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Healthy Indiana Plan 2.0 Beneficiary Survey:
Disenrollees & Lockouts
SURVEY INSTRUCTIONS
•
•
Answer each question by filling in the circle to the left of your answer, like this: Yes
You are sometimes told to skip over some questions in this survey. When this happens you will see an
arrow with a note that tells you what question to answer next, like this:
Yes GO TO QUESTION 1
No
The Centers for Medicare & Medicaid Services is conducting this survey to ask about your recent experiences receiving
health care and should take about 15 minutes to complete. Your participation is voluntary, and there is no loss of
benefits or penalty of any kind for deciding not to participate. You may skip any questions that you do not feel comfortable
answering. Your participation in this research is private, and we will not share your name or any other identifying
information with any outside organization. You may notice a number on the cover of the survey. This number is ONLY used
to let us know if you returned the survey. Please contact Thoroughbred Research Group toll-free at 844-859-7862 with
questions about this research.
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays
a valid OMB control number. The valid OMB control number for this information collection is 0938-1300. The time required to complete
this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing
data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
About Your HIP 2.0 Enrollment
The State of Indiana currently runs an insurance program called the Healthy Indiana Plan (also called HIP
2.0) for Hoosiers ages 19 to 64.
1.
Are you currently enrolled in the “Healthy Indiana Plan 2.0” (also called “HIP 2.0”)?
2.
Yes GO TO QUESTION 38
No
Not sure/Don’t know GO TO END
Have
you ever been enrolled in HIP 2.0?
Yes
No GO TO END
Not sure/Don’t know GO TO END
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3. Were you enrolled in HIP 2.0 within the last 12 months?
Yes
No GO TO END
4. With which HIP 2.0 health plan were you enrolled?
Anthem
MDwise
MHS – Managed Health Services
Not sure/Don’t know
Experiences After Leaving HIP 2.0
The following questions are about your understanding and experiences since you left HIP.
5.
Do you have any health insurance coverage right now?
6.
Not sure/Don't know GO TO QUESTION 8
Less than one month
Between 1 and 6 months
More than 6 months
After you were no longer enrolled in HIP 2.0, how long did it take you to get your current health
insurance coverage?
8.
No GO TO QUESTION 8
How long have you had your current health insurance coverage?
7.
Yes
Less than one month
Between 1 and 6 months
More than 6 months
After you were no longer enrolled in HIP 2.0, was there any time when you needed health care but did
not get it because you could not pay for transportation or could not get transportation?
Yes
No GO QUESTION 10
Not sure/Don't know GO QUESTION 10
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9.
What types of health care were you unable to get because you could not pay for transportation or could not get
transportation?
Could not
pay for
transportation
Could not get
transportation
No trouble with
transportation for
this type of care
N/A
a. A visit to the doctor when you were sick
b. Preventive care (such as blood
pressure check, flu shot, family
planning services, prenatal services,
cholesterol or cancer screenings.)
c. A follow up visit to get tests or care
recommended by your doctor
d. Dental care
e. Vision (eye) care
f. Prescription drugs
g. Emergency room care for a nonemergency condition
Please mark one answer in each row.
10. After you were no longer enrolled in HIP 2.0, was there any time you needed health care but did not
get it because of costs other than transportation?
Yes
No GO QUESTION 12
Not sure/Don’t know GO QUESTION 12
11. After you were no longer enrolled in HIP 2.0, what types of health care were you unable to get
because of costs other than transportation?
Please mark one answer in each row.
Yes
No
N/A
a. A visit to the doctor when you were sick
b. Preventive care (such as blood pressure check, flu shot, family
planning services, prenatal services, cholesterol or cancer
screenings.)
c. A follow up visit to get tests or care recommended by your doctor
d. Dental care
e. Vision (eye) care
f. Prescription drugs
g. Emergency room care
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12. Why did you leave HIP 2.0? Please mark one answer in each row.
I left HIP 2.0 because…
Yes
No
Not sure
a. I got an increase in my income and was no longer eligible for HIP 2.0
b. I had other health insurance available to me
c. I did not finish my paperwork and return it in time to stay in HIP 2.0
d. I did not pay my contribution (for example: forgot, was too late, did not
have money)
13. Would you try to re-enroll in HIP 2.0 if you became eligible for the program again?
Yes
No
Not sure/Don’t know
POWER Accounts and Contributions
The following questions are about your understanding and experiences with HIP contributions and POWER
accounts while you were in HIP 2.0.
14. While you were in HIP 2.0, did you have a POWER account? POWER accounts are health savings
accounts called Personal Wellness and Responsibility Accounts.
Yes
No GO TO QUESTION 16
Not sure/Don’t know GO TO QUESTION 16
15. While you were in HIP 2.0, did you know how much money was in your POWER account?
Yes, I knew exactly how much
Yes, I had a pretty good idea
No, I did not really know at all
16. While you were in HIP 2.0, were you required to make a contribution(s)?
Yes
No GO TO QUESTION 21
Not sure/Don’t know GO TO QUESTION 22
17. While you were in HIP 2.0, how was that contribution(s) paid?
I paid it
Someone paid the full amount for me
I paid part and someone else paid part
The contribution has not been paid
Not sure/Don’t know
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18. While you were in HIP 2.0, would you say the amount you were required to contribute was:
More than I could afford
An amount I could afford
Less than I could afford
Not sure/Don’t know
19. While you were in HIP 2.0, how worried were you about not having enough money to pay
your contribution(s)?
Not at all worried
A little worried
Somewhat worried
Very worried
Extremely worried
20. After you were no longer enrolled in HIP 2.0, was any part of your contribution(s) returned to you
or refunded?
Yes GO TO QUESTION 24
No GO TO QUESTION 24
Account had zero balance GO TO QUESTION 24
Not sure/Don’t know GO TO QUESTION 24
21. Why did you not contribute?
Please mark one answer in each row.
Yes
No
Not sure
a. I did not have to contribute
b. I could not afford to make the contributions
c. I did not understand how to contribute/too confusing to understand
d. I did not think contributing helped me
22. Copays are payments you make at the time you visit your doctor’s office, go to the hospital, or get
prescription drugs. While you were in HIP 2.0, would you say the amount you were required to pay in
copays was:
More than I could afford
An amount that I could afford
Less than I could afford
Not sure/Don’t know
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23. While you were in HIP 2.0, how worried were you about not having enough money to pay your copays?
Not at all worried
A little worried
Somewhat worried
Very worried
Extremely worried
24. While you were in HIP 2.0, what did you think would happen, if anything, if a person’s contribution
was not made on time?
Nothing would change GO TO QUESTION 26
Their HIP 2.0 coverage would end
They would get automatically moved to HIP Basic GO TO QUESTION 26
Not sure/Don’t know GO TO QUESTION 26
25. How long did you think a person would need to wait to re-enroll in HIP 2.0?
No wait time
3 months
6 months
12 months
Not sure/Don’t know
26. How easy or hard was it to understand how to use a POWER account?
Very easy
Somewhat easy
Neither easy nor hard
Somewhat hard
Very hard
27. For each of the following statements about POWER accounts, please tell us whether you agree,
disagree, or are not sure.
Please mark one answer in each row.
Agree
Disagree
Not sure
a. The State of Indiana contributes to POWER accounts
b. HIP 2.0 contribution(s) go to POWER accounts
c. POWER accounts help people pay for the health care services they need
d. POWER accounts help people understand the cost of their health
care services
e. POWER accounts make people feel comfortable about paying for
their health care services
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28. How easy or hard was it to understand what happened to any leftover money in a POWER account at
the end of the year?
Very easy
Somewhat easy
Neither easy nor hard
Somewhat hard
Very hard
Preventive services are routine health care services that include getting a flu shot, annual checkups, blood
pressure checks, family planning services, prenatal services, cholesterol screenings, or cancer screenings
to prevent illness, disease, and other health-related problems. The following questions ask about your
experience with preventive services and POWER accounts in HIP 2.0.
29. Is the cost of preventive services paid from the POWER account?
Yes
No
Not sure/Don’t know
30. If someone gets all or some of their recommended preventive services, would some of the
remaining money in a POWER account get rolled over to next year?
Yes
No
Not sure/Don’t know
31. Please tell us whether you agree, disagree or are not sure about with the following statement:
POWER accounts make it more likely for someone to try and get all or some of their recommended
preventive services.
Agree
Disagree
Not sure/Don’t know
Access
For the following questions please think about your health care experience since you left HIP.
32. After you were no longer enrolled in HIP 2.0, did you go to a doctor, nurse, or any other health
professional or get prescription drugs?
Yes
No GO TO QUESTION 36
Not sure/Don’t know GO TO QUESTION 36
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33. After you were no longer enrolled in HIP 2.0, were you asked to pay a copay at your most recent
visit? Copays are payments you make at the time you visit your doctor’s office, go to the hospital,
or get prescription drugs.
Yes
No GO TO QUESTION 35
No, I was asked to pay the whole bill GO TO QUESTION 35
Not sure/Don’t know GO TO QUESTION 35
34. How was that copay paid, if at all?
I paid it
Someone paid it for me
The co-payment was not paid
Not sure/Don’t know
35. After you were no longer enrolled in HIP 2.0, were any of your health care visits for a routine
checkup? A routine checkup is a general physical exam, not an exam for a specific injury, illness, or
condition.
Yes
No
Not sure/Don’t know
Satisfaction with Healthy Indiana Plan
36. Thinking about your overall experience with HIP 2.0, would you say you are:
Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied GO TO QUESTION 52
Somewhat Dissatisfied
Very Dissatisfied
Not sure/Don’t know GO TO QUESTION 52
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37. Please tell us how satisfied or dissatisfied you are with each HIP 2.0 item below.
Please mark one answer in each row.
Very
Satisifed
Somewhat
Satisfied
Neutral
Somewhat
Dissatisfied
Very
Dissatisfied
a. Length of time for coverage to begin
b. Ability to see my doctors with HIP 2.0
c. Choice of doctors in HIP 2.0
d. Coverage of health care services that I need
e. Understanding how POWER accounts work
f. Cost of contribution(s)
g. HIP 2.0 enrollment process
GO TO QUESTION 52
HIP Basic enrolled, formerly HIP Plus enrolled
38. Are you currently in HIP Basic?
Yes
No GO TO END
Not sure/Don’t know GO TO END
39. Thinking about your current HIP Basic coverage, how does it compare to HIP Plus? Is it better,
about the same, or worse?
Better than HIP Plus coverage
About the same as HIP Plus coverage GO TO QUESTION 42
Worse than HIP Plus coverage GO TO QUESTION 41
Not sure/Don’t know GO TO QUESTION 42
40. Why do you think your current HIP Basic coverage is better? Mark one or more.
I like the benefits in HIP Basic better than HIP Plus GO TO QUESTION 42
I think HIP Basic is cheaper than HIP Plus GO TO QUESTION 42
Other reason GO TO QUESTION 42
41. Why do you think your current HIP Basic coverage is worse? Mark one or more.
I liked the benefits in HIP Plus better than HIP Basic
I think HIP Plus is cheaper than HIP Basic
Other reason
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42. Would you try to re-apply for HIP Plus if you became eligible for HIP Plus again?
Yes
No
Not sure/Don’t know
43. While you were in HIP Plus, what did you think would happen, if anything, if your contribution(s)
were not made on time?
Nothing would change
My HIP 2.0 coverage would end
They would automatically get moved to HIP Basic
Not sure/Don’t know
44. Since your HIP 2.0 coverage changed from HIP Plus to HIP Basic, was there any time you needed
health care but did not get it because you could not pay for transportation or could not get
transportation?
Yes
No GO TO QUESTION 46
Not sure/Don’t know GO TO QUESTION 46
45. What types of health care were you unable to get because you could not pay for transportation or
could not get transportation?
Could not
No trouble with
Please mark one answer in each row.
pay for
Could not get
transportation for
transportation
transportation
this type of care
N/A
a. A visit to the doctor when you were sick
b. Preventive care (such as blood
pressure check, flu shot, family
planning services, prenatal services,
cholesterol or cancer screenings.)
c. A follow up visit to get tests or care
recommended by your doctor
d. Dental care
e. Vision (eye) care
f. Prescription drugs
g. Emergency room care for a nonemergency condition
46. Since your HIP 2.0 coverage changed from HIP Plus to HIP Basic, was there any time you needed
health care but did not get it because of costs other than transportation?
Yes
No GO TO QUESTION 48
Not sure/Don’t know GO TO QUESTION 48
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47. Since your HIP 2.0 coverage changed from HIP Plus to HIP Basic, what types of health care were you
unable to get because of costs other than transportation?
Please mark one answer in each row.
Yes
No
N/A
a. A visit to the doctor when you were sick
b. Preventive care (such as blood pressure check, flu shot, family
planning services, prenatal services, cholesterol or cancer
screenings.)
c. A follow up visit to get tests or care recommended by your doctor
d. Dental care
e. Vision (eye) care
f. Prescription drugs
g. Emergency room care
48. Thinking about your experience in HIP Basic, would you say you are:
Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied GO TO QUESTION 50
Somewhat Dissatisfied
Very Dissatisfied
Not sure/Don’t know GO TO QUESTION 50
49. Please tell us how satisfied or dissatisfied you are with each HIP 2.0 item below in HIP Basic.
Please mark one answer in each row.
Very
Satisifed
Somewhat
Satisfied
Neutral
Somewhat
Dissatisfied
Very
Dissatisfied
a. Length of time for coverage to begin
b. Ability to see my doctors with HIP 2.0
c. Choice of doctors in HIP 2.0
d. Coverage of health care services that I need
e. Understanding how POWER accounts work
f. Cost of contribution(s)
g. HIP 2.0 enrollment process
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50. Thinking about your experience in HIP Plus, would you say you are:
Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied GO TO QUESTION 52
Somewhat Dissatisfied
Very Dissatisfied
Not sure/Don’t know GO TO QUESTION 52
51. Please tell us how satisfied or dissatisfied you are with each HIP 2.0 item below in HIP Plus.
Please mark one answer in each row.
Very
Satisifed
Somewhat
Satisfied
Neutral
Somewhat
Dissatisfied
Very
Dissatisfied
a. Length of time for coverage to begin
b. Ability to see my doctors with HIP 2.0
c. Choice of doctors in HIP 2.0
d. Coverage of health care services that I need
e. Understanding how POWER accounts work
f. Cost of contribution(s)
g. HIP 2.0 enrollment process
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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 what you
would like in your benefits package.
People pay for their health care services in different ways. Some people pay monthly contributions, some
people pay copays, and some people pay both. Copays are payments you make at the time you visit your
doctor’s office, go to the hospital, or get prescription drugs.
52. If you could choose how to pay for your health care services, what would you choose?
I would choose to pay copays at my health care visits
I would choose to make monthly contributions
It does not matter to me
53. How important are each of the following factors when thinking about enrolling in a benefits package?
Very
important
Somewhat
important
Not at all
important
a. The cost of monthly contributions
b. The cost of copays for doctor visits
c. The cost of copays for non-emergency visits to the
emergency room
d. The cost of copays for prescription drugs
e. The length of time with no coverage if I miss a
monthly contribution
f. If I lose coverage, being able to pay a missed
contribution to get my coverage back
Please mark one answer in each row.
Demographics/About You
54. Would you say that in general your health is:
Excellent
Very good
Good
Fair
Poor
55. 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
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56. What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
A homemaker
A full-time student
Unable to work for health reasons
Unemployed
57. What is your age?
18 to 24
55 to 64
25 to 34
65 to 74
35 to 44
75 or older
45 to 54
58. Are you male or female?
Male
Female
59. Are you of Hispanic, Latino/a, or Spanish origin? One or more categories may be selected.
No, not of Hispanic, Latino/a, or Spanish origin
Yes, Mexican, Mexican American, Chicano/a
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino/a, or Spanish origin
60. What is your race? Mark one or more.
White
Vietnamese
Black or African-American
Other Asian
American Indian or Alaska Native
Native Hawaiian
Asian Indian
Guamanian or Chamorro
Chinese
Samoan
Filipino
Other Pacific Islander
Japanese
Some other race
Korean
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61. Please circle the number of people in your family (including yourself) that live in your household. Mark
only one answer that best describes your family’s total income over the last year before taxes and other
deductions. Your best estimate is fine.
Family size
(including yourself)
One person
Two people
Three people
Four people
Five people
Six people
Seven people
Eight people
Nine people
Ten or more
people
Family Income Per Year
At or below $6,000
At or above $12,000 and less than $16,000
Above $6,000 and less than $12,000
At or above $16,000
At or below $8,000
At or above $16,000 and less than $22,000
Above $8,000 and less than $16,000
At or above $22,000
At or below $10,000
At or above $20,000 and less than $28,000
Above $10,000 and less than $20,000
At or above $28,000
At or below $12,000
At or above $24,000 and less than $33,000
Above $12,000 and less than $24,000
At or above $33,000
At or below $14,000
At or above $28,000 and less than $39,000
Above $14,000 and less than $28,000
At or above $39,000
At or below $16,000
At or above $33,000 and less than $45,000
Above $16,000 and less than $33,000
At or above $45,000
At or below $18,000
At or above $37,000 and less than $51,000
Above $18,000 and less than $37,000
At or above $51,000
At or below $20,000
At or above $41,000 and less than $56,000
Above $20,000 and less than $41,000
At or above $56,000
At or below $23,000
At or above $45,000 and less than $62,000
Above $23,000 and less than $45,000
At or above $62,000
At or below $25,000
At or above $49,000 and less than $68,000
Above $25,000 and less than $49,000
At or above $68,000
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62. Did someone help you complete this survey?
Yes
No THANK YOU. Please return the completed survey in the postage-paid envelope.
63. How did that person help you? Mark one or more.
Read the questions to me
Wrote down the answers I gave
Answered the questions for me
Translated the questions into my language
THANK YOU
Please return the completed survey in the postage-paid envelope.
Thoroughbred Research Group, Inc.
PO Box 80490
Conyers, GA 30013-9903
0270
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| File Type | application/pdf |
| File Modified | 2016-09-28 |
| File Created | 2016-07-20 |