CMS-P-0015A Beneficiary Knowledge

2021 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.

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?]

KCARKNOW

KN2

code 1

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

KN25B1 - KNINFMCR

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2021 MCBS Community Questionnaire

KNINFMCR

KN25B1

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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
KN25E-KNCOVREV
(05) DOES NOT MAKE DECISIONS ON
HEALTH INSURANCE
(-8) Don't Know
(-9) Refused

(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
KN35F-KNCOVINF
(06) ONLY ONCE WHEN FIRST
SIGNED UP FOR MEDICARE
(07) JUST SIGNED UP FOR MEDICARE
(-8) DON'T KNOW
(-9) REFUSED

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2021 MCBS Community Questionnaire

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

SHOW CARD KN6

KNCOVINF

KN25F

code 1

To what extent do you agree or disagree with the following statement:
[I have/(SP) has] the information [I need/he needs/she needs] to make an informed
comparison among different health insurance choices.
Would you say you …

SHOW CARD KN7
KNFOSATI

KN26

code 1

KN27IN

KN27INT

no entry

How satisfied are you in general with the availability of information about the Medicare
program when you need it [for (SP)]?

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

SHOW CARD KN8
KBOKRECD

KBOKREAD

KN27

KN28

yes/no

code 1

Did [you/(SP)] receive in the mail or view on the Medicare website a book called "Medicare
and You [CURRENT YEAR]?” This book gives an overview of the Medicare program and is
sent to Medicare beneficiaries every fall. The cover looks like this.

(01) Completely agree
(02) Somewhat agree
(03) Somewhat disagree
(04) Completely disagree
KN26 - KNFOSATI
(05) DOES NOT MAKE DECISIONS ON
HEALTH INSURANCE
(-8) Don't Know
(-9) Refused

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

KN27INT - KN27IN

(01) CONTINUE
(-7) Empty

KN27 - KBOKRECD

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

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

(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
(03) HAVEN'T READ IT AT ALL
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

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2021 MCBS Community Questionnaire

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

SHOW CARD KN9
How easy or difficult did you find (the parts you read/this book) to understand?
KBOKUNDR

KN29

code 1
[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.]

(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

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

KNETPERS

KN51A

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

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?

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

code 1

(01) EVERY DAY
(02) A FEW TIMES A WEEK
How often [do you/does (SP)] access the Internet to seek information, either on (your/his/her)
(03) A FEW TIMES PER MONTH
own or with someone else's help?
(04) A FEW TIMES PER YEAR OR
LESS
Please do not include any time spent reading or sending e-mail.
(-8) Don't Know
(-9) Refused

KNETOFTN

KN51C

BOX KN7

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2021 MCBS Community Questionnaire

KVSITWEB

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

BOX KN7

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 BOX KN8 KN53A-KCOMINTE

KN53

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)])?

Now I have some questions that ask about how Medicare beneficiaries use the Internet to
access health care related information.
KCOMINTE

KN53A

Grid

DURING THE PAST 12 MONTHS, (has anyone/have you) used the Internet to

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

BOX KN8 KN53A-KCOMINTE

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

KN53A -KCOMPRES

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

KN53A -KCOMAPPO

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

KN53A -KCOMCOMM

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

BOX KN8

Look up health information (for [you/(SP)])?

Now I have some questions that ask about how Medicare beneficiaries use the Internet to
access health care related information.
KCOMPRES

KN53A

Grid

DURING THE PAST 12 MONTHS, (has anyone/have you) used the Internet to
Fill a prescription (for [you/(SP)])?

Now I have some questions that ask about how Medicare beneficiaries use the Internet to
access health care related information.
KCOMAPPO

KN53A

Grid

DURING THE PAST 12 MONTHS, (has anyone/have you) used the Internet to
Schedule an appointment with a health care provider (for [you/(SP)])?

Now I have some questions that ask about how Medicare beneficiaries use the Internet to
access health care related information.
KCOMCOMM

KN53A

Grid
DURING THE PAST 12 MONTHS, (has anyone/have you) used the Internet to
Communicate with a health care provider (for [you/(SP)])?

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2021 MCBS Community Questionnaire

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 SP HAS NOT BEEN ASKED KREELINE IN A PREVIOUS ROUND
(SAMPLE_PERSON.P_KREELINE = .), GO TO KREELINE.
ELSE GO TO BOX KN10.

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-OEINTRO1

BOX KN8

KCHIHELP

KREELINE

KCPHINFO

OEINTRO1

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

KN57

KN58

(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-OEINTRO1
(-8)KN58-OEINTRO1
(-9) KN58-OEINTRO1

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

yes/no

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

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
(01) CONTINUE
Annual Coordinated Enrollment Period. The Open Enrollment Period runs each year from midOctober to early-December.

KN58 - OEINTRO1

KN58A - RVWCOST

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2021 MCBS Community Questionnaire

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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?
RVWCOST

KN58A

code 1

(01) YES
(02) NO
(03) NOT APPLICABLE, JUST SIGNED
KN58B - RVWSRVC
UP FOR MEDICARE
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual
(-8) DON'T KNOW
Election Period or Annual Coordinated Enrollment Period – runs each year from mid-October
(-9) REFUSED
to early-December.]

During the last open enrollment period, did [you/(SP)] review [your/his/her] Medicare
insurance coverage to see if the kinds of treatment, drugs, and services covered will meet
[your/his/her] health care needs?
RVWSRVC

CMPRPLN

KN58B

KN58C

code 1

(01) YES
(02) NO
(03) NOT APPLICABLE, JUST SIGNED
KN58C - CMPRPLN
UP FOR MEDICARE
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual
(-8) DON'T KNOW
Election Period or Annual Coordinated Enrollment Period – runs each year from mid-October
(-9) REFUSED
to early-December.]

code 1

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

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

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2021 MCBS Community Questionnaire

KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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

CPLNTYPE

KN58D

select all

KCSUGGST

KN59

verbatim text

KCSUGGVB

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) 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

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

KN59 - KCSUGGST

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

BOX KNEND

GO TO USQ.

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