Form CMS-10615 Alternate Policy Survey Question

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Health Coverage Cost and Payment Options

We are studying ways to meet people’s health care needs, and would like your thoughts about some possible health plan choices.

Health plans work in different ways and people pay for their health care services differently. Some people pay monthly contributions or copays, and some pay both.

1. If you could choose, how would you like to pay for your health care services?

1. I would like to pay copays at my health care visits

2. I would like to make monthly or annual contributions

3. I would like to make a combination of monthly or annual contributions and copays

4. It does not matter to me

When you answer the following questions we would like you to think about a time when you need to choose your benefits package and what choices are important for you. Please keep in mind that these questions are not based on your current plan and will not affect your benefits package. Below we show two possible health plan choices, Health Plan A and Health Plan B.

In Health Plan A:

1. You have monthly contributions and no copays

2. If you miss a monthly contribution your coverage will end for six months

In Health Plan B:

1. You have monthly contributions and some copays

2. If you miss a monthly contribution your coverage will end for three months

2. If you had to choose between Health Plans A and B, which one would you choose?

1. I would choose Health Plan A

2. I would choose Health Plan B

3. I am not sure

3. What factor was the most important to you in choosing between Health Plan A and Health Plan B? Mark only one.

1. The cost of monthly contributions

2. The cost of copays

3. The length of time I would have no coverage if I missed a monthly contribution

4. How likely would you be to enroll in Health Plan A?

1. Very likely

2. Somewhat likely

3. Not likely

5. How likely would you be to enroll in Health Plan B?

1. Very likely

2. Somewhat likely

3. Not likely

Some people can choose their health plans and how they pay for their health care services. We are interested in your thoughts on how much choice you would like.

6. In general, do you like having a choice between health plans?

1. No, I do not like having a choice

2. Yes, I like having a choice

3. Having a choice does not matter to me

Alternate Policy Survey Questions 3