PDP Only - Crosswalk

Current PDP Survey/Question Wording

YOUR FORMER PRESCRIPTION DRUG PLAN

Proposed PDP Survey/Question Wording

YOUR FORMER PRESCRIPTION DRUG PLAN

We are sending you this survey because we believe
We are sending you this survey because we
you recently changed or switched to another Medicare believe you recently switched or dropped your
prescription drug plan or dropped your Medicare
Medicare prescription drug plan.
prescription drug plan.

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Comments

Item count=54
HEADER

Item Count=54
HEADER

Item Count=54
HEADER

Introduction to Q1

Introduction to Q1

Introduction to Q1

Minor revisions made to Q1
introduction to improve
usability

No change to wording.

Our records show that you used to belong to
[MARKETING] (Contract Number [PREV_PLAN]) but no
longer belong to that plan. Is that right?
o Yes, I changed or switched prescription drug plans
o I changed or switched prescription drug plans but my
former plan was not [PLAN NAME]
o No, I did not change, switch or drop prescription drug
plans recently

Our records show that you used to belong to
1
prescription drug plan whose name is printed on
the cover of this survey but that you no longer
belong to that plan. Is that right?
o Yes, I switched to a different Medicare
prescription drug plan
o I switched prescription drug plans but my
former plan was not the plan printed on the
cover of this survey
o No, I did not switch plans or drop my Medicare
prescription drug plan recently

1

1

For streamlining and to reduce
fielding costs, the survey no
longer displays customized text
with the prior contract
name/number. Wording to Q1
and response options changed
for new version.

Did you have to change, switch or drop your
prescription drug plan for any of the following
reasons?
o I moved outside of the area where the plan was
available
o I was dropped by the plan
o The plan was cancelled or discontinued in my area
o The plan was changed or discontinued by the
organization that provides my insurance (such as a
former employer or a union)
o None of the above

Did you have to switch plans or drop your
2
former Medicare prescription drug plan for any
of the following reasons?
o I moved outside of the area where the plan
was available
o I was dropped by the plan
o The plan was cancelled or discontinued in my
area
o The plan was changed or discontinued by the
organization that provides my insurance (such as
a former employer or a union)
o None of the above

2

2

Re-worded Q2 to improve
usability (changed "did you have
to change, switch or drop" to
"did you have to switch plans or
drop").

GETTING INFORMATION OR HELP FROM YOUR
FORMER PRESCRIPTION DRUG PLAN

GETTING INFORMATION OR HELP FROM YOUR HEADER
FORMER PRESCRIPTION DRUG PLAN

HEADER

HEADER

No change to wording.

As you answer the questions in this survey, please
think only of your former health plan.

As you answer the questions in this survey,
please think only of your former prescription
drug plan (whose name is printed on the
cover of this survey).

Q3 preamble

Q3 preamble

Added reference to the plan
name printed on the cover of
the survey.

Did you ever try to get information or help from your
former plan’s customer service?
Yes/No

Did you ever try to get information or help from 3
your former plan’s customer service?
Yes/No

3

3

No change to wording.

1

Q3 preamble

Current PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Item count=54
4

Item Count=54
4

Item Count=54
4

5

DROPPED

DROPPED

How often did your former plan give you all the
Item has been dropped.
information you needed about which prescription
medicines were covered?
o Never
o Sometimes
o Usually
o Always
o I did not try to get information from my former plan
about which prescription medicines were covered.

6

DROPPED

DROPPED

Did you ever try to get information from your former
plan about how much you would have to pay for a
prescription medicine? Yes/No

Item has been dropped.

7

DROPPED

DROPPED

Equivalent item no longer exists
on the MA & PD CAHPS survey
for comparison of enrollee
experiences.

How often did your former plan give you information Item has been dropped.
about how much you would have to pay for a
prescription medicine?
o Never
o Sometimes
o Usually
o Always
o I did not try to get information from my former plan
about how much I would have to pay for a prescription
medicine

8

DROPPED

DROPPED

Equivalent item no longer exists
on the MA & PD CAHPS survey
for comparison of enrollee
experiences.

How often did your former plan’s customer service
give you the information or help you needed?
o Never
o Sometimes
o Usually
o Always
o I did not try to get information or help from my
former plan's customer service
Did you ever try to get information from your former
plan about which prescription medicines were
covered? Yes/No

2

Proposed PDP Survey/Question Wording

How often did your former plan’s customer
service give you the information or help you
needed?
o Never
o Sometimes
o Usually
o Always
o I did not try to get information or help from
my former plan's customer service
Item has been dropped.

Comments

No change to wording.

Equivalent item no longer exists
on the MA & PD CAHPS survey
for comparison of enrollee
experiences.
Equivalent item no longer exists
on the MA & PD CAHPS survey
for comparison of enrollee
experiences.

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Comments

Item Count=54
Item count=54
9 (SPANISH VERSION NA
ONLY)

Item Count=54
DROPPED

How often did the plan give you written information in Item has been dropped
Spanish?
o Never
o Sometimes
o Usually
o Always
o I did not need written information in Spanish

10 (SPANISH
VERSION ONLY)

NA

DROPPED

Spanish language version of the
survey is distributed almost
exclusively in Puerto Rico where
plans customarily provide
information in Spanish. Item
dropped due to low
endorsement and to reduce
burden.
Spanish language version of the
survey is distributed almost
exclusively in Puerto Rico where
plans customarily provide
information in Spanish. Item
dropped due to low
endorsement and to reduce
burden.

GETTING THE PRESCRIPTION MEDICINES YOU NEEDED GETTING THE PRESCRIPTION MEDICINES YOU
FROM YOUR FORMER PRESCRIPTION DRUG PLAN
NEEDED FROM YOUR FORMER PRESCRIPTION
DRUG PLAN

HEADER

HEADER

HEADER

No change in wording.

Did a doctor ever prescribe a medicine for you that
your former plan did not cover? Yes/No

Item has been dropped.

9

DROPPED

DROPPED

How often was it easy to use your former plan to get
the medicines your doctor prescribed?
o Never
o Sometimes
o Usually
o Always
o I did not use my former plan to get any prescription
medicines.

How often was it easy to use your former plan
to get the medicines your doctor prescribed?
o Never
o Sometimes
o Usually
o Always
o I did not use my former plan to get any
prescription medicines.

10

5

5

Equivalent item no longer exists
on the MA & PD CAHPS survey
for comparison of enrollee
experiences.
No change to wording.

11

6

6

No change to wording.

Did you ever need written information from the plan in Item has been dropped
Spanish? Yes/No

Did you ever use your former plan to fill a prescription Did you ever use your former plan to fill a
at a pharmacy? Yes/No
prescription at a pharmacy? Yes/No

3

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Comments

Item count=54
12

Item Count=54
7

Item Count=54
7

No change to wording.

How often was it easy to use your former plan to fill a
prescription at a pharmacy?
o Never
o Sometimes
o Usually
o Always
o I did not have to use my former plan to fill a
prescription at a pharmacy

How often was it easy to use your former plan
to fill a prescription at a pharmacy?
o Never
o Sometimes
o Usually
o Always
o I did not have to use my former plan to fill a
prescription at a pharmacy

Did you ever use your former plan to fill any
prescriptions by mail? Yes/No

Did you ever use your former plan to fill any
prescriptions by mail? Yes/No

13

8

8

No change to wording.

How often was it easy to use your former plan to fill
prescriptions by mail?
o Never
o Sometimes
o Usually
o Always
o I did not use my former plan to fill a prescription by
mail

How often was it easy to use your former plan
to fill prescriptions by mail?
o Never
o Sometimes
o Usually
o Always
o I did not use my former plan to fill a
prescription by mail

14

9

9

No change to wording.

Using any number from 0 to 10, where 0 is the worst
prescription drug plan possible and 10 is the best
prescription drug plan possible, what number would
you use to rate your former plan?

Using any number from 0 to 10, where 0 is the 15
worst prescription drug plan possible and 10 is
the best prescription drug plan possible, what
number would you use to rate your former
plan?
REASONS YOU LEFT YOUR FORMER
HEADER
PRESCRIPTION DRUG PLAN
The next questions are about reasons you may Q16 preamble
have had for switching or dropping your former
prescription drug plan.

10

10

No change to wording.

HEADER

HEADER

No change to wording.

Q11 preamble

Q11 preamble

REASONS YOU LEFT YOUR FORMER PRESCRIPTION
DRUG PLAN
The next questions are about reasons you may have
had for changing, switching or dropping your former
prescription drug plan.

Did you leave your former plan because you found out Did you leave your former plan because you
that someone had signed you up for the plan without found out that someone had signed you up for
your permission? Yes/No
the plan without your permission? Yes/No

16

11

11

Re-worded preamble to
improve usability by revising
"changing, switching or
dropping" to "switching or
dropping."
No change to wording.

Did you leave your former plan because you were
taken off the plan by mistake? Yes/No

17

12

12

No change to wording.

4

Did you leave your former plan because you
were taken off the plan by mistake? Yes/No

Current PDP Survey/Question Wording

Did you leave your former plan because the dollar
amount you had to pay each time you filled or refilled
a prescription went up?
o Yes
o No
o I did not have to pay for my prescription medicines

Proposed PDP Survey/Question Wording

Did you leave your former plan because the
dollar amount you had to pay each time you
filled or refilled a prescription went up?
o Yes
o No
o I did not have to pay for my prescription
medicines

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Item count=54
18

Item Count=54
13

Item Count=54
13

No change to wording.

14

14

No change to wording.

Some people have to pay their prescription drug plan a Some people have to pay their prescription drug 19
monthly fee (called a premium) out of their own
plan a monthly fee (called a premium) out of
pocket for prescription drug coverage.
their own pocket for prescription drug coverage.

Comments

Did you leave your former plan because this monthly
fee went up?
o Yes
o No
o I did not have to pay my former plan a monthly fee
out of my own pocket

Did you leave your former plan because this
monthly fee went up?
o Yes
o No
o I did not have to pay my former plan a
monthly fee out of my own pocket

Prescription drug plans have a list of the prescription
medicines they will cover. Did you leave your former
plan because they changed the list of prescription
medicines they cover? Yes/No

Prescription drug plans have a list of the
prescription medicines they will cover. Did you
leave your former plan because they changed
the list of prescription medicines they cover?
Yes/No

20

15

15

No change to wording.

Did you leave your former plan because you found a
prescription drug plan that costs less? Yes/No

Did you leave your former plan because you
found a prescription drug plan that costs less?
Yes/No

21

16

16

No change to wording.

Did you leave your former plan because a change in
your personal finances meant you could no longer
afford the plan? Yes/No

Did you leave your former plan because a
change in your personal finances meant you
could no longer afford the plan? Yes/No

22

17

17

No change to wording.

5

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Item count=54
NOT INCLUDED

Item Count=54
18

Item Count=54
18

NOT INCLUDED

19

19

Did you leave your former plan because the plan
Did you leave your former plan because the plan 23
refused to pay for a medicine your doctor prescribed? refused to pay for a medicine your doctor
Yes/No
prescribed? Yes/No

20

20

New item added to further
assess possible reasons
beneficiaries leave their former
plan.
New item added to further
assess possible reasons
beneficiaries leave their former
plan.
No change to wording.

Did you leave your former plan because you had
problems getting the medicines your doctor
prescribed? Yes/No

Did you leave your former plan because you had 24
problems getting the medicines your doctor
prescribed? Yes/No

21

21

No change to wording.

Did you leave your former plan because it was difficult
to get brand name medicines?
o Yes
o No
o I did not try to get brand name medicines through
my former plan

Did you leave your former plan because it was
difficult to get brand name medicines?
o Yes
o No
o I did not try to get brand name medicines
through my former plan

25

22

22

No change to wording.

Did you leave your former plan because you were
Did you leave your former plan because you
frustrated by the plan’s approval process for medicines were frustrated by the plan’s approval process
for medicines your doctor prescribed? Yes/No
your doctor prescribed? Yes/No

26

23

23

No change to wording.

Did you leave your former plan because you did not
Did you leave your former plan because you did 27
know whom to contact when you had a problem filling not know whom to contact when you had a
or refilling a prescription?
problem filling or refilling a prescription? Yes/No
Yes/No

24

24

No change to wording.

Did you leave your former 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?
Yes/No

Did you leave your former plan because it was 28
hard to get information from the plan
-- like which prescription medicines were
covered or how much a specific medicine would
cost? Yes/No

25

25

No change to wording.

Did you leave your former plan because you were
unhappy with how the plan handled a question or
complaint?
Yes/No

Did you leave your former plan because you
were unhappy with how the plan handled a
question or complaint?
Yes/No

26

26

No change to wording.

NOT INCLUDED

Did you leave your former plan because a
change in your health meant the plan no longer
met your needs? Yes/No

NOT INCLUDED

Did you leave your former plan because it
turned out to be more expensive than you
expected? Yes/No

6

29

Comments

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Item count=54
30

Item Count=54
27

Item Count=54
27

No change to wording.

Did you leave your former plan because their customer Did you leave your former plan because their
service staff did not treat you with courtesy and
customer service staff did not treat you with
respect? Yes/No
courtesy and respect? Yes/No

31

28

28

No change to wording.

Every year Medicare evaluates all prescription drug
plans and gives them a star rating that gives
information on prescription drug plan quality.

Every year Medicare evaluates all prescription
drug plans and gives them a star rating.

Q32 preamble

Q29 preamble

Q29 preamble

Re-worded the preamble to
improve usability.

Have you ever seen the Medicare Star Rating for any
health plan? Yes/No

Item has been dropped

32

DROPPED

DROPPED

Low endorsement; removed to
reduce respondent burden

Did you leave your former plan because it got a low
star rating? Yes/No

Did you leave your former plan because it got a 33
low Medicare star rating? Yes/No

29

29

Inserted "Medicare" before
"star rating" for added clarity.

Did you leave your former plan because you found
another plan with a higher star rating? Yes/No

Did you leave your former plan because you
34
found another plan with a higher Medicare star
rating? Yes/No

30

30

Inserted "Medicare" before
"star rating" for added clarity.

In the past year, did you consider Medicare Star
Ratings when trying to choose a plan? Yes/No

Item has been dropped

DROPPED

DROPPED

Low endorsement; removed to
reduce respondent burden

OTHER REASONS FOR LEAVING YOUR FORMER
PRESCRIPTION DRUG PLAN

OTHER REASONS FOR LEAVING YOUR FORMER HEADER
PRESCRIPTION DRUG PLAN

HEADER

HEADER

No change in wording.

Did you leave your former plan because a family
member or friend told you about a better plan?
Yes/No

Did you leave your former plan because a family 36
member or friend told you about a better plan?
Yes/No

31

31

No change to wording.

Did you leave your former plan because you saw a
commercial or advertisement for a health plan you
thought you would like better? Yes/No

Did you leave your former plan because you saw 37
a commercial or advertisement for a health plan
you thought you would like better? Yes/No

32

32

No change to wording.

33

33

No change to wording.

Did you leave your former plan because you could not Did you leave your former plan because you
get the information or help you needed from the plan? could not get the information or help you
Yes/No
needed from the plan? Yes/No

Did you leave your former plan because you found
Did you leave your former plan because you
another plan that better met your prescription needs? found another plan that better met your
Yes/No
prescription needs? Yes/No

7

35

38

Comments

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Comments

Item count=54
39

Item Count=54
34

Item Count=54
34

No change in wording.

HEADER
40

HEADER
35

HEADER
35

No change in wording.
No change in wording.

Did you leave your former plan because you take very
few prescription medicines and don’t need a
prescription drug plan?
Yes/No
ABOUT YOU
In general, how would you rate your overall health?
o Excellent
o Very good
o Good
o Fair
o Poor

Did you leave your former plan because you
take very few prescription medicines and don’t
need a prescription drug plan?
Yes/No
ABOUT YOU
In general, how would you rate your overall
health?
o Excellent
o Very good
o Good
o Fair
o Poor

In general, how would you rate your overall mental or
emotional health?
o Excellent
o Very good
o Good
o Fair
o Poor

In general, how would you rate your overall
mental or emotional health?
o Excellent
o Very good
o Good
o Fair
o Poor

41

36

36

No change to wording.

In the past 12 months, how many different
prescription medicines did you take?
o None
o 1 to 2 medicines
o 3 to 5 medicines
o 6 or more medicines
In the past 12 months, have you seen a doctor or other
health provider 3 or more times for the same condition
or problem? Yes/No

In the past 12 months, how many different
42
prescription medicines did you take?
o None
o 1 to 2 medicines
o 3 to 5 medicines
o 6 or more medicines
In the past 12 months, have you seen a doctor 43
or other health provider 3 or more times for the
same condition or problem? Yes/No

37

37

No change to wording.

38

38

No change to wording.

Is this a condition or problem that has lasted for at
least 3 months? Yes/No

Is this a condition or problem that has lasted for 44
at least 3 months? Yes/No

39

39

No change to wording.

45

40

40

No change to wording.

46

41

41

No change to wording.

Do you now need or take any medicine prescribed by a Do you now need or take any medicine
doctor for any condition? Yes/No
prescribed by a doctor for any condition?
Yes/No
Is this medicine to treat a condition that has lasted for Is this medicine to treat a condition that has
at least 3 months? Yes/No
lasted for at least 3 months? Yes/No

8

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Has a doctor ever told you that you have any of the
following conditions?
o A heart attack
o Angina or coronary heart disease
o High blood pressure or hypertension
o Cancer, other than skin cancer
o Emphysema, asthma or COPD (chronic obstructive
pulmonary disease)
o Any kind of diabetes or high blood sugar

Item count=54
Has a doctor ever told you that you have any of 47
the following conditions?
o A heart attack
o Angina or coronary heart disease
o High blood pressure or hypertension
o Cancer, other than skin cancer
o Emphysema, asthma or COPD (chronic
obstructive pulmonary disease)
o Any kind of diabetes or high blood sugar

Item Count=54
42

Item Count=54
42

No change to wording.

What is the highest grade or level of school that you
have completed?
o 8th grade or less
o Some high school, but did not graduate
o High school graduate or GED
o Some college or 2-year degree
o 4-year college graduate
o More than 4-year college degree

What is the highest grade or level of school that 48
you have completed?
o 8th grade or less
o Some high school, but did not graduate
o High school graduate or GED
o Some college or 2-year degree
o 4-year college graduate
o More than 4-year college degree

43

43

No change in wording.

Are you of Hispanic or Latino origin or descent?
o Yes, Hispanic or Latino
o No, not Hispanic or Latino

Are you of Hispanic or Latino origin or descent? 49
o Yes, Hispanic or Latino
o No, not Hispanic or Latino

44

44

No change in wording.

What is your race? Please mark one or more.
o White
o Black or African-American
o Asian
o Native Hawaiian or other Pacific Islander
o American Indian or Alaska Native

What is your race? Please mark one or more.
o White
o Black or African-American
o Asian
o Native Hawaiian or other Pacific Islander
o American Indian or Alaska Native

50

45

45

No change in wording.

What language do you mainly speak at home?
o Chinese
o English
o Russian
o Spanish
o Vietnamese
o Some other language (please print)

What language do you mainly speak at home?
o Chinese
o English
o Russian
o Spanish
o Vietnamese
o Some other language (please print)

51

46

46

No change in wording.

9

Current English
Language Survey
Question Number

Comments

Current PDP Survey/Question Wording

Proposed PDP Survey/Question Wording

Current English
Language Survey
Question Number

Proposed English
Language Survey
Question Number

Proposed Spanish
Language Survey
Question Number

Comments

Item count=54
52

Item Count=54
47

Item Count=54
47

No change in wording.

Did someone help you complete this survey?
Yes/No

Did someone help you complete this survey?
Yes/No

How did that person help you? Please mark one or
more.
o Read the questions to me
o Wrote down the answers I gave
o Answered the questions for me
o Translated the questions into my
language
o Helped in some other way (please
print) _____________________________

How did that person help you? Please mark one 53
or more.
o Read the questions to me
o Wrote down the answers I gave
o Answered the questions for me
o Translated the questions into my
language
o Helped in some other way (please
print) _____________________________

48

48

No change to wording.

May we contact you again if we have questions about
your survey responses or if we have other questions
about the health care services that you received?
Yes/No

May we contact you again if we have questions 54
about your survey responses or if we have other
questions about the health care services that
you received?
Yes/No

49

49

No change to wording.

10