Form CMS-10710.GenIC#4 Healthcare.gov Web Satisfaction Survey

HealthCare.gov Satisfaction Survey 2020 Instrument Page 1
HealthCare.gov is looking for your feedback. Thanks for taking a moment to tell us about your
experience today on HealthCare.gov!
Ask ALL

Q1 Which of these best describes you?
1. An individual or family who currently does NOT have Marketplace health insurance, but
is interested in getting Marketplace insurance
2. An individual or family who currently has Marketplace health insurance (Non-OE) OR
An individual or family interested in re-enrolling or renewing Marketplace health
insurance (During OE)
3. A small business employee
4. A small business employer
5. A CMS call center representative
6. A CMS certified assister or navigator
7. A CMS certified broker or agent
8. An insurance company representative
9. Other (Specify)
Skip To: Q3 If Which of these best describes you? = 3-9
Ask Q2 series if Q1 = 1 or 2

Q2 Do you currently have health insurance?
1. Yes
2. No
3. Don’t know
4. Refused
Q2A Have you ever had health insurance through the Health Insurance Marketplace?
1. Yes
2. No
3. Don’t know
4. Refused
Q2B Who are you interested in getting insurance for?
1. Only for myself
2. For myself and others
3. Only for others, not myself
4. Other (specify)
Ask ALL

Q3 What is the main reason you came to HealthCare.gov today? If you came for more than
one reason, please select the main one.
1. Find information about Marketplace health insurance (like how it works, what’s covered,
or cost information)
2. Create an account
3. View plans and prices BEFORE filling out an application -- (See Plans and Prices)
4. Start, continue, or update an application
5. Shop and compare plans AFTER filling out an application
6. Enroll in or re-enroll a plan
7. Other (Specify)
Skip To: Q3A2 if Q3 = 7

HealthCare.gov Satisfaction Survey 2020 Instrument Page 2

Ask if Q3 = 1-6

Q3A1 You selected [insert Q5 response] as the main reason you came to HealthCare.gov.
Were you able to successfully complete the activity you came to do during your visit today?
1. Yes
2. No
3. Don’t know
4. Not Applicable
Skip To: Q4
Ask if Q3 = 7

Q3A2 Were you able to successfully complete the activity you came to do during your visit
today?
1. Yes
2. No
3. Don’t know
4. Not Applicable
Ask ALL

Q4 Overall, how easy or difficult was it to do that activity?
1. Very easy
2. Somewhat easy
3. Neutral
4. Somewhat difficult
5. Very difficult
6. Not applicable – did not attempt an activity
Ask Q5A if Q3 = 1

Q5A1 Did you find the information you were looking for on HealthCare.gov?
1. Yes
2. No
3. Not applicable
Skip To: Q6
Ask Q5B series if Q3 = 4 or 5

Q5B1 Did you submit your application for health insurance on HealthCare.gov by pressing
the SUBMIT APPLICATION button?
1. Yes
2. No
Skip To: Q6 if Q5b = 2

Q5B2 After you submitted your application, did the website give you information showing
if you are eligible to get help paying for insurance?
1. Yes
2. No
3. I don't know
Skip To: Q6 if Q5B2 = 2 or 3

HealthCare.gov Satisfaction Survey 2020 Instrument Page 3
Ask if Q5B2 = 1

Q5B3 Did the Eligibility Notice say that someone in your household qualifies for any of
these? (Check all that apply)
1. A health plan with extra savings through reduced deductibles or copayments (called costsharing reduction plans)
2. A health plan with a premium tax credit to lower your monthly premium
3. A health plan, but no cost-sharing reduction and no tax credit
4. A state insurance program for people with low income, such as Medicaid or CHIP
5. I don’t know
Ask if Q5B2 = 1

Q5B4 Overall, how easy or difficult was it to understand your Eligibility Notice?
1. Very easy
2. Somewhat easy
3. Neutral
4. Somewhat difficult
5. Very difficult
6. I didn’t read the Eligibility Notice
Skip To: Q6
Ask if Q3 = 5 or 6

Q5C How confident are you that the information you saw on HealthCare.gov will help you
select the right health plan for you?
1. Very confident
2. Somewhat confident
3. Neutral
4. Not very confident
5. Not at all confident
6. I don’t know
7. Not applicable
Skip To: Q6
Ask if Q3 = 3 or 5

Q5D When you were comparing health plans or choosing your plan, did you notice that the
website showed star ratings to indicate the quality of each health plan?
1. Yes
2. No
3. I don't know
Skip To: Q6 If Q5D = 2 or 3
Ask Q5D series if Q5D = 1

Q5D1 How important were the star ratings in helping you decide what health plan to
choose?
1. Very important
2. Somewhat important
3. Neutral
4. Not very important
5. Not at all important
6. I don't know

HealthCare.gov Satisfaction Survey 2020 Instrument Page 4
Q5D2 How confident are you that the star ratings helped you select a high-quality health
plan?
1. Very confident
2. Somewhat confident
3. Neutral
4. Not very confident
5. Not at all confident
6. I don't know
Ask Q6 Series of ALL

Q6A How satisfied are you with the information provided on HealthCare.gov?
1. Very satisfied
2. Somewhat satisfied
3. Neither satisfied nor dissatisfied
4. Not very satisfied
5. Not at all satisfied
6. I don't know
Q6B How satisfied are you with how well the HealthCare.gov website worked today?
1. Very satisfied
2. Somewhat satisfied
3. Neither satisfied nor dissatisfied
4. Not very satisfied
5. Not at all satisfied
6. I don't know
Q6C How satisfied are you with your overall experience on HealthCare.gov?
1. Very satisfied
2. Somewhat satisfied
3. Neither satisfied nor dissatisfied
4. Not very satisfied
5. Not at all satisfied
6. I don't know
Ask if Q6A, Q6B, or QcC =4 or 5

Q6D How can we improve your overall experience on HealthCare.gov? Please be specific.
OPEN ENDED ________________________________________________________________
Ask ALL

Q7 How likely are you to recommend HealthCare.gov to family or friends who need health
insurance?
1. Very likely
2. Somewhat likely
3. Neutral
4. Not very likely
5. Not at all likely
6. Not applicable

HealthCare.gov Satisfaction Survey 2020 Instrument Page 5
Ask ALL

Q8 How likely will you be to return to HealthCare.gov if you need information in the
future?
1. Very likely
2. Somewhat likely
3. Neutral
4. Not very likely
5. Not at all likely
6. Not applicable
Thank you for completing the survey.

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