CMS-P-0015A Beneficiary Knowledge

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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 CVQ.

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

KNINTMCR

KN25B1

KN25C

yes/no

code 1

In the past year, have you tried to find any information [for (SP)] about Medicare?

SHOW CARD KN3
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 …

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

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

KN25E-KNCOVREV

Page 1 of 7

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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

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

KN35F-KNCOVINF

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

KN26 - KNFOSATI

(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

KNFOSATI

KN26

code 1

KN27IN

KN27INT

no entry

KBOKRECD

KN27

yes/no

(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.

KBOKREAD

KN28

code 1

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?

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

SHOW CARD KN9
KBOKUNDR

KN29

code 1

How easy or difficult did you find (the parts you read/this book) to understand?
[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?]

(01) KN28 - KBOKREAD
(02) KN50A- COMPDESK
(-8) KN50A- COMPDESK
(-9) KN50A- COMPDESK

(01) READ IT THOROUGHLY
(02) READ PARTS OF IT
(03) HAVEN'T READ IT AT ALL
(-8) Don't Know
(-9) Refused

(01) KN29 - KBOKUNDR
(02) KN29 - KBOKUNDR
(03) KN50A-COMPDESK
(-8) KN50A- COMPDESK
(-9) KN50A- COMPDESK

(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused

KN50A- COMPDESK

Page 2 of 7

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

COMPDESK

KN50A

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

Question Text/Description

Next, I'd like to ask about [your/(SP's)] use of computers.
grid

[Do you/Does (SP)] own or use any of the following types of computers? Please tell me yes or no for each item I list.
Desktop or laptop

Next, I'd like to ask about [your/(SP's)] use of computers.
COMPPHON

KN50A

grid

[Do you/Does (SP)] own or use any of the following types of computers? Please tell me yes or no for each item I list.
Smartphone

Next, I'd like to ask about [your/(SP's)] use of computers.
COMPTAB

KN50A

grid

[Do you/Does (SP)] own or use any of the following types of computers? Please tell me yes or no for each item I list.
Tablet or other portable wireless computer

Some people use the Internet to get different kinds of information. The next questions ask about the Internet.

Code List

Routing

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

KN50A- COMPPHON

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

KN50A- COMPTAB

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

KN51INT - KN51IN

(01) CONTINUE
(-7) Empty

INTERNET-INTERNET

KN51IN

KN51INT

no entry

INTERNET

INTERNET

yes/no

[Do you/ Does (SP)] have access to the internet?

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

(01) KN51A-USENET
(02) KN51B- SOMELNET
(-8) KN51B- SOMELNET
(-9) KN51B- SOMELNET

USENET

KN51A

code 1

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

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

(01) KN51C - OFTNNET
(02) KN51B - SOMELNET
(-8) AUDIOVID
(-9) AUDIOVID

SOMELNET

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

(01) KN51C - OFTNNET
(02) AUDIOVID
(-8) AUDIOVID
(-9) AUDIOVID

code 1

(01) EVERY DAY
How often [do you/does (SP)] access the Internet to seek information, either on (your/his/her) own or with someone (02) A FEW TIMES A WEEK
else's help?
(03) A FEW TIMES PER MONTH
(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

OFTNNET

KN51C

[EXPLAIN IF NECESSARY: The Internet includes web sites, e-mail, newsgroups, and other forums.]

AUDIOVID

Page 3 of 7

2023 MCBS Community Questionnaire

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

Routing

AUDIOVID

AUDIOVID

yes/no

Since (REFERENCE DATE), [have you/ has (SP)] participated in video or voice calls or conferencing over the
internet, such as with Zoom, Skype or FaceTime?

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

BOX KN7

BOX KN7

routing

IF SP DID NOT REPORT VISITING OR ACCESSING THE OFFICAL WEBSITE FOR MEDICARE INFORMATION
IN ANY PREVIOUS ROUND (SAMPLE_PERSON.P_KVSTSITE^=1) GO TO KN53 - KVSTSITE.
ELSE GO TO 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)])?

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

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

KVSTSITE

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/has (SP)] used the Internet to
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/has (SP)] 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/has (SP)] 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/has (SP)] used the Internet to
Communicate with a health care provider (for [you/(SP)])?

BOX KN8

routing

IF PROXY IS RESPONDENT, GO TO USEMSP.
ELSE GO TO KN54 - KCHIHELP.

Page 4 of 7

2023 MCBS Community Questionnaire

Variable Name

KCHIHELP

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

MR Screen Name Question Type

Question Text/Description

Code List

Routing

KN54

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?

(01) MAKES DECISIONS ON OWN
(02) GETS HELP ON DECISIONS
(03) SOMEONE ELSE MAKES DECISIONS
(-8) Don't Know
(-9) Refused

USEMSP

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

(01) BOX KN9
(02) APPLYMSP
(-8) APPLYMSP
(-9) APPLYMSP

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

BOX KN9

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

(01) KN57 - KCPHINFO
(02) RGHTAPL
(-8) RGHTAPL
(-9) RGHTAPL

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

RGHTAPL

code 1

We’re interested in learning about how Medicare beneficiaries navigate certain programs available to help them pay
for their health care costs. As you may know, the government has a set of programs, called Medicare Savings
Programs (MSP), that help beneficiaries pay for the costs associated with Medicare, such as Part A (Hospital
Insurance) or Part B (Medical Insurance) premiums, deductibles, coinsurance, and copayments. Unlike additional
insurance plans that require a monthly premium, Medicare Savings Programs provide financial help at no cost to
eligible beneficiaries who have limited income and resources. We’re going to ask you a few questions about these
programs, and what [your/(SP)’s] experience, if any, has been with them.
USEMSP

USEMSP

yes/no

[Are you/Is (SP)] receiving any assistance from a Medicare Savings Program (MSP) to help pay for [your/his/her]
(CURRENT YEAR) health care costs?
[EXPLAIN IF NECESSARY: Medicare Savings Programs pay for remaining costs (premiums, deductibles,
coinsurance, and copayments) not covered by Medicare. These programs are different from additional insurance
plans, such as Medicare Supplement Insurance (Medigap) or private insurance plans, in that beneficiaries will not
pay for this extra financial help. Instead, beneficiaries must be eligible (i.e., have limited resources or income) and
apply to receive this financial assistance from an MSP.

APPLYMSP

KREELINE

KCPHINFO

APPLYMSP

yes/no

Did [you/(SP)] apply to the [STATE] Medicare office for help with (CURRENT YEAR) expenses?

BOX KN9

routing

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 RGHTAPL

KN57

yes/no

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

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

Page 5 of 7

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Code List

Everyone covered by Medicare has certain rights and protections under their Medicare coverage.
These rights include the right to file a complaint or appeal any decision or action made by a medical provider if you
think you are being unfairly denied coverage, or denied adequate and complete treatment of your condition.

Routing

KN58-OEINTRO1

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. (01) CONTINUE
The Open Enrollment Period runs each year from mid-October to early-December.

KN58A - RVWCOST

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
(01) YES
expenses?
(02) NO
(03) NOT APPLICABLE, JUST SIGNED UP FOR
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual Election Period or Annual
MEDICARE
Coordinated Enrollment Period – runs each year from mid-October 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.]

KN58B - RVWSRVC

RGHTAPL

yes/no

OEINTRO1

KN58

KN58A

Question Text/Description

(01) YES
(02) NO
(-8) Don't Know
If [you/(SP)] had concerns about the quality of care [you were/[he/she was]] receiving from a healthcare provider or
(-9) Refused
facility, would [you/he/she] know how to file a complaint or an appeal with Medicare?

RGHTAPL

RVWCOST

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
the kinds of treatment, drugs, and services covered will meet [your/his/her] health care needs?
RVWSRVC

KN58B

code 1

(01) YES
(02) NO
[EXPLAIN IF NECESSARY: The Open Enrollment Period – sometimes called the Annual Election Period or Annual (03) NOT APPLICABLE, JUST SIGNED UP FOR
Coordinated Enrollment Period – runs each year from mid-October to early-December.]
MEDICARE
(-8) DON'T KNOW
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS THE RESONDENT’S
(-9) REFUSED
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?
CMPRPLN

KN58C

code 1

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

KN58C - CMPRPLN

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

Page 6 of 7

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

KNQ-BENEFICIARY KNOWLEDGE AND INFORMATION NEEDS

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

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.]
[PLEASE INCLUDE SITUATIONS WHERE A PROXY OR SOMEONE ELSE REVIEWS THE RESONDENT’S
MEDICARE INSURANCE COVERAGE FOR OR WITH THEM.]

KCSUGGST

KN59

verbatim text

KCSUGGVB

KN59

verbatim text

BOX KNEND

routing

(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 7 of 7