan because you take very few prescription medicines and don’t need a prescription drug plan? Yes No 40 41 42 What was the one most important reason you left [PLAN NAME]? (please print) __________________________ __________________________ ____ 46 YOUR EXPERIENCE WITH INSURANCE AGENTS, Heading BROKERS, OR PLAN REPRESENTATIVES 43 Did you leave the plan because you found another plan that better met your prescription needs? Yes No Did you leave the plan because you take very few prescription medicines and don’t need a prescription drug plan? Yes No What was the one most important reason you left [PLAN NAME]? (Check one) Financial or cost reasons Problems getting prescription drugs through the plan Problems getting information from the plan about prescription drugs Switched to another plan that offers better benefits or coverage Another reason. Please specify: __________________________ __________________________ YOUR EXPERIENCE WITH INSURANCE AGENTS, BROKERS, Heading OR PLAN REPRESENTATIVES 13 of 38 09/16/202613 Disenrollee Survey Comparison PDP Only Question Number 47 48 49 50 2010 Version: PDP_Pilot Question 2013 Version: 2PDP Survey Number Different kinds of people sell health insurance. Insurance may be sold by independent insurance agents or brokers who don’t work for the health plan OR by plan representatives who work directly for the plan. Did an insurance agent, broker, or plan representative ever call you without your asking them to, to tell you about insurance for prescription medicines? Yes No Different kinds of people sell health insurance. Insurance may be sold by independent insurance agents or brokers who don’t work for the health plan OR by plan representatives who work directly for the plan. Did an insurance agent, broker, or plan representative ever call you without your asking them to, to tell you about insurance for prescription medicines? Yes No Did an insurance agent, broker, or plan representative ever visit your home you without your asking them to, to tell you about insurance for prescription medicines? Yes No Did you decide to leave [PLAN NAME] because of information you got from an insurance agent, broker, or plan representative? Yes No Did an insurance agent or broker give you any information that was not correct? Yes No 44 45 46 47 Did an insurance agent, broker, or plan representative ever visit your home without your asking them to, to tell you about insurance for prescription medicines? Yes No Did you decide to leave [PLAN NAME] because of information you got from an insurance agent, broker, or plan representative? Yes No Did an insurance agent, broker, or plan representative give you any information that was not correct? Yes No If No, go to #49 If No, go to #52 14 of 38 09/16/202614 Disenrollee Survey Comparison PDP Only Question Number 51 2010 Version: PDP_Pilot What kind of information was not correct? What the plan covered What the plan would cost you Which pharmacies were covered by the plan Some other information (Please print) __________________________ _ I did not get any information that was not correct Question 2013 Version: 2PDP Survey Number 48 What kind of information was not correct? Please check all that apply. What the plan covered What the plan would cost you Which pharmacies were covered by the plan Some other information (please print) ____________________________ _ ____________________________ _ Heading ABOUT YOU In general, how would you rate your overall health? Excellent Very good 52 Good Fair Poor Heading ABOUT YOU In general, how would you rate your overall health? Excellent Very good 49 Good Fair Poor In general, how would you rate your overall mental health? Excellent Very good Good Fair Poor 50. In general, how would you rate your overall mental health? Excellent Very good Good Fair Poor 53 54 In the last 12 months, how many different prescription medicines did you fill or have refilled? None 1 to 2 medicines 3 to 5 medicines 6 or more medicines 50 51 In the last 12 months, how many different prescription medicines did you fill? (Don’t count the same prescriptions twice) None 1 to 2 medicines 3 to 5 medicines 6 or more medicines 15 of 38 09/16/202615 Disenrollee Survey Comparison PDP Only Question Number 55 56 57 2010 Version: PDP_Pilot In the past 12 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem? Yes No If No, go to #57 Is this a condition or problem that has lasted for at least 3 months? Yes No Do you now need or take medicine prescribed by a doctor? Yes No Question 2013 Version: 2PDP Survey Number 52 53 54 In the past 12 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem? Yes No-->If No, go to #54 Is this a condition or problem that has lasted for at least 3 months? Yes No Do you now need or take medicine prescribed by a doctor? Yes No If No, go to #56 If No, go to #59 58 Is this to treat a condition that has lasted for at least 3 months? Yes No 55 Is this to treat a condition that has lasted for at least 3 months? Yes No 16 of 38 09/16/202616 Disenrollee Survey Comparison PDP Only Question Number 59 2010 Version: PDP_Pilot Has a doctor ever told you that you had any of the following conditions? a. A heart attack? Yes No b. Angina or coronary heart disease? Yes No c. A stroke? Yes No d. Cancer, other than skin cancer? Yes No e. Emphysema, asthma or COPD (chronic obstructive pulmonary disease)? Yes No f. Any kind of diabetes or high blood sugar? Yes No Question 2013 Version: 2PDP Survey Number 56 What is your age? 60 61 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 79 80 to 84 85 or older Are you male or female? Male Female 57 58 Has a doctor ever told you that you had any of the following conditions? a. A heart attack? Yes No b. Angina or coronary heart disease? Yes No c. Hypertension of high blood pressure? Yes No d. Cancer, other than skin cancer? Yes No e. Emphysema, asthma or COPD (chronic obstructive pulmonary disease)? Yes No f. Any kind of diabetes or high blood sugar? Yes No What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 79 80 to 84 85 or older Are you male or female? Male Female 17 of 38 09/16/202617 Disenrollee Survey Comparison PDP Only Question Number 62 63 64 65 2010 Version: PDP_Pilot What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree Are you of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino What is your race? Please mark one or more. White Black or African-American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native What language do you mainly speak at home? Chinese English Russian Spanish Vietnamese Some other language (Please print) __________________________ __ Question 2013 Version: 2PDP Survey Number 59 60 61 62 What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree Are you of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino What is your race? Please mark one or more. White Black or African-American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native What language do you mainly speak at home? Chinese English Russian Spanish Vietnamese Some other language (please print) ____________________________ 18 of 38 09/16/202618 Disenrollee Survey Comparison PDP Only Question Number 66 67 2010 Version: PDP_Pilot Did someone help you complete this survey? Yes No Question 2013 Version: 2PDP Survey Number 63 Did someone help you complete this survey? Yes No If No, Go to #68 If No, Go to #65 How did that person help you? Please mark one or more. Read the questions to me Entered the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way (Please print) How did that person help you? Please mark one or more. Read the questions to me Entered the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way (please print) ____________________________ _ 64 __________________________ __ 68 The Medicare Program is trying to learn more about the health care or services provided to people with Medicare. May we contact you again about the health care services that you received? Yes No 65 The Medicare Program is trying to learn more about the health care or services provided to people with Medicare. May we contact you again about the health care services that you received? Yes No 19 of 38 09/16/202619 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to wording. Changed word order/added underlining for emphasis. Findings from the field test indicate that some beneficiaries had difficulty navigating the front end questions. We expanded the response options in question 1 to make it easier to screen out as well as identify beneficiaries who truly didn't disenroll voluntarily. 20 of 38 09/16/202620 Disenrollee Survey Comparison PDP Only Description of Change Comments Findings from the field test indicate that some beneficiaries had difficulty navigating the front end questions. We reworded question 2 and expanded the response options to make it easier to navigate this question and to better identify and screen out beneficiaries who truly didn't disenroll voluntarily. Dropped this question to improve navigation and to make it easier to screen out beneficiaries who did not disenroll voluntarily (this question was folded into the response options for question 1). Dropped this question to improve navigation and to make it easier to screen out beneficiaries who did not disenroll voluntarily (this question was folded into the response options for question 1). 21 of 38 09/16/202621 Disenrollee Survey Comparison PDP Only Description of Change Comments Dropped this question as it did not seem to include navigation of the survey. No change to wording. No change to item wording. No change to item wording. 22 of 38 09/16/202622 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. 23 of 38 09/16/202623 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to wording. No change to item wording. 24 of 38 09/16/202624 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to item wording. No change to item wording. 25 of 38 09/16/202625 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to wording. Changed wording order in the first sentence and dropped the last sentence to reduce reading burden. No change to item wording. 26 of 38 09/16/202626 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. Shortened and revised question wording to make it easier to understand based on findings from cognitive interviews (avoid using the term "premium" and instead describe what a premium is). Revised question wording to make it easier to understand based on findings from cognitive interviews. Revised question wording to make it easier to understand based on findings from cognitive interviews. 27 of 38 09/16/202627 Disenrollee Survey Comparison PDP Only Description of Change Comments Revised question wording to make it easier to understand based on findings from cognitive interviews (avoid using the word "formulary"). Dropped based on findings from field test (item with low endorsement). No change to item wording. No change to item wording. No change to item wording. 28 of 38 09/16/202628 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. Revised question wording to make it easier to understand based on findings from cognitive interviews (avoid using the word "formulary"). No change to item wording. 29 of 38 09/16/202629 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to item wording. No change to wording. New text. 30 of 38 09/16/202630 Disenrollee Survey Comparison PDP Only Description of Change Comments New Item added upon request from CMS. New Item added upon request from CMS. New Item added upon request from CMS. Dropped based on findings from field test (item with low endorsement). Dropped based on findings from field test (item with low endorsement). No change to item wording. 31 of 38 09/16/202631 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. Revised item to make it a close-ended item (created response options from open ended responses from the field test). No change to wording. 32 of 38 09/16/202632 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to item wording. 33 of 38 09/16/202633 Disenrollee Survey Comparison PDP Only Description of Change Comments Dropped the last response option added instruction to the question for clarity. No change to wording. No change to item wording. No change to item wording. Added instructions based on findings from cognitive interviews. 34 of 38 09/16/202634 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to item wording. 35 of 38 09/16/202635 Disenrollee Survey Comparison PDP Only Description of Change Comments Changed option c from "Stroke" to "Hypertension or high blood pressure." No change to item wording. No change to item wording. 36 of 38 09/16/202636 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. No change to item wording. 37 of 38 09/16/202637 Disenrollee Survey Comparison PDP Only Description of Change Comments No change to item wording. No change to item wording. No change to item wording. 38 of 38 09/16/202638