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pdf2021 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?]
Page 1 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
Code list
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
KNINFMCR
KN25B1
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 …
Routing
KN25B1 - KNINFMCR
(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
Page 2 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
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?
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.
Code list
Routing
(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
(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
Page 3 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
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.
How easy or difficult did you find (the parts you read/this book) to understand?
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
Routing
(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
SHOW CARD KN9
KBOKUNDR
Code list
no entry
[EXPLAIN IF NECESSARY: The Internet includes web sites, e-mail, newsgroups, and other
forums.]
(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
Page 4 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
Code list
Routing
(01) KN51C - KNETOFTN
(02) KN51B - KNETFRND
(03) BOX KN7
(-8) BOX KN7
(-9) BOX KN7
(01) KN51C - KNETOFTN
(02) BOX KN7
(-8) BOX KN7
(-9) BOX KN7
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
KN51C
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
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 - KVSTSITE.
ELSE GO TO KN53A-KCOMINTE
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)])?
KNETOFTN
KVSTSITE
KN53
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
BOX KN7
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
KN53A-KCOMINTE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
KN53A -KCOMPRES
Look up health information (for [you/(SP)])?
Page 5 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
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
Code list
Routing
(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
(01) MAKES DECISIONS ON OWN
(02) GETS HELP ON DECISIONS
(03) SOMEONE ELSE MAKES
DECISIONS
(-8) Don't Know
(-9) Refused
BOX KN9
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)])?
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.
BOX KN8
KCHIHELP
Page 6 of 9
2021 MCBS Community Questionnaire
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Variable Name
MR Screen Name
Question type
Question text/description
Code list
Routing
KREELINE
KN56
yes/no
Before today, were you aware of the 1-800-MEDICARE toll-free line?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) KN57 - KCPHINFO
(02)KN58-OEINTRO1
(-8)KN58-OEINTRO1
(-9) KN58-OEINTRO1
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
KCPHINFO
KN57
yes/no
Have you ever called 1-800-MEDICARE to get information about Medicare?
OEINTRO1
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
(01) CONTINUE
Annual Coordinated Enrollment Period. The Open Enrollment Period runs each year from midOctober to early-December.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
KN58 - OEINTRO1
KN58A - RVWCOST
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
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual
(03) NOT APPLICABLE, JUST SIGNED
KN58B - RVWSRVC
Election Period or Annual Coordinated Enrollment Period – runs each year from mid-October UP FOR MEDICARE
to early-December.]
(-8) DON'T KNOW
(-9) REFUSED
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS
THE RESONDENT’S MEDICARE INSURANCE COVERAGE FOR OR WITH THEM.]
Page 7 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
Code list
Routing
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
code 1
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual
(03) NOT APPLICABLE, JUST SIGNED
KN58C - CMPRPLN
Election Period or Annual Coordinated Enrollment Period – runs each year from mid-October UP FOR MEDICARE
to early-December.]
(-8) DON'T KNOW
(-9) REFUSED
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS
THE RESONDENT’S MEDICARE INSURANCE COVERAGE FOR OR WITH THEM.]
As you know, Medicare beneficiaries can choose different types of Medicare insurance plans.
During the last open enrollment period, did [you/(SP)] compare [your/his/her] Medicare
insurance plan with other Medicare plans that were available?
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual
(03) NOT APPLICABLE, JUST SIGNED
Election Period or Annual Coordinated Enrollment Period – runs each year from mid-October UP FOR MEDICARE
to early-December.]
(-8) DON'T KNOW
(-9) REFUSED
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS
THE RESONDENT’S MEDICARE INSURANCE COVERAGE FOR OR WITH THEM.]
(01) KN58D - CPLNTYPE
(02) KN59 - KCSUGGST
(03) KN59 - KCSUGGST
(-8) KN59 - KCSUGGST
(-9) KN59 - KCSUGGST
SHOW CARD KN10
What types of Medicare plans did [you/(SP)] compare with [your/his/her] Medicare insurance
plan?
CPLNTYPE
KN58D
select all
[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
KN59 - KCSUGGST
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS
THE RESONDENT’S MEDICARE INSURANCE COVERAGE FOR OR WITH THEM.]
Page 8 of 9
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
KNQ- BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS
Question type
Question text/description
(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
KCSUGGST
KN59
verbatim text
KCSUGGVB
KN59
verbatim text
BOX KNEND
routing
Code list
Routing
(01) BOX KNEND
(02) KN58 - KCSUGGVB
(-8) BOX KNEND
(-9) BOX KNEND
BOX KNEND
GO TO USQ.
Page 9 of 9
| File Type | application/pdf |
| File Title | KNQ.xlsx |
| Author | Wishart-Marisa |
| File Modified | 2020-11-10 |
| File Created | 2020-11-10 |