PHASE 2 Medicare Parts C & D Cognitive Interview Study Updated Interview Guide
STEP 2: INTERVIEW
Earlier this year you completed a Medicare Part C or D Enrollment Form for your [health plan or prescription drug plan – INSERT NAME]. The form asked you to provide information on the plan you wanted to join, like your name, birthdate, gender, phone number, and address and it also asked some optional questions on your ethnicity and race. I would like to talk to you today about the questions on that form.
Since you did not complete the optional questions on your ethnicity or race, we are interested in learning about any concerns you had about those questions when you completed the form.
My first question is do you remember seeing or completing the part of the enrollment form with the questions that asked you to report your ethnicity and race? Yes No
If yes, what did you think?
If no, skip to Question #9
What concerns did you have when you were asked questions about your ethnicity or your race on a Medicare enrollment form?
Probes:
Confidentiality, privacy
How the government uses that information
No concerns, really
The enrollment form says, “Answering these questions is your choice. You can’t be denied coverage because you don’t fill them out.” Did the question raise any concerns about your Medicare coverage? What did you think about/do you think about when I read the instructions?
Now, I am going to ask you some questions about the available response options that were provided for you to report on your ethnicity and race. If you are not sure whether you remember what the response options were, I can read them to you. Would you like me to read the response options for those questions to you?
The first question was: Are you Hispanic, Latino/a, or Spanish origin? Select all that apply. And the response options were:
£No, not of Hispanic, Latino/a, or Spanish origin
£ Yes, Mexican, Mexican American, Chicano/a
£Yes, Puerto Rican
£Yes, Cuban
£Yes, another Hispanic, Latino/a, or Spanish origin
What concerns, if any, did you have about the available response options for this question?
Probe: Did you think there are enough options? Was your preferred response to these questions missing? Do you understand the differences between the different options?
The second question was: What’s your race? Select all that apply. And the response options were:
£ American Indian or Alaska Native
Asian
£ Asian Indian
£Japanese
£Korean
£Vietnamese
£ Other Asian
£ Black or African American
Native Hawaiian and Pacific Islander
£Guamanian or Chamorro
£Native Hawaiian
£Samoan
£Other Pacific Islander
Probe: Did you think there are enough options? Was your preferred response to these questions missing? Do you understand the differences between the different options?
Have you ever seen these questions about race and ethnicity on other forms, Do you have the same concerns about providing your race or ethnicity?
How do you think CMS could change these types of questions so people with Medicare would be more likely to answer them?
Probes: Is it the wording? Is it the location on the form? Is it that you would prefer to be asked about your ethnicity and/or race in some other way, not on an enrollment form?
Do you think it is important for Medicare to have information on race and ethnicity?
Why?
Skip to Question 15 to continue interview
BEGIN HERE for participants who don’t recall seeing the Part C or D enrollment form, ask Q9-Q14.
You told me that you don’t think you saw the questions about your ethnicity or your race. I would like to read the questions to you now and then I have a few questions for you about each of the questions.
Do you remember seeing the question about your ethnicity?
Now I would like to read the response options to you and see what you think about them?
The response options to the ethnicity question were as follows and you could select all that apply:
£No, not of Hispanic, Latino/a, or Spanish origin (pause)
£ Yes, Mexican, Mexican American, Chicano/a
£Yes, Puerto Rican
£Yes, Cuban
£Yes, another Hispanic, Latino/a, or Spanish origin
£ I choose not to answer.
The second question was: What’s your race? Select all that apply.
Do you remember seeing the question about your race?
Now I would like to read the response options to you and see what you think about them?
The response options to the race question were as follows and you could select all that apply:
£ American Indian or Alaska Native
Asian and the choices for the category were:
£Chinese
£Filipino
£Japanese
£Korean
£Vietnamese
£ Other Asian
£ Black or African American
Native Hawaiian and Pacific Islander and the choices for the category were:
£Guamanian or Chamorro
£Native Hawaiian
£Samoan
£Other Pacific Islander
£ I choose not to answer.
If you had seen the question, do you think you would have answered it? Why?
Have you ever seen these questions about race and ethnicity on other forms? Do you have the same concerns about providing your race or ethnicity?
How do you think CMS could change these types of questions so people with Medicare would be more likely to answer them?
Probes: Is it the wording? Is it the location on the form? Is it that you would prefer to be asked about your ethnicity and/or race in some other way, not on an enrollment form?
Conclusion
For all participants
This year when enrolling in a Medicare plan, where did you get information on the health plan you were choosing?
Probes:
Medicare.gov or the internet
Insurance brokers
Family or friends
Called the health plan
State Health Insurance Assistance Program (SHIP Program)
Other organizations that help seniors
Did you ask anyone to help you complete the form and if so, can you describe how they helped you or what you did together?
Probes:
Completed it with a family member
Completed it with an insurance broker
Completed it with a SHIP volunteer
Other
Is there anything else about your experience completing the enrollment form that we have not discussed that you would like to share with me?
Thank you for your participation. As a token of our appreciation, we would like to send you a $40 gift card. We can provide your gift card to you electronically or we can mail it to you. Can you please provide the cell phone number, email address or mailing address you would like us to use?
Email address:
Mailing address:
DO NOT READ
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 0938-1440. The time required to complete this information collection is estimated to average 30 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. Please do not send applications, claims, payments, medical records, or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact 1-800-MEDICARE or William Long at 410-786-7927.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Susan Cahn |
| File Modified | 0000-00-00 |
| File Created | 2023-12-18 |