Cms-p-0015a Mcbs

Drug Coverage (RXQ)
Variable Name

MR Screen Name
BOX RX1

Question type
routing

PDXHIDEC

RX1

yes/no

PDEASY

RXPD2

code 1

Question text/description
BESIDES MEDICARE, IF TRICARE IS THE ONLY "CURRENT" PLAN, GO TO BOX RXEND.
ELSE IF THE RESPONDENT IS A PROXY, GO TO RX1 - PDXHIDEC.
ELSE GO TO RXPD2 - PDEASY.
Do you help (SP) make decisions regarding [his/her] health insurance coverage?

SHOW CARD RX1
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?

PDKNOW

RXPD3

code1

Would you say it is very easy to understand, somewhat easy, somewhat difficult, or very difficult to
understand?
SHOW CARD RX2
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?

BOX RXPD2

routing

PDCOMPPL

RXPD8A

yes/no

PDCONSDR

RXPD9

yes/no

Code list

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused
(01) JUST ABOUT EVERYTHING YOU NEED TO KNOW
(02) MOST OF WHAT YOU NEED TO KNOW
(03) SOME OF WHAT YOU NEED TO KNOW
(04) A LITTLE OF WHAT YOU NEED TO KNOW
(05) ALMOST NONE OF WHAT YOU NEED TO KNOW
(-8) Don't Know
(-9) Refused

IF SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN, GO TO BOX RXPD3A.
ELSE IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS RX COVERAGE, GO TO RXPD9 PDCONSDR.
ELSE IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO TO RXPD8A - PDCOMPPL.
ELSE GO TO RXPD20 - PDEXAPLY.
[You/(SP)] currently [have/has] drug coverage through [READ PLAN(S) LISTED ABOVE].

(01) YES
(02) NO
Did [you/(SP), or someone for (SP),] compare the (CURRENT YEAR) drug coverage offered by [READ PLAN(S) (-8) Don't Know
LISTED ABOVE] with any Medicare Prescription Drug plans?
(-9) Refused
[EXPLAIN IF NECESSARY: A Medicare Prescription Drug plan adds drug coverage to Original Medicare.]
([You/(SP)] currently [have/has] drug coverage through (CURRENT MEDICARE MANAGED CARE PLAN).
Medicare calls this type of plan a Medicare Advantage plan. Medicare also offers separate plans that
provide only drug coverage.)

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Did [you/(SP), or someone for (SP),] consider enrolling [her/him] in a separate Medicare Prescription Drug
plan for (CURRENT YEAR)?

PDMABENS

BOX RXPD3

routing

RXPD10

yes/no

BOX RXPD3A

routing

[EXPLAIN IF NECESSARY: A separate Medicare Prescription Drug plan is typically used together with
medical benefits from Original Medicare.]
IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO TO BOX RX2.
ELSE GO TO RXPD10 - PDMABENS.
Did [you/(SP), or someone for (SP),] compare the (CURRENT YEAR) drug coverage offered by [your/his/her] (01) YES
(CURRENT MEDICARE MANAGED CARE PLAN) plan with any other Medicare Advantage plans in
(02) NO
[your/his/her] area?
(-8) Don't Know
(-9) Refused
IF SP HAS REPORTED BEING AUTOMATICALLY ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN IN ANY
PREVIOUS ROUND, GO TO RXPD12 - PDAUTENR.
ELSE GO TO RXPD11 - PDEVROLL.

Drug Coverage (RXQ)
Variable Name
PDEVROLL

PDAUTENR

MR Screen Name
RXPD11

RXPD12

Question type
yes/no

yes/no

Question text/description
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?
[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?
([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.])
Before today, did you know that people who are automatically enrolled by Medicare in a Medicare
Prescription Drug plan can switch plans at any time without a penalty?

PDSWITCH

RXPD14

code 1

PDCOMPRE

RXPD15

yes/no

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?

BOX RXPD4

routing

RXPD18

list

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

PDOPTPRE

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES DID KNOW
(02) NO DID NOT KNOW
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (-9) Refused
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…
the cost of the plan's monthly premium?

PDOPTDUC

RXPD18

list

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.

(01) YES
(02) NO
(-8) Don't Know
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (-9) Refused
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…
the plan's deductible?

PDOPTFOR

RXPD18

list

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.

(01) YES
(02) NO
(-8) Don't Know
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (-9) Refused
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]
the plan's list of covered medicines, or formulary?

PDOPTVEN

RXPD18

list

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.

(01) YES
(02) NO
(-8) Don't Know
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (-9) Refused
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…
the convenience of the pharmacies that the plan allows [you(SP)] to use?

Drug Coverage (RXQ)
Variable Name
PDOPTREC

MR Screen Name
RXPD18

Question type
list

Question text/description
Code list
(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
(02) NO
(-8) Don't Know
someone's recommendation of the plan?
(-9) Refused

PDOPTGAP

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
(02) NO
(-8) Don't Know
the gap in coverage or "donut hole"?
(-9) Refused

PDOPTPAY

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
(02) NO
(-8) Don't Know
the dollar amount [you/(SP)] would pay for prescribed medicines [you use/he uses/she uses]?
(-9) Refused

BOX RXPD4A

routing

PDOPMOST

RXPD18A

code 1

IF RESPONDENT ANSWERED "YES" TO MORE THAN ONE QUESTION AT RXPD18, GO TO RXPD18A PDOPMOST.
ELSE GO TO RXPD18B - PDRECLIS.
Which of these was the most important consideration when [you or (SP)]/you] thought about [your/(SP's)] (01) THE COST OF THE PLANS MONTHLY PREMIUM
options for (CURRENT YEAR) prescription drug coverage?
(02) THE PLAN'S DEDUCTIBLE
(03) THE PLAN'S LIST OF MEDICINES OR FORMULARY
[READ ITEMS BELOW IF NECESSARY.]
(04) CONVENIENCE OF THE PHARMACIES THAT THE
PLAN ALLOWS (SP) TO USE
(05) SOMEONE'S RECOMMENDATION OF THE PLAN
(06) THE GAP IN COVERAGE OR DONUT HOLE
(07) THE DOLLAR AMOUNT (SP) WOULD PAY FOR
PRESCRIBED MEDICINES
(-8) Don't Know
(-9) Refused

PDRECLIS

RXPD18B

yes/no

PDEXAPLY

RXPD20

yes/no

PDEXACCP

RXPD21

code 1

BOX RX2

routing

As you may know, the government has programs that help beneficiaries pay for the costs associated with a (01) YES
Medicare drug plan and the purchase of prescription drugs. The help provided is referred to as a "low(02) NO
income subsidy" or "extra help".
(-8) Don't Know
(-9) Refused
[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 coinsurance and copayments
for prescription drugs, and have no coverage gap.]
Did [you/(SP)] apply to the Social Security Administration for extra help with (CURRENT YEAR) drug
(01) YES
coverage?
(02) NO
(-8) Don't Know
(-9) Refused
Was [your/(SP's)] application for extra help accepted or denied?
(01) ACCEPTED
(02) DENIED
(03) STILL PENDING/NO DECISION YET
(-8) Don't Know
(-9) Refused
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.
ELSE GO TO RX19 - PDNTENR.

Drug Coverage (RXQ)
Variable Name
RXINTRO

MR Screen Name
RXINTRO

Question type
no entry

BOX RX3

routing

PDSATSFY

RXPD23A

code 1

PDCONFID

RX2

code 1

RXUSEPLN

RX3

yes/no

RXCOSTLY

RX4

code 1

RXAMNTLY

RX5

code 1

PDNOCVG

RX7

yes/no

RXCHGMED

RX8

yes/no

RXSWTCH

RX9

yes/no

RXPARTIC

RX16

code 1

Question text/description
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)].
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.
ELSE GO TO RX2 - PDCONFID.
SHOW CARD RX3
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through ([CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], how satisfied were you with the
information that you had to make that decision?

Code list
(01) CONTINUE
(-7) Empty

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(-8) Don't Know
(-9) Refused
SHOW CARD RX4
(01) Extremely confident,
How confident are you that [you now have/(SP) now has] the drug coverage that best meets [your/his/her] (02) Very confident,
needs? Would you say you are…
(03) Moderately confident,
(04) Slightly confident, or
(05) Not confident?
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] used [your/his/her] [(CURRENT MEDICARE MANAGED CARE PLAN) drug/(CURRENT
(01) YES
MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage when (02) NO
purchasing medicines since January 1 of this year?
(-8) Don't Know
(-9) Refused
Compared to last year, is the cost of the monthly premium for [your/(SP's)] [(CURRENT MEDICARE
(01) MORE THAN LAST YEAR
MANAGED CARE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT PRIVATE (02) LESS THAN LAST YEAR
PLAN NAMES WITH RX)] coverage more, less, or the same?
(03) THE SAME AS LAST YEAR
(04) NO DRUG COVERAGE PREMIUM LAST YEAR
(-8) Don't Know
(-9) Refused
Are the amounts that [you pay/(SP) pays] for medicines at the pharmacy using [your/his/her] [(CURRENT
(01) MORE THAN LAST YEAR
MEDICARE MANAGED CARE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT
(02) LESS THAN LAST YEAR
PRIVATE PLAN NAMES WITH RX)] coverage more, less, or the same compared to what [you/he/she] paid
(03) THE SAME AS LAST YEAR
last year?
(04) NO COST FOR RX LAST YEAR
(-8) Don't Know
(-9) Refused
Are there any prescribed medicines that [you regularly take/(SP) regularly takes] that are not covered by
(01) YES
(your/his/her) (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN) drug/(CURRENT MEDICARE (02) NO
PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] had to change any of [your/his/her] prescribed medicines from a brand name to a
(01) YES
generic medicine because of [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN) (02) NO
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
(-8) Don't Know
coverage?
(-9) Refused
[Have you/Has (SP)] had to switch to a different medication because a drug [you/he/she] needed was not (01) YES
available through [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
(02) NO
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
(-8) Don't Know
coverage?
(-9) Refused
Does the [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG
(01) YES
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] drug plan network include the pharmacy that [you
(02) NO
generally prefer/(SP) generally prefers] to use?
(-8) Don't Know
(-9) Refused

Drug Coverage (RXQ)
Variable Name
PDRXRATE

MR Screen Name
RX17

Question type
code 1

PDNOUSE

RX18

code all

PDNOOTHOS
PDNTENR

RX18
RX19

verbatim text
code all

PDNTOTHOS

RX19
BOX RXEND

verbatim text
routing

Question text/description
SHOW CARD RX3
Overall, how satisfied are you with [your/(SP's)] drug plan through [(CURRENT MEDICARE MANAGED CARE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]?

Code list
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(-8) Don't Know
(-9) Refused
Why [haven't you/hasn't (SP)] used [your/his/her] [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT (01) HAVE NOT PURCHASED MEDICINE
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage in (CURRENT (02) DON'T HAVE CARD OR OTHER ENROLLMENT
YEAR)?
VERIFICATION/NOT ABLE DUE TO PLAN PROBLEM
CHECK ALL THAT APPLY.
(03) PHARMACY WOULDN'T GIVE MEDICINE
(04) COST OF RX TOO HIGH/EXPENSIVE
(05) DRUG(S) NEEDED NOT COVERED BY PLAN
(91) OTHER
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) [Continuous answer.]
You said that [you are/(SP) is] not enrolled in a Medicare Prescription Drug plan. What is the reason [you
(01) HAVE RX COVERAGE THROUGH A NON-PDP
are/he is/she is] not enrolled in such a plan?
PLAN/SOURCE
CHECK ALL THAT APPLY.
(02) DON'T TAKE ENOUGH PRESCRIPTIONS TO NEED
IT
(03) PLANS DON'T COVER PRESCRIPTIONS SP TAKES
(04) DON'T KNOW HOW TO ENROLL
(05) DON'T KNOW ENOUGH ABOUT PLANS
(06) TOO EXPENSIVE OR CAN'T AFFORD
(07) TOO CONFUSING OR TOO COMPLICATED
(08) TOO MANY PLANS TO CHOOSE FROM OR CAN'T
DECIDE ON ONE PLAN
(09) WON'T BENEFIT OR WON'T SAVE MONEY
(10) HAD A PDP, DIDN'T LIKE IT OR WASN'T USEFUL
(11) SP BUYS MEDICINE OUTSIDE OF THE U.S.
(91) OTHER REASON
(-8) Don't Know
(-9) Refused
OTHER REASON (SPECIFY)
(01) [Continuous answer.]
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