CMS-10710.GenIC#5 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 2

Medicare.gov Satisfaction Survey 2020 Instrument Page 1

Medicare.gov Sitewide Exit Survey
Q1 Browser question (automated – not asked)

Q2. Who are you using Medicare.gov for?
1 Myself
2 Someone else

Q3. [IF Q2 = 1] Do you have Medicare?
1 Yes
2 No

Q4. [If Q3=1] How do you currently get Medicare coverage?
1 I have Original Medicare (sometimes called 80/20 or Fee-for-Service Medicare)
2 I have a Medicare Advantage Plan (like an HMO or PPO)
3 I’m not sure

Q5. [If Q4=1 or Q4-=3] Do you have any of these? [Select all that apply.]
1 A Medicare prescription drug (Part D) plan
2 Medicare Supplement Insurance (Medigap) policy
3 Neither
4 I’m not sure

Q6. [If Q3 = 2] Will you get Medicare soon?
1 Yes
2 No
3 I’m not sure

Medicare.gov Satisfaction Survey 2020 Instrument Page 2
Q7. [If Q2=2] Were you looking at Medicare.gov today as a:
1 Friend, relative, or unpaid caregiver
2 Health care provider or health care staff
3 Assistor, navigator, agent or broker
4 SHIP counselor
5 Researcher
6 Other

Q8. [ALL] What was the main reason you came to Medicare.gov today?
If you came for more than one reason, select the main one.

1 Get general information about Medicare (like how it works, what’s covered, or cost
information)
2 Create or use my online Medicare account (like viewing claims)
3 Apply or sign up for Medicare (Part A and/or Part B)
4 Enroll in a Medicare Advantage Plan, Part D drug plan, or Medigap policy
5 Look for, review, or compare Medicare Advantage Plans, Part D drug plans, or Medigap
policies
6 Look for a doctor, hospital, or other health care provider/facility.
7 Pay my premium
8 Other (specify)

Q9. [If Q8 =1] Which best describes the type of information you were looking for today?
1 When can a person get Medicare? Or how do they apply?
2 How does Medicare work in general?
3 How much does Medicare cost (like premium, deductibles, and copayments)?
4 How does Medicare work with my insurance?
5 Is a test, item, or service covered?
6 Just looking
7 Other (specify)

Medicare.gov Satisfaction Survey 2020 Instrument Page 3

Q10. [If Q8=2] What did you do in {your or another person’s} online Medicare account?
1 Created {my or another person’s} online account
2 Reviewed {my or another person’s} claim
3 Updated {my or another person’s} information (like name, address, email)
4 Changed how {I or another person} get(s) {my or their MSNs} or Medicare & You handbook (by
email or by mail)
5 Reviewed my current coverage
6 Other (specify)

Q11 [If Q8= 4 or 5] What type of plan or plans were you interested in (if Q8=4 “enrolling in” and if
Q8=5 “looking for, reviewing, or comparing”}? [Select all that apply.]
1 Medicare Advantage Plan
2 Medicare prescription drug (Part D) plan
3 Medicare Supplement Insurance (Medigap) policy
4 I don’t know
5 Other (specify)

Q12 [IfQ8=6] What, specifically, were you looking for today? [Select all that apply.]
1 Doctor or other health care provider
2 Nursing home
3 Hospital
4 Home health services
5 Dialysis facility
6 Medical equipment supplier
7 Long-term care hospital
8 Inpatient rehabilitation facility
9 Hospice care
10 Other (specify)

Medicare.gov Satisfaction Survey 2020 Instrument Page 4

Q13 [If Q8=4 or 5]: How confident are you that you could (or did) enroll in the right plan for you?
1 Very confident
2 Somewhat confident
3 Neutral
4 Not very confident
5 Not at all confident

Q14 [If Q8 = 6]: How confident are you that the information on Medicare.gov will help you select the
right provider or facility for you?
1 Very confident
2 Somewhat confident
3 Neutral
4 Not very confident
5 Not at all confident

Q15. [ALL] Were you able to successfully {Q8 response or “do what you came to do” if Q8 response =
7} during your visit today?
1 Yes
2 No
3 I don’t know

Q16 [ALL] How easy was it to {Q8 Response or “do what you came to do” if Q8=7} on Medicare.gov
today?
1 Very difficult
2 Somewhat difficult
3 Neutral
4 Somewhat easy
5 Very easy
Q17 [If Q15=2 or 3] What will you do next?

Medicare.gov Satisfaction Survey 2020 Instrument Page 5
1 Keep looking at Medicare.gov
2 Come back to Medicare.gov later
3 Go to a different website
4 Contact 1-800-MEDICARE
5 Get in-person help
6 Check the Medicare & You handbook
7 Don’t know/not sure
8 Other (specify)

Q18a [ALL] How satisfied were you with your overall experience on Medicare.gov?
1 Very dissatisfied
2 Somewhat dissatisfied
3 Neither satisfied nor dissatisfied
4 Somewhat satisfied
5 Very satisfied

Q18b [ALL] How satisfied were you with the information on Medicare.gov?
1 Very dissatisfied
2 Somewhat dissatisfied
3 Neither satisfied nor dissatisfied
4 Somewhat satisfied
5 Very satisfied

Q18c [ALL] How satisfied were you with how well the Medicare.gov website worked today?
1 Very dissatisfied
2 Somewhat dissatisfied
3 Neither satisfied nor dissatisfied
4 Somewhat satisfied
5 Very satisfied

Medicare.gov Satisfaction Survey 2020 Instrument Page 6

Q19 [ALL] How likely are you to return to Medicare.gov if you need information about Medicare in the
future?
1 Very likely
2 Somewhat likely
3 Neutral
4 Not very likely
5 Not at all likely

Q20 [ALL] How can we improve Medicare.gov? [open-ended responses]

Q21 [ALL] Would you be interested in being contacted in the future to take part in
research activities related to Medicare.gov? If so, please include your email address below:
You have the right to get Medicare information in an accessible format, like large print,
Braille, or audio. You also have the right to file a complaint if you feel you’ve been
discriminated against.
Visit Medicare.gov/about-us/accessibility-nondiscrimination-notice, or call 1-800-MEDICARE
(1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0938-1382 (Expires 9/30/2026). This is a voluntary information collection. Although CMS is not invoking statutory
support for confidentiality, the quality of this type of information requires respondent candor and anonymity. Therefore,
CMS pledges to keep the information collected private unless otherwise required by law. Respondents will be notified
on the data collection form that their information will only be reported in aggregated form and no personally identifiable
responses will be publicly released. The time required to complete this information collection is estimated to average 4
minutes per response, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.