Form CMS-P-0015A Comm2017R77KNQ

2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

KNQ-Beneficiary Knowledge and Information Needs

Question Text/Description

Code List

Routing

(01) CONTINUE
(-7) Empty

KN1 - KNOWMC

(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused

KN2 - KCARKNOW

BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007, C010
SPALIVE=1
SEASON=WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after PVQ.
Now I have some questions that ask how you get information about the Medicare program [for (SP)]. Your
answers will help Medicare provide the information that people need.
KNINTR

KNINTRO

no entry
Keep in mind that, generally, there are no right or wrong answers to these questions. Your opinions and
experiences are important to us.
SHOW CARD KN1

KNOWMC

KN1

code 1

Overall, how easy or difficult do you think the Medicare program is to understand?
[PROBE IF NECESSARY: Would you say it is very easy to understand, somewhat easy to understand,
somewhat difficult to understand, or very difficult to understand?]

(01) JUST ABOUT EVERYTHING YOU NEED TO
KNOW
(02) MOST OF WHAT YOU NEED TO KNOW
How much do you think you know about the Medicare program?
(03) SOME OF WHAT YOU NEED TO KNOW
KN25B1 - KNINFMCR.
(04) A LITTLE OF WHAT YOU NEED TO KNOW
Do you know just about everything you need to know, most of what you need to know, some of what you need to (05) ALMOST NONE OF WHAT YOU NEED TO KNOW
know, a little of what you need to know or almost none of what you need to know about the Medicare program?
(-8) Don't Know
(-9) Refused
SHOW CARD KN2

KCARKNOW

KNINFMCR

KN2

KN25B1

code 1

yes/no

In the past year, have you tried to find any information [for (SP)] about Medicare?

SHOW CARD KN3
KNINTMCR

KN25C

code 1
How interested are you in getting (more) information [for (SP)] about Medicare?

SHOW CARD KN4
KNCOVOPT

KN25D

code 1

How easy or difficult would you say it is for [you/(SP)] to review and compare [your/his/her] Medicare coverage
options? Would you say it is …

SHOW CARD KN5
KNCOVREV

KN25E

code 1

How often [do you/does (SP)] review or compare [your/his/her] Medicare coverage options? Would that be at
least once every year, once every few years, rarely, or never?

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

KN25C - KNINTMCR

(01) VERY INTERESTED
(02) SOMEWHAT INTERESTED
(03) NOT VERY INTERESTED
(04) NOT AT ALL INTERESTED
(-8) Don't Know
(-9) Refused

KN25D-KNCOVOPT

(01) Very easy
(02) Somewhat easy
(03) Somewhat difficult
(04) Very difficult
(05) DOES NOT MAKE DECISIONS ON HEALTH
INSURANCE
(-8) Don't Know
(-9) Refused

KN25E-KNCOVREV

(01) AT LEAST ONCE EVERY YEAR
(02) ONCE EVERY FEW YEARS
(03) RARELY
(04) NEVER
(05) ONLY ONCE WHEN FIRST SIGNED UP FOR
DRUG PLAN
(06) ONLY ONCE WHEN FIRST SIGNED UP FOR
MEDICARE
(07) JUST SIGNED UP FOR MEDICARE
(-8) DON'T KNOW
(-9) REFUSED

KN35F-KNCOVINF

Page 1 of 3

2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

KNQ-Beneficiary Knowledge and Information Needs

Question Text/Description

Code List

Routing

code 1

(01) Completely agree
(02) Somewhat agree
(03) Somewhat disagree
To what extent do you agree or disagree with the following statement:
(04) Completely disagree
[I have/(SP) has] the information [I need/he needs/she needs] to make an informed comparison among different
(05) DOES NOT MAKE DECISIONS ON HEALTH
health insurance choices.
INSURANCE
(-8) Don't Know
Would you say you …
(-9) Refused

KN26 - KNFOSATI

KN27INT - KN27IN

SHOW CARD KN6

KNCOVINF

KN25F

KNFOSATI

KN26

code 1

(01) VERY SATISFIED
(02) SATISFIED
SHOW CARD KN7
(03) DISSATISFIED
(04) VERY DISSATISFIED
How satisfied are you in general with the availability of information about the Medicare program when you need it
(05) NOT APPLICABLE
[for (SP)]?
(-8) Don't Know
(-9) Refused

KN27IN

KN27INT

no entry

Now I would like to ask you about publications that are available to you [and (SP)] about the Medicare program.

(01) CONTINUE
(-7) Empty

SHOW CARD KN8
KBOKRECD

KBOKREAD

KN27

KN28

yes/no

code 1

(01) YES
(02) NO
Did [you/(SP)] receive in the mail or view on the Medicare website a book called "Medicare and You [CURRENT
(-8) Don't Know
YEAR]?” This book gives an overview of the Medicare program and is sent to Medicare beneficiaries every fall.
(-9) Refused
The cover looks like this.

Would you say you have read this book thoroughly, that you have read parts of it, or that you haven't read it at
all?

SHOW CARD KN9
KBOKUNDR

KN29

code 1

How easy or difficult did you find (the parts you read/this book) to understand?
[PROBE IF NECESSARY: Would you say (they were/it was) very easy to understand, somewhat easy to
understand, somewhat difficult to understand, or very difficult to understand?]
Next, I'd like to ask about [your/(SP's)] use of computers.

KNHAVCOM

KN50

yes/no
[Do you/Does (SP)] have a personal computer in (your/his/her) home?

Some people use the Internet to get different kinds of information. The next questions ask about the Internet.
KN51IN

KN51INT

no entry
[EXPLAIN IF NECESSARY: The Internet includes web sites, e-mail, newsgroups, and other forums.]

KNETPERS

KNETFRND

KNETOFTN

KN51A

KN51B

KN51C

(01) KN28 - KBOKREAD
(02) KN50 - KNHAVCOM
(-8) KN50 - KNHAVCOM
(-9) KN50 - KNHAVCOM

(01) READ IT THOROUGHLY
(02) READ PARTS OF IT
(03) HAVEN'T READ IT AT ALL
(-8) Don't Know
(-9) Refused

(01) KN29 - KBOKUNDR
(02) KN29 - KBOKUNDR
(03) KN50 - KNHAVCOM
(-8) KN50 - KNHAVCOM
(-9) KN50 - KNHAVCOM

(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused

KN50 - KNHAVCOM

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

KN51INT - KN51IN

(01) CONTINUE
(-7) Empty

KN51A - KNETPERS

(01) KN51C - KNETOFTN
(02) KN51B - KNETFRND
(03) BOX KN8
(-8) BOX KN8
(-9) BOX KN8

code 1

[Do you/Does (SP)] personally ever use the Internet to get information of any kind?

(01) YES
(02) NO
(03) NEVER HEARD OF THE INTERNET
(-8) Don't Know
(-9) Refused

yes/no

[Do you/Does(SP)] have someone else, such as a friend, relative, or anyone else, get information for
(you/him/her) on the Internet?

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

(01) KN51C - KNETOFTN
(02) BOX KN8
(-8) BOX KN8
(-9) BOX KN8

(01) EVERY DAY
(02) A FEW TIMES A WEEK
(03) A FEW TIMES PER MONTH
(04) A FEW TIMES PER YEAR OR LESS
(-8) Don't Know
(-9) Refused

BOX KN7

code 1

How often [do you/does (SP)] access the Internet to seek information, either on (your/his/her) own or with
someone else's help?
Please do not include any time spent reading or sending e-mail.

BOX KN7

KN27 - KBOKRECD

routing

IF SP DID NOT REPORT VISITING OR ACCESSING THE OFFICAL WEBSITE FOR MEDICARE
INFORMATION IN ANY PREVIOUS ROUND (SAMPLE_PERSON.P_KVISITWEB ^=1) GO TO KN53 KVSITWEB.
ELSE GO TO KN53D - KNDOCREC.

Page 2 of 3

2017 MCBS Community Questionnaire

Variable Name

KVSITWEB

MR Screen Name

KN53

KNQ-Beneficiary Knowledge and Information Needs

Question Type

Question Text/Description

Code List

Routing

yes/no

(Has anyone/[Have you/Has (SP)]) ever visited or ever accessed the official website for Medicare information www.medicare.gov (- for [you/(SP)])?

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

KN53D - KNDOCREC

Many health care providers are beginning to use electronic or computer-based medical records instead of using
paper-based records.
KNDOCREC

KCHIHELP

KREELINE

KN53D

yes/no

BOX KN8

routing

IF PROXY IS RESPONDENT, GO TO BOX KN9.
ELSE GO TO KN54 - KCHIHELP.

KN54

code 1

Most of the time, do you make decisions about Medicare health insurance on your own, do you get help from
someone in making these decisions, or do you rely on someone else to make decisions about health insurance
for you?

BOX KN9

routing

IF IT IS UNKNOWN WHETHER OR NOT THIS SP IS AWARE OF THE 1-800 MEDICARE LINE
(SAMPLE_PERSON.P_KREELINE = .), GO TO KN56 - KREELINE.
ELSE GO TO BOX KN10.

KN56

BOX KN10

KCPHINFO

KCSUGGST

(01) YES
When [you/(SP)] (visit/visits) (your/his/her) usual health care provider, does a doctor or other health professional (02) NO
generally enter [your/(SP's)] health information into a computer while (you are/he is/she is) present?
(-8) Don't Know
(-9) Refused
[EXPLAIN IF NECESSARY: "Health Information" includes information such as symptoms, vital signs, test
results, or prescribed medicines.]

KN57

KN58

yes/no

Before today, were you aware of the 1-800-MEDICARE toll-free line?

routing

IF SP DID NOT REPORT CALLING 1-800-MEDICARE TO GET INFORMATION ABOUT MEDICARE IN ANY
PREVIOUS ROUND (SAMPLE_PERSON.P_KCHPINFO ^= 1) GO TO KN57 - KCPHINFO.
ELSE GO TO KN58 - KCSUGGST.

yes/no

verbatim text

Have you ever called 1-800-MEDICARE to get information about Medicare?

As you know, this survey is sponsored by the Centers for Medicare and Medicaid Services, which is the
government agency that runs Medicare. What are your suggestions or concerns about Medicare?
RECORD VERBATIM.

KCSUGGVB

KN58

verbatim text

BOX KNEND

routing

BOX KN8

(01) MAKES DECISIONS ON OWN
(02) GETS HELP ON DECISIONS
(03) SOMEONE ELSE MAKES DECISIONS
(-8) Don't Know
(-9) Refused

BOX KN9

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

(01) KN57 - KCPHINFO
(02) KN58 - KCSUGGST
(-8) KN58 - KCSUGGST
(-9) KN58 - KCSUGGST

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

KN58 - KCSUGGST

(01) R DOES NOT HAVE SUGGESTIONS OR
CONCERNS
(02) RECORD ALL OTHER RESPONSES VERBATIM
(-8) Don't Know
(-9) Refused

(01) BOX KNEND
(02) KN58 - KCSUGGVB
(-8) BOX KNEND
(-9) BOX KNEND

BOX KNEND
IF INTTYPE in(C001, C004, C005, C006, C007, C010), GO TO CLQ.
IF INTTYPE in(C002), GO TO AVQ.

Page 3 of 3