CMS-P-0015A Beneficiary Knowledge

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name

KNQ - BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

Question Type

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
SPALIVE=1
SEASON=WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after PVQ.

KNINTR

KNINTRO

no entry

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.
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?]
SHOW CARD KN2

KCARKNOW

KN2

code 1

How much do you think you know about the Medicare program?
Do you know just about everything you need to know, most of what you need to know, some of what you need to
know, a little of what you need to know or almost none of what you need to know about the Medicare program?

KNINFMCR

KN25B1

yes/no

KNINTMCR

KN25C

code 1

KNCOVOPT

KN25D

code 1

KNCOVREV

KN25E

code 1

KNCOVINF

KN25F

code 1

KNFOSATI

KN26

code 1

KN27IN

KN27INT

no entry

KBOKRECD

KN27

yes/no

KBOKREAD

KN28

code 1

KBOKUNDR

KN29

code 1

(01) JUST ABOUT EVERYTHING YOU NEED TO
KNOW
(02) MOST OF WHAT YOU NEED TO KNOW
(03) SOME OF WHAT YOU NEED TO KNOW
KN25B1 - KNINFMCR.
(04) A LITTLE OF WHAT YOU NEED TO KNOW
(05) ALMOST NONE OF WHAT YOU NEED TO KNOW
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
In the past year, have you tried to find any information [for (SP)] about Medicare?
(-8) Don't Know
(-9) Refused
(01) VERY INTERESTED
(02) SOMEWHAT INTERESTED
SHOW CARD KN3
(03) NOT VERY INTERESTED
(04) NOT AT ALL INTERESTED
How interested are you in getting (more) information [for (SP)] about Medicare?
(-8) Don't Know
(-9) Refused
(01) Very easy
(02) Somewhat easy
SHOW CARD KN4
(03) Somewhat difficult
(04) Very difficult
How easy or difficult would you say it is for [you/(SP)] to review and compare [your/his/her] Medicare coverage
(05) DOES NOT MAKE DECISIONS ON HEALTH
options? Would you say it is …
INSURANCE
(-8) Don't Know
(-9) Refused
(01) AT LEAST ONCE EVERY YEAR
(02) ONCE EVERY FEW YEARS
(03) RARELY
(04) NEVER
SHOW CARD KN5
(05) ONLY ONCE WHEN FIRST SIGNED UP FOR
DRUG PLAN
How often [do you/does (SP)] review or compare [your/his/her] Medicare coverage options? Would that be at least
(06) ONLY ONCE WHEN FIRST SIGNED UP FOR
once every year, once every few years, rarely, or never?
MEDICARE
(07) JUST SIGNED UP FOR MEDICARE
(-8) DON'T KNOW
(-9) REFUSED
(01) Completely agree
SHOW CARD KN6
(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
(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 [for
(05) NOT APPLICABLE
(SP)]?
(-8) Don't Know
(-9) Refused
(01) CONTINUE
Now I would like to ask you about publications that are available to you [and (SP)] about the Medicare program.
(-7) Empty
SHOW CARD KN8
(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. The
(-9) Refused
cover looks like this.
(01) READ IT THOROUGHLY
(02) READ PARTS OF IT
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?
(03) HAVEN'T READ IT AT ALL
(-8) Don't Know
(-9) Refused
SHOW CARD KN9
(01) VERY EASY
(02) SOMEWHAT EASY
How easy or difficult did you find (the parts you read/this book) to understand?
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
[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?]
(-9) Refused

KN25C - KNINTMCR

KN25D-KNCOVOPT

KN25E-KNCOVREV

KN35F-KNCOVINF

KN26 - KNFOSATI

KN27INT - KN27IN

KN27 - KBOKRECD
(01) KN28 - KBOKREAD
(02) KN50 - KNHAVCOM
(-8) KN50 - KNHAVCOM
(-9) KN50 - KNHAVCOM
(01) KN29 - KBOKUNDR
(02) KN29 - KBOKUNDR
(03) KN50 - KNHAVCOM
(-8) KN50 - KNHAVCOM
(-9) KN50 - KNHAVCOM

KN50 - KNHAVCOM

Page 1 of 3

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name

KNQ - BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

Question Type

KNHAVCOM

KN50

yes/no

KN51IN

KN51INT

no entry

Question Text/Description
Next, I'd like to ask about [your/(SP's)] use of computers.
[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.
[EXPLAIN IF NECESSARY: The Internet includes web sites, e-mail, newsgroups, and other forums.]

KNETPERS

KN51A

code 1

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

KNETFRND

KN51B

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?

KNETOFTN

KN51C

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

KVSITWEB

KN53

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.

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

KNDOCREC

KN53D

yes/no

When [you/(SP)] (visit/visits) (your/his/her) usual health care provider, does a doctor or other health professional
generally enter [your/(SP's)] health information into a computer while (you are/he is/she is) present?
[EXPLAIN IF NECESSARY: "Health Information" includes information such as symptoms, vital signs, test results, or
prescribed medicines.]

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.

BOX KN8

KCHIHELP

KREELINE

KN56

yes/no

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

BOX KN10

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.

Code List

Routing

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

KN51INT - KN51IN

(01) CONTINUE
(-7) Empty

KN51A - KNETPERS

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

KN53D - KNDOCREC

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

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
TKN58 - OEINTRO

KN57

yes/no

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

OEINTRO

KN58

no entry

Now I would like to ask you about comparisons [you/(SP)] may have made during the last Medicare Open Enrollment
Period, which is sometimes called the Annual Election Period or Annual Coordinated Enrollment Period. The Open
(01) CONTINUE
Enrollment Period runs each year from mid-October to early-December.

RVWSRVC

CMPRPLN

KN58A

KN58B

KN58C

BOX KN7

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

KCPHINFO

RVWCOST

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

(01) YES
(02) NO
(03) NOT APPLICABLE, JUST SIGNED UP FOR
MEDICARE
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual Election Period or Annual (-8) DON'T KNOW
Coordinated Enrollment Period – runs each year from mid-October to early-December.]
(-9) REFUSED

KN58B - RVWSRVC

code 1

(01) YES
During the last open enrollment period, did [you/(SP)] review [your/his/her] Medicare insurance coverage to see if the
(02) NO
kinds of treatment, drugs, and services covered will meet [your/his/her] health care needs?
(03) NOT APPLICABLE, JUST SIGNED UP FOR
MEDICARE
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual Election Period or Annual
(-8) DON'T KNOW
Coordinated Enrollment Period – runs each year from mid-October to early-December.]
(-9) REFUSED

KN58C - CMPRPLN

code 1

As you know, Medicare beneficiaries can choose different types of Medicare insurance plans. During the last open
(01) YES
enrollment period, did [you/(SP)] compare [your/his/her] Medicare insurance plan with other Medicare plans that were (02) NO
available?
(03) NOT APPLICABLE, JUST SIGNED UP FOR
MEDICARE
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual Election Period or Annual (-8) DON'T KNOW
Coordinated Enrollment Period – runs each year from mid-October to early-December.]
(-9) REFUSED

(01) KN58D - CPLNTYPE
(02) KN59 - KCSUGGST
(03) KN59 - KCSUGGST
(-8) KN59 - KCSUGGST
(-9) KN59 - KCSUGGST

code 1

During the last open enrollment period, did [you/(SP)] review [your/his/her] Medicare insurance coverage to see if
there were going to be changes in [your/his/her] monthly premium, deductibles, co-payments, or other out of pocket
expenses?

KN58A - RVWCOST

Page 2 of 3

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name

KNQ - BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

Question Type

Question Text/Description

Code List

Routing

(01) Medicare Parts A and B (Original Medicare)
(02) Medicare Part C, Medicare Advantage (MA) Plans
(03) Medicare Part D, Medicare Prescription Drug Plans
(MPDPs)
(04) Medigap Plans
(-8) DON'T KNOW
(-9) REFUSED

KN59 - KCSUGGST

SHOWCARD KN10
What types of Medicare plans did [you/(SP)] compare with [your/his/her] Medicare insurance plan?

CPLNTYPE

KN58D

select all

KCSUGGST

KN58 KN59

verbatim text

KCSUGGVB

KN58 KN59

verbatim text

BOX KNEND

routing

[EXPLAIN IF NECESSARY:
-Medicare Parts A and B, commonly referred to as “Original Medicare,” provide hospital and medical insurance.
-Medicare Part C includes Medicare Advantage plans. These are plans offered to Medicare beneficiaries by private
companies (approved by Medicare) and provide beneficiaries with their Part A and B benefits. Medical Advantage is
an alternative to Original Medicare.
-Part D covers prescription drugs -- this type of plan is also known as an MPDP. Prescription drug plans are offered
by private companies (approved by Medicare).
- Medigap is a supplemental insurance plan sold by private companies for use with Original Medicare. It cannot be
used with Medicare Advantage. Medigap plans help pay some of the health care costs that Original Medicare doesn't
cover, like copayments, coinsurance and deductibles.]

(01) R DOES NOT HAVE SUGGESTIONS OR
As you know, this survey is sponsored by the Centers for Medicare and Medicaid Services, which is the government
CONCERNS
agency that runs Medicare. What are your suggestions or concerns about Medicare?
(02) RECORD ALL OTHER RESPONSES VERBATIM
(-8) Don't Know
RECORD VERBATIM.
(-9) Refused

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

GO TO USQ.

Page 3 of 3