Plan Report Sample

Attachment IX Plan Report Sample.pdf

Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)

Plan Report Sample

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Attachment IX Plan Report Sample

2015 Medicare Advantage Health and Drug Plan
Disenrollment Reasons Survey Results
Report for: HMO ABC (HXXXX)
Issued August 2016
By the Centers for Medicare & Medicaid Services

Contents
Part 1: Highlights of the Report ................................................................................................................... 1
Overview .................................................................................................................................................. 2
How This Report Is Organized ............................................................................................................. 2
How Scores Are Compared .................................................................................................................. 2
How to Use This Report ....................................................................................................................... 3
Summary Tables .......................................................................................................................................... 3
Disenrollment Rate .............................................................................................................................. 3
Characteristics of Enrollees and Rates of Disenrollment for Beneficiaries with Certain
Characteristics...................................................................................................................................... 4
Reasons for Disenrollment .................................................................................................................. 4
Part 2: Detailed Results............................................................................................................................. 8
Financial Reasons for Disenrollment (Composite) .................................................................................. 9
Financial Reasons: Monthly Premium Went Up ............................................................................... 10
Financial Reasons: Prescription Co-Payment Went Up .................................................................... 11
Financial Reasons: Found a Plan That Costs Less .............................................................................. 12
Financial Reasons: Could No Longer Afford the Plan ........................................................................ 13
Problems with Prescription Drug Benefits and Coverage (Composite) ................................................ 14
Problems with Prescription Drug Benefits and Coverage: Change in Drug Formulary .................... 15
Problems with Prescription Drug Benefits and Coverage: Refusal to Pay for a Prescribed
Medication ......................................................................................................................................... 16
Problems with Prescription Drug Benefits and Coverage: Getting Prescribed Medications ........... 17
Problems with Prescription Drug Benefits and Coverage: Getting Brand Name Medications ........ 18
Problems with Prescription Drug Benefits and Coverage: Approval Process for Off-Formulary
Medications ....................................................................................................................................... 19
Problems Getting Information about Prescription Drugs (Composite) ................................................ 20
Problems Getting Information about Prescription Drugs: Did Not Know Whom to Contact about
Filling a Prescription ........................................................................................................................... 21
Problems Getting Information about Prescription Drugs: Coverage and Cost of Prescription
Medications ....................................................................................................................................... 22
Problems Getting Information about Prescription Drugs: Handling of a Question or Complaint ...23

Problems Getting Information about Prescription Drugs: Getting Needed Information or
Assistance........................................................................................................................................... 24
Problems Getting Information about Prescription Drugs: Customer Service Staff .......................... 25
Problems Getting Needed Care, Coverage, and Cost Information (Composite).................................. 26
Problems Getting Needed Care, Coverage, and Cost Information: Approval for Care, Tests, or
Treatment .......................................................................................................................................... 27
Problems Getting Needed Care, Coverage, and Cost Information: Getting Needed Care, Tests,
or Treatment ...................................................................................................................................... 28
Problems Getting Needed Care, Coverage, and Cost Information: Difficulty Getting Claims Paid..29
Problems Getting Needed Care, Coverage, and Cost Information: Getting Information about
Coverage and Cost of Health Services ............................................................................................... 30
Problems with Coverage of Doctors and Hospitals (Composite).......................................................... 31
Problems with Coverage of Doctors and Hospitals: Preferred Provider Not Covered by Plan ........ 32
Problems with Coverage of Doctors and Hospitals: Preferred Clinic or Hospital Not Covered
by Plan ................................................................................................................................................ 33
Single Item: Co-Payment for Doctor Visit Went Up ............................................................................ 34
Single Item: Low Medicare Star Rating ................................................................................................. 35
Single Item: Found Plan with a Higher Medicare Star Rating ............................................................. 36
Single Item: Family Member or Friend Recommended Another Plan ................................................. 37
Single Item: Saw Commercial or Advertisement for Another Plan ..................................................... 38
Single Item: Another Plan Better Met Prescription Needs................................................................... 39
Single Item: Another Plan Offered Better Benefits or Coverage of Health Services............................ 40
Appendix 1: Background and Methodology.............................................................................................. 41
Background ......................................................................................................................................... 42
Methodology .......................................................................................................................................... 42
The Survey Instrument ...................................................................................................................... 42
Calculation of Composite Means....................................................................................................... 46
Reporting of Composite Means on the Medicare Plan Finder……………………………………………………..47
Sample Selection and Eligibility Criteria ............................................................................................ 48
Survey Implementation ..................................................................................................................... 48
Sample Disposition ............................................................................................................................ 49

Weighting and Case-Mix Adjustment ............................................................................................. 49
Significance Testing............................................................................................................................ 51
Assessing Reliability of Scores ........................................................................................................... 52
Comparison of Reasons for Disenrollment: January-November versus December Disenrollees…..52
State or Regional Comparisons ......................................................................................................... 55
Contact Information ....................................................................................................................... 55
Appendix 2: Frequency Tables ................................................................................................................... 56

Part 1: Highlights of the Report

Overview
This report contains results for your contract HXXXX from the 2015 Medicare Advantage and Prescription
Drug Plan Disenrollment Reasons Survey, a Centers for Medicare & Medicaid Services-sponsored survey
that assesses the reasons for disenrollment among Medicare beneficiaries who have voluntarily
disenrolled from their Part C and Part D contracts. The survey period covers disenrollment that occurred
between January and December 2015. Although beneficiaries provide ratings of their “plans,” the unit of
analysis is not a health and/or prescription drug plan but rather a health and/or prescription drug plan
contract. When considered in conjunction with disenrollment rates, beneficiaries' responses to the survey
provide information about the quality of a contract as it is experienced by beneficiaries who have chosen
to disenroll from the contract. Currently, detailed results from the 2015 survey are being shared with plans
to facilitate quality improvement efforts; CMS plans to display scores for the composite measures on the
Part C and D Measure Display Page.

How This Report Is Organized
The remainder of this "highlights" section explains the benchmarks included for comparison and shows
your plan’s performance on disenrollment rates, several composite (summary) measures of reasons for
disenrollment derived from the survey, and individual items from the survey.
Part 2 of the report presents detailed results, including your plan’s performance on both composite
measures of reasons for disenrollment and on individual survey questions, showing both national and
state benchmarks. Appendix 1 of the report provides information about the survey and its contents and
describes sample selection and other methodological topics. Appendix 2 of the report contains frequency
tables that display unadjusted (i.e., not adjusted for case-mix) responses to all survey questions.

How Scores Are Compared
Your contract's disenrollment rate, mean scores on the composite measures of reasons for disenrollment,
and results on individual survey questions underlying the composite measures are each compared to the
national average for all MA plans. Each composite measure score is tested against the national average
for that composite measure, and a note in the margin of Table 1.3 shows whether the difference is
statistically significant. Table 1.4 provides results, including comparisons with the national average, for
individual survey items about reasons for disenrollment. In the detailed results provided in Part 2, a state
or regional average is also provided as a basis for comparison; because of a lack of statistical power,
however, statistical tests of the difference between your contract and the state or regional average were
not performed.

How to Use This Report
MA-PD plans can use the information in this report to identify program strengths and opportunities for
improvement. Comparing the reasons that beneficiaries give for voluntarily leaving your contract with the
reasons beneficiaries give for leaving MA contracts nationally may provide some insight on your contract's
strengths and weaknesses.

Summary Tables
Disenrollment Rate – Table 1.1 shows the rate of voluntary disenrollment from your contract for
calendar year 2015 (January 2015 to December 2015) as a percentage of your contract’s total enrollment.
Information on disenrollment comes from patient-level disenrollment files maintained by the Centers for
Medicare & Medicaid Services. Voluntary disenrollment refers to a beneficiary either dropping coverage
entirely or switching to another contract for coverage. Excluded from this calculation are beneficiaries
who involuntarily disenrolled from your contract because they were no longer eligible for coverage,
moved out of your contract’s service area, switched benefits packages within your contract, were
involuntarily re-assigned or passively enrolled in a Medicare-Medicaid Plan, or died. The table also shows
the national average rate of voluntary disenrollment for MA contracts in 2015, whether the difference
between your contract’s rate of voluntary disenrollment in 2015 and the national average rate of
disenrollment was statistically (p < .05) and practically (at least one percentage point) significant, and your
contract’s voluntary disenrollment rate in 2014.
Table 1.1

Beneficiaries may disenroll from their Medicare health or prescription drug plans at different times of the
year. The majority of beneficiaries who disenroll do so in the month of December as part of the annual
Medicare Open Enrollment period.1 Beneficiaries may switch plans outside the Open Enrollment Period
under special circumstances, such as if they move out of the plan’s service area, are dually eligible for
Medicare and Medicaid, qualify for the Low Income Subsidy, qualify for membership in a Special Needs
Plan, or enroll in a plan with a 5-star rating. In 2015, the percent of all disenrollees from MA plans who
disenrolled in December was 50.2% whereas the percent of disenrollees from your contract who
disenrolled in December was 19.1%. Appendix 1 of this report shows how December disenrollees,
1

The Medicare Open Enrollment Period is from October 15th through December 7th annually, but disenrollments that occur
within the Open Enrollment Period are not effective until December.

nationally, compare with those who disenroll during other times of the year in terms of their reasons for
disenrollment.
Characteristics of Enrollees and Rates of Disenrollment for Beneficiaries with Certain Characteristics –
The first two columns in Table 1.2 provide information about the characteristics of beneficiaries in your
contract and how they compare to the characteristics of MA beneficiaries nationally. The second two
columns show the disenrollment rate for beneficiaries in your contract with certain characteristics and
how those disenrollment rates compare with rates observed nationally among beneficiaries with the
same characteristics.
Table 1.2

Note: The voluntary disenrollment rate for “ALL Beneficiaries” (row 1) is calculated according to the
Medicare 2017 Part C & D Star Rating Technical Notes for “Members Choosing to Leave the Plan.” For
the voluntary disenrollment rates for the subgroup categories (rows 2-6), we were unable to apply all
of the same exclusions and therefore these rates may appear slightly higher or lower than the rates for
“ALL Beneficiaries.”

Reasons for Disenrollment – Responses to individual survey questions were combined to form five
composite (summary) measures of reasons for disenrollment. For each composite measure, Table 1.3
shows your contract’s mean on a 0-100 scale, the national average for all MA contracts, and whether your
contract’s mean was significantly different from or not significantly different from the national average.
The mean score for your contract is the average percentage of reasons endorsed in a composite
multiplied by 100. See Appendix 1: Background and Methodology section of this report (p. 46) for an
example of how composite means are calculated. A lower mean on a measure indicates that fewer
disenrollees from your contract cited reasons included in the composite as a cause of their disenrollment.
Your contract's results on the individual survey questions that are included in each composite, as well as
4

on other survey questions about reasons for disenrollment that are not included in a composite, are listed
in Table 1.4. Your contract’s score on an individual survey question is simply the percentage of survey
respondents who endorsed the reason as a cause of their disenrollment.
Table 1.3 Composite Measures

Reasons for Disenrollment
Financial Reasons
Problems with Prescription Drug Benefits and Coverage
Problems Getting Information about Prescription Drugs
Problems Getting Needed Care, Coverage, and Cost
Information
Problems with Coverage of Doctors and Hospitals

Your
Contract
13.6
16.4
33.3

Significantly
National Different from the
Average National Average?
26.5
Yes (Lower)
13.0
No
13.4
Yes (Higher)

43.1

19.4

Yes (Higher)

48.4

27.8

Yes (Higher)

Note: Scores in bold have adequate reliability (0.70 or higher). Scores that are not in bold have low reliability
(below 0.70). N/A means too few disenrollees answered the questions that make up the composite to permit
reporting. For information on how we tested for statistical significance, assessed reliability, and adjusted for
case-mix, see Appendix 1 of this report, pp. 49-52.

Table 1.4 Individual Items

Reasons for Disenrollment
Financial Reasons:
Monthly premium went up
Prescription co-payment went up
Found a plan that costs less
Could no longer afford plan
Problems with Prescription Drug Benefits and
Coverage:
Change in drug formulary
Plan refused to pay for a prescribed medication
Problems getting prescribed medication
Difficult to get brand name medications
Frustrating approval process for off-formulary
medications
Problems Getting Information about Prescription Drugs
Did not know whom to contact about filling a
prescription
Hard to get information about coverage and cost of
prescription drugs
Unhappy with how the plan handled a question or
complaint
Could not get information or help needed from the
plan
Customer service not courteous or respectful

Problems getting Needed Care, Coverage and Cost
Information
Frustration with approval process for care, tests, or
treatment
Problems getting needed care, tests, or treatment
Problems getting claims paid
Hard to get information about coverage and cost of
health services

Your
Contract

Significantly
National Different from the
Average National Average?

12.3%
7.4%
26.3%
8.4%

24.5%
19.2%
43.0%
19.2%

Yes (Lower)
Yes (Lower)
Yes (Lower)
Yes (Lower)

14.6%
13.8%
19.4%
10.7%

11.5%
13.7%
13.2%
11.0%

No
No
No
No

23.9%

15.6%

9.9%

7.2%

10.2%

11.0%

57.1%

19.9%

Yes (Higher)

54.8%

21.2%

Yes (Higher)

34.4%

8.0%

Yes (Higher)

58.4%

25.3%

Yes (Higher)

60.7%
16.9%

24.3%
13.3%

Yes (Higher)
No

36.4%

14.6%

Yes (Higher)

Individual Survey Items (cont.)

Reasons for Disenrollment
Problems with Coverage of Doctors and Hospitals
Preferred provider not in plan
Preferred clinic or hospital not covered by plan

Single Items (not in a composite)
Co-Payment for doctor visit went up
Low Medicare star rating
Found a plan with a higher Medicare star rating
Family member or friend recommended another plan
Saw commercial or advertisement for another plan that
looked better
Another plan better met prescription needs
Another plan offered better benefits or coverage of
health services

Your
Contract

Significantly
National Different from the
Average National Average?

55.3%
41.4%

32.9%
22.8%

Yes (Higher)
Yes (Higher)

7.2%
3.6%
13.9%
32.2%

18.6%
4.3%
14.4%
27.3%

Yes (Lower)
No
No
No

14.8%

18.1%

47.7%

33.6%

38.8%

45.2%

Note: N/A means too few disenrollees answered the question to permit reporting. For information on how we
tested for statistical significance and adjusted for case-mix, see Appendix 1 of this report, pp. 49-51.

Part 2: Detailed Results
In the following pages, we provide detailed results of the 2015 Medicare Advantage and Prescription Drug
Plan Disenrollment Reasons Survey, including your contract’s performance on the individual survey
questions that make up each of the composite measures and other individual survey questions that may
be of interest. Please note that there may be apparent discrepancies in the individual survey item
percentages shown based on proper application of the rounding rules. For example, a value of 19.46%
would get rounded to 19 in the bar chart (integer value), but would get rounded to 19.5 for the onedecimal value.

Financial Reasons for Disenrollment (Composite)
This figure below shows how your contract performed on the measure “Financial Reasons for
Disenrollment,” a composite of survey questions 20, 22, 24, and 25. Each of these questions asked
about a reason for disenrollment that was related to the cost or affordability of services. The figure
shows the number of disenrollees from your contract who answered at least one of these questions
and the percentage of those disenrollees who endorsed 0, 1, or 2 or more of the reasons as a cause of
their disenrollment. The figure also shows your contract’s mean on the composite (the average
percentage of reasons endorsed in the composite multiplied by 100) and whether the mean was
higher or lower than the national average for all MA contracts. A lower mean indicates that financial
reasons were endorsed less frequently by disenrollees from your contract. If the mean for your
contract appears in bold, it signifies that the mean has adequate reliability (0.70 or above in a 0 to 1.0
range). Mean scores not appearing in bold have low reliability (below 0.70). N/A signifies that too few
disenrollees answered the questions to permit reporting. Results for the individual survey questions
that this composite measure comprises are on the following pages.
Financial Reasons for Disenrollment

Note: N/A means too few disenrollees answered the questions to permit reporting. Percentages may not add
to 100 due to rounding. The mean score is calculated as the average percentage of reasons endorsed in this
composite (0 to 100 scale). Contract means appearing in bold have adequate reliability (0.70 or above). For
information on how we tested for statistical significance, assessed reliability, and adjusted for case-mix, see
Appendix 1 of this report, pp. 49-52.

Financial Reasons: Monthly Premium Went Up
Question 20: Did you leave the plan because the monthly fee that the health plan charges to provide
coverage for health care and prescription medicines went up?
Disenrolled Because Monthly Premium Went Up

Note: N/A means too few disenrollees answered the question to permit reporting. For information on how we
tested for statistical significance, and adjusted for case-mix, see Appendix 1 of this report, pp. 49-51.

Financial Reasons: Prescription Co-Payment Went Up
Question 22: Did you leave the plan because the dollar amount you had to pay each time you filled or
refilled a prescription went up?
Disenrolled Because Prescription Co-Payment Went Up

Financial Reasons: Found a Plan That Costs Less
Question 24: Did you leave the plan because you found a health plan that costs less?
Disenrolled Because Found a Plan that Costs Less

Financial Reasons: Could No Longer Afford the Plan
Question 25: Did you leave the plan because a change in your personal finances meant you could no
longer afford the plan?
Disenrolled Because Could No Longer Afford the Plan

Problems with Prescription Drug Benefits and Coverage (Composite)
The figure below shows how your contract performed on the measure “Problems with Prescription
Drug Benefits and Coverage,” a composite of survey questions 21, 26, 27, 28, and 29. Each of these
questions asked about a reason for disenrollment that was related to prescription drug benefits and
coverage. The figure shows the number of disenrollees from your contract who answered at least one
of these questions and the percentage of those disenrollees who endorsed 0, 1, or 2 or more of the
reasons as a cause of their disenrollment. The figure also shows your contract’s mean on the
composite (the average percentage of reasons endorsed in the composite multiplied by 100) and
whether the mean was higher or lower than the national average for all MA contracts. A lower mean
indicates that problems with prescription drug benefits and coverage were cited less frequently by
disenrollees from your contract. If the mean for your contract appears in bold, it signifies that the
mean has adequate reliability (0.70 or above in a 0 to 1.0 range). Means not appearing in bold have
low reliability (below 0.70). N/A signifies that too few disenrollees answered the question to permit
reporting. Results for the individual survey questions that this composite measure comprises are on
the following pages.
Problems with Prescription Drug Benefits and Coverage

Problems with Prescription Drug Benefits and Coverage: Change in Drug Formulary
Question 21: Did you leave the plan because they changed the list of prescription medicines they
cover?
Disenrolled Because of Change in Drug Formulary

Problems with Prescription Drug Benefits and Coverage: Refusal to Pay for a
Prescribed Medication
Question 26: Did you leave the plan because the plan refused to pay for a medicine your doctor
prescribed?
Disenrolled Because Plan Refused to Pay for a Prescribed Medication

Problems with Prescription Drug Benefits and Coverage: Getting Prescribed
Medications
Question 27: Did you leave the plan because you had problems getting the medicines your doctor
prescribed?
Disenrolled Because of Problems Getting Prescribed Medications

Problems with Prescription Drug Benefits and Coverage: Getting Brand Name
Medications
Question 28: Did you leave the plan because it was difficult to get brand name medicines?
Disenrolled Because It Was Difficult to Get Brand Name Medications

Problems with Prescription Drug Benefits and Coverage: Approval Process for OffFormulary Medications
Question 29: 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?
Disenrolled Because of Frustrating Approval Process for Off-Formulary Medications

Problems Getting Information about Prescription Drugs (Composite)
The figure below shows how your contract performed on the measure “Problems Getting Information
about Prescription Drugs,” a composite of survey questions 30, 31, 38, 39, and 40. Each of these
questions asked about a reason for disenrollment that was related to the beneficiary’s experiences
with getting information about prescription drugs. The figure shows the number of disenrollees from
your contract who answered at least one of these questions and the percentage of those disenrollees
who endorsed 0, 1, or 2 or more of the reasons as a cause of their disenrollment. The figure also
shows your contract’s mean on the composite (the average percentage of reasons endorsed in the
composite multiplied by 100) and whether the mean was higher or lower than the national average
for all MA contracts. A lower mean indicates that problems getting information about prescription
drugs were cited less frequently by disenrollees from your contract. If the mean for your contract
appears in bold, it signifies that the mean has adequate reliability (0.70 or above in a 0 to 1.0 range).
Means not appearing in bold have low reliability (below 0.70). N/A signifies that too few disenrollees
answered the question to permit reporting. Results for the individual survey questions that this
composite measure comprises are on the following pages.
Problems Getting Information about Prescription Drugs

Problems Getting Information about Prescription Drugs: Did Not Know Whom to
Contact about Filling a Prescription
Question 30: Did you leave the plan because you did not know whom to contact when you had a
problem filling or refilling a prescription?
Disenrolled Because Did Not Know Whom to Contact about Filling a Prescription

Problems Getting Information about Prescription Drugs: Coverage and Cost of
Prescription Medications
Question 31: 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?
Disenrolled Because It Was Hard to Get Information about Coverage and Cost of
Prescription Drugs

Problems Getting Information about Prescription Drugs: Handling of a Question or
Complaint
Question 38: Did you leave the plan because you were unhappy with how the plan handled a question
or complaint?
Disenrolled Because Unhappy with How the Plan Handled a Question or Complaint

Problems Getting Information about Prescription Drugs: Getting Needed Information
or Assistance
Question 39: Did you leave the plan because you could not get the information or help you needed
from the plan?
Disenrolled Because Could Not Get Information or Help Needed from the Plan

Problems Getting Information about Prescription Drugs: Customer Service Staff
Question 40: Did you leave the plan because their customer service staff did not treat you with
courtesy and respect?
Disenrolled Because Customer Service Not Courteous or Respectful

Problems Getting Needed Care, Coverage, and Cost Information (Composite)
The figure below shows how your contract performed on the measure “Problems Getting Needed
Care, Coverage, and Cost Information,” a composite of survey questions 32, 33, 34, and 37. Each of
these questions asked about a reason for disenrollment that was related to the beneficiary’s
experiences with getting needed health care services and cost information and getting claims paid for
these services. The figure shows the number of disenrollees from your contract who answered at least
one of these questions and the percentage of those disenrollees who endorsed 0, 1, or 2 or more of
the reasons as a cause of their disenrollment. The figure also shows your contract’s mean on the
composite (the average percentage of reasons endorsed in the composite multiplied by 100) and
whether the mean was higher or lower than the national average for all MA contracts. A lower mean
indicates that problems getting needed care, coverage, and cost information were cited less
frequently by disenrollees from your contract. If the mean for your contract appears in bold, it
signifies that the mean has adequate reliability (0.70 or above in a 0 to 1.0 range). Means not
appearing in bold have low reliability (below 0.70). N/A signifies too few disenrollees answered the
question to permit reporting. Results for the individual survey questions that this composite measure
comprises are on the following pages.
Problems Getting Needed Care, Coverage, and Cost Information

Problems Getting Needed Care, Coverage, and Cost Information: Approval for Care,
Tests, or Treatment
Question 32: Did you leave the plan because you were frustrated by the plan’s approval process for
care, tests, or treatment?
Disenrolled Because of Frustration with Approval Process for Care, Tests, or Treatment

Problems Getting Needed Care, Coverage, and Cost Information: Getting Needed Care,
Tests, or Treatment
Question 33: Did you leave the plan because you had problems getting the care, tests, or treatment
you needed?
Disenrolled Because of Problems Getting Needed Care, Tests, or Treatment

Problems Getting Needed Care, Coverage, and Cost Information: Difficulty Getting
Claims Paid
Question 34: Did you leave the plan because you had problems getting the plan to pay a claim?
Disenrolled Because of Difficulty Getting Claims Paid

Problems Getting Needed Care, Coverage, and Cost Information: Getting Information
about Coverage and Cost of Health Services
Question 37: Did you leave the plan because it was hard to get information from the plan – like which
health care services were covered or how much a specific test or treatment would cost?
Disenrolled Because of Difficulty Getting Information about Coverage and Cost of Health Services

Problems with Coverage of Doctors and Hospitals (Composite)
The figure below shows how your contract performed on the measure “Problems with Coverage of
Doctors and Hospitals,” a composite of survey questions 35 and 36. Each of these questions asked
about a reason for disenrollment that was related to the coverage of doctors and hospitals by the
plan. The figure shows the number of disenrollees from your contract who answered at least one of
these questions and the percentage of those disenrollees who endorsed 0, 1, or both of the reasons as
a cause of their disenrollment. The figure also shows your contract’s mean on the composite (the
average percentage of reasons endorsed in the composite multiplied by 100) and whether the mean
was higher or lower than the national average for all MA contracts. A lower mean indicates that
problems with coverage of doctors and hospitals were cited less frequently by disenrollees from your
contract. If the mean for your contract appears in bold, it signifies that the mean has adequate
reliability (0.70 or above in a 0 to 1.0 range). Means not appearing in bold have low reliability (below
0.70). N/A signifies that too few disenrollees answered the question to permit reporting. Results for
the individual survey questions that this composite measure comprises are on the following pages.
Problems with Coverage of Doctors and Hospitals

Problems with Coverage of Doctors and Hospitals: Preferred Provider Not Covered by
Plan
Question 35: Did you leave the plan because the doctors or other health care providers you wanted to
see did not belong to the plan?
Disenrolled Because Preferred Provider Not in Plan

Problems with Coverage of Doctors and Hospitals: Preferred Clinic or Hospital Not
Covered by Plan
Question 36: Did you leave the plan because clinics or hospitals that you wanted to go to for care were
not covered by the plan?
Disenrolled Because Preferred Clinic or Hospital Not Covered by Plan

Single Item: Co-Payment for Doctor Visit Went Up
(Not included in a composite)
Question 23: Did you leave the plan because the dollar amount you had to pay each time you visited a
doctor went up?
Disenrolled Because Co-Payment for Doctor Visit Went Up

Single Item: Low Medicare Star Rating
(Not included in a composite)
Question 41: Did you leave the plan because it got a low Medicare Star Rating?
Disenrolled Because of Low Medicare Star Rating

Single Item: Found Plan with a Higher Medicare Star Rating
(Not included in a composite)
Question 42: Did you leave the plan because you found another plan with a higher Medicare Star Rating?
Disenrolled Because Found a Plan with a Higher Medicare Star Rating

Single Item: Family Member or Friend Recommended Another Plan
(Not included in a composite)
Question 44: Did you leave the plan because a family member or friend told you that another health
plan was a better plan?
Disenrolled Because Family Member or Friend Recommended Another Plan

Single Item: Saw Commercial or Advertisement for Another Plan
(Not included in a composite)
Question 45: Did you leave the plan because you saw a commercial or advertisement for a health
plan you thought you would like better?
Disenrolled Because Saw Commercial or Advertisement for Another Plan

Single Item: Another Plan Better Met Prescription Needs
(Not included in a composite)
Question 46: Did you leave the plan because you found another plan that better met your prescription
needs?
Disenrolled Because Another Plan Better Met Prescription Needs

Single Item: Another Plan Offered Better Benefits or Coverage of Health Services
(Not included in a composite)
Question 47: Did you leave the plan because another plan offered better benefits or coverage for
some type of care, treatment or services (for example, dental or vision care)?

Appendix 1: Background and Methodology

Background
Since 2000, CMS has been collecting information on beneficiaries’ experiences with health care for
Medicare managed care and traditional fee-for-service (FFS) Medicare through the Medicare Consumer
Assessment of Healthcare Plans and Systems (MCAHPS) survey. In 2007, a new section was added to the
survey to assess prescription drug plans under the new Medicare Part D benefit, including both MA-PDs
and PDPs.
In 2012, CMS launched the Medicare Advantage and Prescription Drug Plan Disenrollment Reasons
Survey, which is designed to capture the reasons Medicare beneficiaries voluntarily disenroll from
their Part C and Part D contracts. The survey excludes beneficiaries who involuntarily disenrolled from
contracts for eligibility reasons, moved out of their contract’s service area, or died. Voluntary
disenrollment occurs when a beneficiary either drops coverage entirely or switches to another
contract for coverage.
The survey was tested extensively in a full national implementation conducted between November
2010 and July 2011. Based on experience with this pilot implementation, refinements in sampling,
question wording, and administration mode were made for the surveys that were fielded between
January and December 2015.

Methodology
The Survey Instrument
The Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey includes three
versions, directed respectively at disenrollees in three different types of plans:
•
•
•

Medicare Advantage-only (MA-Only) plans
Medicare Advantage Health and Drug (MA-PD) plans
Medicare Prescription Drug Plans (PDPs)

The MA-PD Survey contains 69 questions, organized into the following sections:
• Your Former Health Plan (2 questions)
• Getting Information or Help from Your Former Health Plan (6 questions)
• Getting Health Care and the Prescription Medicines You Needed from Your Former Health
Plan (9 questions)
• Reasons You Left Your Former Health Plan (26 questions)
• Other Reasons for Leaving Your Former Health Plan (4 questions)
• Your Experience with Insurance Agents, Brokers or Plan Representatives (5 questions)
• About You (17 questions)
A copy of the Medicare Advantage Health and Drug Plan Disenrollment Reasons Survey instrument is
included on the CD along with this report.
42

Some of the questions on the Medicare Advantage Health and Drug Plan Disenrollment Reasons
Survey are preceded by screener questions, so that only those beneficiaries for whom the question is
relevant (i.e., those with relevant needs or experiences) are asked to answer those questions.
For scoring and reporting purposes, we combined some questions about reasons for disenrollment
into the following five composite measures:
•
•
•
•
•

Financial Reasons for Disenrollment
Problems with Prescription Drug Benefits and Coverage
Problems Getting Information about Prescription Drugs
Problems Getting Needed Care, Coverage, and Cost Information
Problems with Coverage of Doctors and Hospitals.

Table A1.1 displays the survey questions that go into each of these composites. Table A1.2 contains
questions that are not part of composites but that may be helpful for informing quality improvement
efforts.
Table A1.1. Medicare Advantage Health and Drug Plan Disenrollment Reasons Survey Composites
Composite Measure

Survey Questions Included in the Composite
Q20: Did you leave the plan because the monthly fee that the
health plan charges to provide coverage for health care and
prescriptions went up?

Financial Reasons for
Disenrollment

Q22: Did you leave the plan because the dollar amount you had
to pay for each time you filled or refilled a prescription went up?
Q24: Did you leave the plan because you found a health
plan that costs less?
Q25: Did you leave the plan because a change in your
personal finances meant you could no longer afford the
plan?

Composite Measure

Survey Questions Included in the Composite
Q21: Did you leave the plan because they changed the
list of prescription medicines they cover?
Q26: Did you leave the plan because the plan refused to pay
for a medicine your doctor prescribed?

Problems with Prescription
Drug Benefits and Coverage

Q27: Did you leave the plan because you had problems
getting the medicines your doctor prescribed?
Q28: Did you leave the plan because it was difficult to get brand
name medicines?
Q29: 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?
Q30: Did you leave the plan because you did not know whom to
contact when you had a problem filling or refilling a prescription?
Q31: 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?

Problems Getting
Information about
Prescription Drugs

Q38: Did you leave the plan because you were unhappy with
how the plan handled a question or complaint?
Q39: Did you leave the plan because you could not
get the information or help you needed from the
plan?
Q40: Did you leave the plan because their customer service
staff did not treat you with courtesy and respect?

Composite Measure

Survey Questions Included in the Composite
Q32: Did you leave the plan because you were frustrated by the
plan’s approval process for care, tests, or treatment?

Problems Getting Needed
Care, Coverage, and Cost
Information

Q33: Did you leave the plan because you had problems
getting the care, tests, or treatment you needed?
Q34: Did you leave the plan because you had problems
getting the plan to pay a claim?
Q37: Did you leave the plan because it was hard to get
information from the plan—like which health care services
were covered or how much a specific test or treatment would
cost?

Problems with Coverage of
Doctors and Hospitals

Q35: Did you leave the plan because the doctors or other health
care providers you wanted to see did not belong to the plan?
Q36: Did you leave the plan because clinics or hospitals you
wanted to go to for care were not covered by the plan?

Table A1.2. Single Survey Questions Not Included in a Composite*
Single Survey Questions Not Included in a Composite
Co-Payment for Doctor
Visit Went Up
Low Medicare Star Rating
Found Plan with a Higher
Medicare Star Rating
Family Member or Friend
Recommended Another
Plan
Saw Commercial or
Advertisement for Another
Plan

Q23: Did you leave the plan because the dollar amount you had
to pay each time you visited a doctor went up?
Q41: Did you leave the plan because it got a low
Medicare Star Rating?
Q42: Did you leave the plan because you found another plan
with a higher Medicare Star Rating?
Q44: Did you leave the plan because a family member or
friend told you that another health plan was a better plan?
Q45: Did you leave the plan because you saw a commercial
or advertisement for a health plan you thought you would
like better?

Another Plan Better Met
Prescription Needs

Q46: Did you leave the plan because you found another
plan that better met your prescription needs?

Another Plan Offered
Better Benefits or Coverage
of Health Services

Q47: Did you leave the plan because another plan offered
better benefits or coverage for some types of care,
treatment or services (for example, dental or vision care)?

*Responses to these questions were not strongly related to responses to questions included in the composites
presented in Table A1.1. Thus, these questions were analyzed individually.

Calculation of Composite Means
Your contract’s mean on a composite measure is calculated as the average percentage of reasons
endorsed in the composite multiplied by 100. To understand this calculation, consider a composite
measure comprised of four survey questions (i.e., reasons for disenrollment). Suppose that 150
disenrollees from your contract answered these questions, and that 60 of those disenrollees endorsed
none of the four reasons in the composite (or 0% of all reasons in the composite), 40 disenrollees
endorsed 1 of the 4 reasons (25% of all reasons in the composite), 25 disenrollees endorsed 2 of the 4
reasons (50% of all reasons in the composite), 15 disenrollees endorsed 3 of the 4 reason (75% of all
reasons in the composite), and 10 disenrollees endorsed all four reasons (100% of all reasons in the
composite). In that case, the average percentage of reasons in the composite that were endorsed by
disenrollees from your contract would be 29.2% or [(60*0) + (40*0.25) + (25*0.50) + (15*0.75) +
(10*1.00)]/150. Multiplying this average percentage by 100 would yield your contract’s mean score on
the composite: 29.2.
46

Reporting of Composite Means on the Medicare Plan Finder
The Medicare Plan Finder on the Medicare.gov website displays your contract’s mean scores on the
composite measures of disenrollment. These scores are presented on that site so that consumers can
see the reasons that beneficiaries gave for disenrolling from your contract in 2015. Unlike in this
report, which presents scores to 1 decimal digit, the Medicare Plan Finder presents scores rounded to
the nearest integer (whole number). In rounding decimals to integers, we followed these standard
rules: If the number beyond the decimal is less than 5, it is rounded down to the next whole number; if
the number beyond the decimal is 5 or more, it is rounded up to the next whole number. This can
occasionally lead to apparent discrepancies in the table below even though the rounding rules have
been properly applied. For example, a score of 19.46 would get rounded to 19.5 to produce a score for
this report, but it would get rounded down to 19 to produce a score for the Medicare Plan Finder. For
comparison, Table A1.3 shows your contract’s composite scores to 1 decimal digit (as they are
presented in this report) and to the nearest integer (as they are presented on the Medicare Plan
Finder). Table A1.3 also shows the labels used for the composite measures on the Medicare Plan
Finder which are different from the labels used in this report.
Table A1.3 Composite Measure Labels and Mean Scores as Presented
in This Report vs. the Medicare Plan Finder

Sample Selection and Eligibility Criteria
The survey was intended to represent the population of beneficiaries who disenrolled voluntarily
from Part C or Part D contracts during the period January 2015 through December 2015. To represent
that population, 150 cases were sampled from each MA contract’s disenrollment for that period and
300 from each PDP. Because beneficiaries who disenroll at different times of the year may tend to do
so for different reasons and have somewhat different characteristics, a further goal of the sample
design was to be representative of the distribution of each contract’s disenrollment across months of
the year. Sampling was done month by month over the course the year rather than retrospectively, so
that the number of cases to be sampled each month had to be calculated before disenrollment counts
from later months were known. Monthly allocations were projected based on historical patterns of
the distribution of disenrollment over months and adjusted each month as new disenrollment data
were received.
There were some very small contracts that were projected not to attain the target number of
disenrollments for sampling over the course of the year. These were excluded from sampling for
contract reporting, but were sampled at a 4% rate for national (but not contract) representativeness.
Also for national representativeness, sample sizes were increased in the largest contracts, using
sampling rates of 0.50% in PDP contracts and 1.34% in MA contracts when these rates yielded larger
samples than 300 and 150, respectively.
In MA plans with some but not all beneficiaries enrolled for the prescription drug (PD) benefit, samples
were drawn from both PD enrollees and non-enrollees, and each group was mailed the appropriate
questionnaire form. In a few contracts with low rates of PD enrollment, the sampling rate was slightly
increased for PD enrollees and reduced for non-PD enrollees. Data from both groups were combined to
obtain estimates for non-PD survey items.

Survey Implementation
The 2015 survey of disenrollees was conducted between January and December 2015. It asked about
beneficiaries’ experiences with their plan and reasons for disenrollment. Data were collected on an
ongoing basis and as close as possible to a beneficiary’s actual date of disenrollment to help with
respondent recall. The majority of voluntary disenrollment occurs in December of each year. Surveys
mailed in March 2015 covered disenrollments that happened in the January 2015 time period
(approximately a six week lag). Surveys mailed in April 2015 covered disenrollments that happened in
February 2015, and so forth. The data collection protocol included mailing of pre-notification letters
and up to two mailings of paper surveys. The surveys were available in English and Spanish. Residents
of Puerto Rico received a double-stuffed envelope that contained both English and Spanish-language
versions of the survey, while the remainder of disenrollees received an English version but could
request a Spanish language version of the survey by calling a 1-800 number maintained by the survey
vendor.
48

Sample Disposition
The sample disposition and response rates for the 2015 Medicare Advantage and Prescription Drug
Plan Disenrollment Reasons Survey are presented in Table A1.4. Of the 98,912 MA disenrollees in the
original sample, 3,569 (3.6%) were classified as ineligible because they were institutionalized,
deceased, mentally or physically incapable of responding, or had a language barrier that prevented
them from completing the survey. Eligible sample members who refused to take the survey or could
not be contacted were considered non-respondents (56.6% of sample members). The adjusted
response rate, after accounting for ineligible sample members, is 41.3 percent (39,384 partial or
completed surveys divided by 98,912 disenrollees in the original sample minus 3,569 disenrollees
deemed ineligible).
Table A1.4. 2015 Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey, MA
Sample Disposition

Weighting and Case-Mix Adjustment
Two adjustments to the data are made to permit fair comparisons among contracts: (1) weighting and
(2) case-mix adjustment.

Weighting to the Distribution of Disenrollment between December and Other Months
Our first step is to weight the respondents to be representative of the distribution of disenrollments
between December (which accounts for the majority of annual voluntary disenrollment) and the rest of
the year. December disenrollments include those under the open enrollment period which for many
beneficiaries is the only time when they are allowed to switch to another contract; all such
disenrollments take effect at the end of December even if the beneficiary elected the switch in one of
the preceding months. The respondent proportions in December typically do not match the
49

corresponding proportions of the entire disenrollee population because of the general unpredictability
of future disenrollments when samples are drawn earlier in the year, and because response rates are
almost twice as high in December as in the rest of the year. Given that the weighting scheme must be
kept simple to avoid detrimental effects on the precision of estimates, there are several reasons to
select December disenrollment as the most important variable. Month of disenrollment reflects an
aspect of the beneficiary's response to experiences, and should not have its effects adjusted away by
case-mix adjustment like those of characteristics like age and sex that are inherent in the
beneficiary. Previous analyses have shown substantial differences between reports of December and
other disenrollees (see pp. 52-54 of this report), and these effects differ across contracts. Furthermore,
correcting the proportions of December responses by weighting has been shown to improve the
proportionality of representation of other groups such as dual eligibles as well.

Adjustment to Address Discrepancies between Each Contract and the Average Contract in Terms
of the Characteristics of Enrolled Beneficiaries (Case-Mix Adjustment)
A second adjustment is made to address discrepancies between each contract and the average
contract in terms of the characteristics of enrolled beneficiaries. Analyses of CAHPS data have shown
that beneficiaries with certain characteristics tend to report more favorable or less favorable
experiences, even when they are members of the same contract and have therefore been exposed to
the same level of contract quality. Notably, older patients, healthier patients, less educated plan
members, and those with lower socioeconomic status (SES) tend to assess their experiences more
favorably than younger, sicker, more educated members and those with higher SES. Contracts do not
all have the same distribution ("case mix") of enrollees with these characteristics, so these tendencies
can bias comparisons among contracts. If a contract has a large number of patients whose
characteristics make them a "tough audience," its patients may report less favorable experiences than
the contract would receive if it delivered the same care to patients with average characteristics.
We perform a procedure called "case-mix adjustment" to correct for these effects using a statistical
model (linear regression) to estimate the scores that would be obtained by each contract if every
contract had the same distribution of member characteristics, equivalent to the average across all
contracts. Because the overall national mean is the same before and after adjustment, scores for
some contracts (those with beneficiaries who tend to provide more favorable assessments) will be
adjusted downwards, and others will be adjusted upwards.
The following variables are used in case mix adjustment:
• Age: A self-reported six-category survey variable ranging from 18 to 85 plus; the age group 6574 was used as the reference category
• Education: A self-reported six-category survey variable ranging from less than eighth grade to
more than college; high school diploma was used as the reference category
• Self-reported general health status: Five-category variable (excellent, very good, good, fair,
poor), where good was used as the reference category
50

•
•
•

Self-reported mental health status: Five-category variable (excellent, very good, good, fair,
poor), where excellent was used as the reference category
Proxy assistance: Included as two indicators—one for receiving any proxy assistance and one
for a proxy answering questions for the respondent
Low income supplement (LIS) eligibility and Medicaid dual eligibility: Three-category
variable (dual eligible, Non-dual/LIS, Non-dual/Non-LIS), where non-dual/non-LIS is
used as the reference category. This variable comes from the administrative data
files.

Significance Testing
For composite measures of reasons for disenrollment, where scores are the mean percentage of
items in the composite that were endorsed multiplied by 100, two-tailed t-tests were used to assess
whether the case-mix adjusted mean for each contract differed significantly from the overall mean for
all contracts in the nation. When, contract scores are significantly different from the national mean at
the p<0.05 level, this is noted in the last column of Table 1.3 under "Different from National
Average?" A "No" entry in this column means that the contract's score was not significantly different
from the national average, "Higher" means that it differs significantly from the national mean and is
higher, and "Lower" means that it differs significantly from the national mean and is lower. In
accordance with confidentiality requirements, "N/A" is reported for any item or composite with fewer
than 10 observations (see below). If the minimum sample size is met but the reliability of the measure
is below 0.70 (in a 0-1 range), the mean score is shown without bolding. Even when low reliability
limits the ability to detect smaller differences from the national mean, the last column of Table 1.3
indicates "Higher" or “Lower” in parentheses whenever differences were sufficiently large to
distinguish a contract's score from the national average with p<0.05.
Table 1.4 reports results for individual items, again using the last column on the right to indicate
whether a score differed significantly from the national mean.
In Part 2 of the report, results are displayed graphically for both composites and individual items.
When a contract score is significantly different from the national average, that fact is noted by an
asterisk next to the score and with text at the top of the figure.
To compare the contract's disenrollment rate with the national average, we used a chi-square test. To
compare rates of endorsement of individual questions underlying the composites with the national
average, we used a chi-square test on case-mix-adjusted results. For all tests performed, differences
that are significant at the p<0.05 level are noted in the table or figure as described above.

Assessing Reliability of Scores
For each composite measure, criteria based on inter-unit reliability (IUR) were applied to classify each
contract’s data as acceptable or low reliability. Inter-unit reliability is defined by IUR=s2/(SE2+ s2),
where s2 = between-contract model variance, and SE = standard error of contract mean. IUR may be
interpreted as the fraction of variation in contract mean scores (among those with about the same
IUR) that is attributable to actual differences among contracts (“signal”) rather than sampling
variability (“noise”). Thus IUR close to 1 indicates that sampling variability is negligible, while IUR close
to 0 means that we are unable to detect any variation among contracts and differences in the data are
only random error. Contracts with fewer than 11 responses for a measure have their scores masked, in
conformity with CMS policies on confidentiality of beneficiary data. Contracts for which IUR<.70 are
considered to have low reliability. However, no more than 12% of contracts (those with lowest IUR on
the corresponding measure) are flagged as low reliability for a given composite measure, after
excluding masked scores.
Reliability of the estimates also is affected by a number of other factors, including the fraction of the
contract’s respondents who are eligible to answer an item based on their experiences, the variability
of responses within the contract, and the amount by which contracts differ from each other nationally
on that measure. Reliability summarizes the influence of these factors on the precision with which a
contract’s score can be compared to national distributions.
Within a given measure, low-reliability scores typically are those with fewer respondents, or possibly
with more variability in their responses. Across measures, more low-reliability scores will be reported
for measures with fewer responses (more respondents for whom the measure does not apply), less
variation in scores across contracts, and more variability in scores within each contract.

Comparison of Reasons for Disenrollment: January-November versus December
Disenrollees
Analyses of results from the Medicare Advantage and Prescription Drug Plan Disenrollment Reasons
Survey have shown that the reasons why beneficiaries report disenrolling from their health or
prescription drug plans differ between those who disenroll in the January-November months as
compared to those who disenroll in December. Table A1.5 shows national average scores on the
composite measures of disenrollment as well as on the items that make up those composite measures
broken down between January-November disenrollees and December disenrollees. Table A1.6 shows a
similar breakdown of national average scores on the single items that are not included in a composite.
Contract-specific scores for January-November and December disenrollees are not reported because of
insufficient sample size. Nevertheless, it may be useful to keep the differences shown below in mind
when interpreting your own contract’s scores.

Table A1.5. National Average Scores on Composite Measures and Their Constituent Items: JanuaryNovember Disenrollees vs. December Disenrollees

Table A1.6. National Average Scores on Single Items (not in a composite): January-November
Disenrollees vs. December Disenrollees

State or Regional Comparisons
In addition to comparing your contract's results with a national benchmark, it may be useful to compare
the results with a state or regional benchmark. We have provided such a benchmark for your contract.
For most contracts, the benchmark is the state with the largest number of beneficiaries from that
contract in the 2015 Medicare Advantage Health and Drug Plan Disenrollment Reasons Survey.
However, we used broader regional benchmarks (census divisions) instead of states when any of the
following occurred:
• The reliability of any of the five composite measures was < 0.70 within the state
• The state had no more than one contract with 10 or more respondents represented in the
disenrollment survey
• A single contract with large market share accounted for 75% or more of the disenrollments in
the state
Under these conditions, state-level benchmarks would not be meaningful or useful.
Because sample sizes for state and regional benchmarks are much smaller than for national
benchmarks, we do not provide statistical tests for these comparisons.

Contact Information
If you have questions about the survey or this report, please send them to
[email protected].

Appendix 2: Frequency Tables

Frequency Tables
Q1. Our records show that you used to belong to HMO ABC (Contract Number HXXXX), but no
longer belong to that plan. Is that right?

Note: The frequencies shown in this appendix are not case-mix adjusted and therefore may not be consistent
with means displayed in the body of the report. In addition, percentages may not add to 100 due to rounding.
Questions not pertaining to reasons for disenrollment are presented here for general information.

Q2. Did you have to change or drop your former health plan for any of the following reasons?

Q3. Customer service is information you get from staff about what is covered and how to use the
plan. Did you ever try to get information or help from HMO ABC'S customer service?

Q4. How often did the plan’s customer service give you the information or help you needed?

Q5. Did you ever try to get information from the plan about which prescription medicines were
covered?

Q6. How often did the plan give you all the information you needed about which prescription
medicines were covered?

Q7. Did you ever try to get information from the plan about how much you would have to pay
for a prescription medicine?

Q8. How often did the plan give you all the information you needed about how much you
would have to pay for a prescription medicine?

Q9. Did you ever try to get any kind of care, tests, or treatment through the plan?

Q10. How often was it easy to get the care, tests, or treatment you thought you needed through the
plan?

Q11. Did a doctor ever prescribe a medicine for you that the plan did not cover?

Q12. How often was it easy to use the plan to get the medicines your doctor prescribed?

Q13. Did you ever use the plan to fill a prescription at a local pharmacy?

Q14. How often was it easy to use the plan to fill a prescription at a local pharmacy?

Q15. Did you ever use the plan to fill any prescriptions by mail?

Q16. How often was it easy to use the plan to fill prescriptions by mail?

Q17. Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best
health plan possible, what number would you use to rate the plan?

Q18. Did you leave the plan because you found out that someone had signed you up for the plan
without your permission?

Q19. Did you leave the plan because you were accidentally taken off the plan (or because of some
other paperwork or clerical error)?

Q20. Some Medicare beneficiaries have to pay their health plan a monthly fee out of their own
pocket for coverage for health and prescription medicines. Did you leave the plan because the
monthly fee that the health plan charges to provide coverage for health care and prescription
medicines went up?

Q21. Health 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?

Q22. Did you leave the plan because the dollar amount you had to pay each time you filled or refilled
a prescription went up?

Q23. Did you leave the plan because the dollar amount you had to pay each time you visited a doctor
went up?

Q24. Did you leave the plan because you found a health plan that costs less?

Q25. Did you leave the plan because a change in your personal finances meant you could no longer
afford the plan?

Q26. Did you leave the plan because the plan refused to pay for a medicine your doctor prescribed?

Q27. Did you leave the plan because you had problems getting the medicines your doctor prescribed?

Q28. Did you leave the plan because it was difficult to get brand name medicines?

Q29. 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?

Q30. Did you leave the plan because you did not know whom to contact when you had a problem
filling or refilling a prescription?

Q31. 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?

Q32. Did you leave the plan because you were frustrated by the plan’s approval process for care,
tests, or treatment?

Q33. Did you leave the plan because you had problems getting the care, tests, or treatment you
needed?

Q34. Claims are sent to a health plan for payment. You may send in the claims yourself or doctors,
hospitals, or others may do this for you. Did you leave the plan because you had problems getting the
plan to pay a claim?

Q35. Did you leave the plan because the doctors or other health care providers you wanted to see did
not belong to the plan?

Q36. Did you leave the plan because clinics or hospitals you wanted to go to for care were not
covered by the plan?

Q37. Did you leave the plan because it was hard to get information from the plan -- like which health
care services were covered or how much a specific test or treatment would cost?

Q38. Did you leave the plan because you were unhappy with how the plan handled a question or
complaint?

Q39. Did you leave the plan because you could not get the information or help you needed from the
plan?

Q40. Did you leave the plan because their customer service staff did not treat you with courtesy and
respect?

Q41. Every year Medicare evaluates all Medicare health and 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. Did you leave
the plan because it got a low Medicare Star Rating?

Q42. Did you leave the plan because you found another plan with a higher Medicare Star Rating?

Q43. In the past year, did you think about the Medicare Star or Plan Ratings when making a decision
about enrolling in a health plan?

Q44. Did you leave the plan because a family member or friend told you that another health plan was
a better plan?

Q45. Did you leave the plan because you saw a commercial or advertisement for a health plan you
thought you would like better?

Q46. Did you leave the plan because you found another plan that better met your prescription needs?

Q47. Did you leave the plan because another plan offered better benefits or coverage for some types
of care, treatment, or services (for example, dental or vision care)?

Q48. 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 health care or prescription medicines?

Q49. Did an insurance agent, broker, or plan representative ever visit your home without your asking
them to, to tell you about insurance for health care or prescription medicines?

Q50. Did you decide to leave HMO ABC because of information you got from an insurance agent,
broker, or plan representative?

Q51. Did an insurance agent, broker, or plan representative give you any information that was not
correct?

Q52. What kind of information was not correct? Please check all that apply.

Q53. In general, how would you rate your overall health?

Q54. In general, how would you rate your overall mental health?

Q55. In the last 12 months, how many different prescription medicines did you fill? (Don’t count the
same prescriptions twice.)

Q56. In the past 12 months, have you seen a doctor or other health provider 3 or more times for the
same condition or problem?

Q57. Is this a condition or problem that has lasted for at least 3 months?

Q58. Do you now need or take medicine prescribed by a doctor?

Q59. Is this to treat a condition that has lasted for at least 3 months?

Q60. Has a doctor ever told you that you had any of the following conditions?
a. A heart attack?

b. Angina or coronary heart disease?

c. Hypertension or high blood pressure?

d. Cancer, other than skin cancer?

e. Emphysema, asthma or COPD (chronic obstructive pulmonary disease)?

f. Any kind of diabetes or high blood sugar?

Q61. What is your age?

Q62. Are you male or female?

Q63. What is the highest grade or level of school that you have completed?

Q64. Are you of Hispanic or Latino origin or descent?

Q65. What is your race? Please mark one or more.

Q66. What language do you mainly speak at home?

Q67. Did someone help you complete this survey?

Q68. How did that person help you? Please mark one or more.

Q69. 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?

Note that the two items below appeared only on the Spanish-language version of the survey, which was
sent to disenrollees from Puerto Rico and to sample members who requested a Spanish-language
version of the survey.
Did you ever need written information from the plan in a language other than English?

How often did the plan give you written information in a language other than English?

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Author	cmurray
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File Created	2016-08-18