Attachment 1 - MEPS Respondent Materials

Attachment 1 - MEPS Respondent Materials.pdf

Medical Expenditure Panel Survey - Household and Medical Provider Components

Attachment 1 - MEPS Respondent Materials

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

2024-07-02 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

MEPS Tip Sheet
A few tips to help you prepare for your MEPS interview

HEALTH CARE

What we will ask about:
Your interviewer will ask you about visits to all different types of
health care providers, such as:
•
•
•
•
•

hospitals -- for inpatient, outpatient, or emergency room care
doctors’ offices, clinics, or HMOs
visits for blood tests, x-rays, or other tests
visits to the dentist
visits to chiropractors, physical therapists, optometrists,
or other kinds of healthcare providers

The interviewer will also ask about health-related purchases,
such as:
•
•
•
•

prescription medicines
eyeglasses or contact lenses
diabetic supplies
other health-related equitpment

Who we will ask about:
Your interviewer will ask questions about the healthcare received
by each family member living with you. Check with family
members who will not be present for the interview to find out
about their health care.

How to get ready:
Having records to look at during the interview can be very helpful.
Records can include:
•
•

•
•
•

a calendar -- on a phone, computer, or paper
computerized health care records, including those from
your provider or patient portal
appointment cards
bills and explanations of benefits
medicine bottles or receipts

Your interviewer will be happy to help you use your records to find the information needed for
the study.

If you have questions before your visit, please call Alex Scott toll-free at 1-800-945-6377.
1196115379.0421

Thank You!

21-107

Dear Community Authority Representative,
In response to the need for accurate figures about the use, cost, and quality of medical care in this country,
Westat, a national research organization, is conducting the Medical Expenditure Panel Survey (MEPS) on
behalf of the Agency for Health Care Research and Quality (AHRQ), a part of the Department of Health
and Human Services. This large-scale national survey will be conducted in your community and
approximately 150 others across the nation.
During the next two and a half years, survey representatives will interview participants from selected
households in your area. Every interviewer is professionally trained and carries an identification card
certifying that the interviewer is an authorized survey representative.
The impact of COVID-19 on communities highlights the importance of public health care data. We
assure every household that safeguarding health is our highest concern. We monitor conditions week
by week and adjust our interview protocol as needed.
The purpose of the study is to understand how changes in the way Americans receive and pay for health
care have affected health care use. This information will be used to help guide future changes in health
care policy.
Because the entire U.S. population cannot be interviewed, we have chosen a sample of communities and
households that represent the nation. This statistically reliable sample selection process ensures that the
households selected represent thousands of other similar households across the country, as well as
themselves. Their participation is very important if the survey is to provide a true picture of the health
care experiences of people living in the United States in the 21st century.
All answers to the survey are confidential and will be kept private to the extent permitted by law. No
identifying information is ever used in reports. Individual answers are summarized to give an overall
picture of the health care use and expenses of people in this country.
We would greatly appreciate your help in reassuring persons who make inquiries as to both the
importance and legitimacy of this undertaking. If you would like additional information about the study,
please ask the survey representative. You also may visit the study website at: http://www.meps.ahrq.gov.
If you have any other questions about the survey, please contact Alex Scott, toll free, at 1-800-945-MEPS
(6377).
Sincerely,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

21-204R

OMB #0935-0118

I missed you

SORRY
The Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

59996.1020

PUBLICATION 21-405

OMB #0935-0118

I missed you

SORRY
The Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

59996.1020

PUBLICATION 21-405

SORRY
I missed you
I will try again soon.

Your participation in the
Medical Expenditure Panel Survey
is so very important.
Thank you, in advance, for your cooperation.

A Reminder from
Your Friends at MEPS

1196115396_MEPS_Appt_Card_ENG.indd 1

4/27/21 10:06 AM

Dear:______________________________________________________________
This card is to confirm our appointment for the Medical Expenditure
Panel Survey on
Date:________________________________________________________
Time:______________________________________________ (a.m./p.m.)
I’m looking forward to seeing you!
If you need to reschedule your appointment, please call.
__________________________________________________________________
ID:
__________________________________________________________________
OMB #0935-0118

1196115396_MEPS_Appt_Card_ENG.indd 2

1193546619.0421
21-406

4/27/21 10:06 AM

OMB #0935-0118

THANK YOU
The Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

59997.1020

PUBLICATION 21-407

OMB #0935-0118

THANK YOU
The Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

59997.1020

PUBLICATION 21-407

Thank you
for your participation in the
Medical Expenditure Panel Survey.

Certificate of Appreciation
In recognition of your participation
in the Medical Expenditure Panel Survey
for the U.S. Department of Health and Human Services

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

1652538904.0921

22_415_MEPS_Certificates_of_Appreciation_English_V2.indd 1

22-415

9/27/21 12:56 PM

IMPORTANT INFORMATION ABOUT YOUR PARTICIPATION IN
THE MEDICAL EXPENDITURE PANEL SURVEY

The Purpose of This Research
The Medical Expenditure Panel Survey (MEPS)
is one of the major research efforts of the U.S.
Department of Health and Human Services.
It is conducted by the Agency for Healthcare
Research and Quality (AHRQ). MEPS is an ongoing, nationwide survey that studies the cost
of health care and the way Americans pay
for that health care. Information is collected
through household interviews and linked
to information collected from your medical
providers.

How Your Household Can
Participate
Information for this survey is collected for
all family members living in your household.
Generally, one adult family member answers
the survey questions for the entire family
although all family members are encouraged
to be present. Interviews are conducted by
trained field interviewers who call on you
at home to conduct the interview. We want
to assure you that safeguarding your health
during the coronavirus is our highest concern.
We are monitoring conditions week by week.
Each household is asked to complete 5
interviews over a 2 ½ year period. While
the length of each in-person interview
varies depending on family size and health
experiences, the average interview can be
completed in about 1 to 1 ½ hours. Having
notes or records of your family’s health care
will make it easier to answer the survey
questions. The interviewer will ask about
your family’s visits for health care and
about related topics that help researchers
understand health care experiences such as
age, education, health status, employment,
and health insurance coverage.

Protecting the Confidentiality of
the Information You Provide
This survey is authorized under 42 U.S.C.
299a. Privacy is protected by the Privacy
Act and Section 308(d) of the Public Health
Service Act [42 U.S.C. 299c-3(c) and 42
U.S.C. 242m(d)]. The confidentiality of your
responses to this survey is protected by
Section 944(c). Information that could
identify you will not be disclosed unless
you have consented to that disclosure. All
personally identifiable information such as
names or addresses will be removed before
information from this survey is released to
researchers outside the Department of Health
and Human Services.

Participation in MEPS
Households selected for MEPS have an
opportunity to provide an important and
valuable public service. Participation in the
study is voluntary. There is no penalty or loss
of benefits if a household or an individual
member of the household chooses not to
participate in the study or in any particular
part of the study.

Benefits of This Research
MEPS data are used by researchers in Federal
and State governments, universities, and the
private sector to understand the costs of
health care and inform decisions about health
care issues.

To Learn More About MEPS
To learn more about this study, you may visit
the study website at:
http://www.meps.ahrq.gov or contact Alex
Scott, a study representative at
1-800-945-MEPS (6377).

1652538966.1021

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Name ___________________________

Address _________________________

________________________________

Phone ___________________________

Name ___________________________

Address _________________________

________________________________

Phone ___________________________

Name ___________________________

Address _________________________

________________________________

Phone ___________________________

Name ___________________________

Address _________________________

________________________________

Phone ___________________________

Name ___________________________

Address _________________________

________________________________

Phone ___________________________

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MEPS
Medical Expenditure Panel Survey

Your Health Care

Record
Keeper
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

1652538799.1021

OMB #0935-0118
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Instructions
You may use this record
keeper to help prepare
for your MEPS interviews.
Each time you or a family
member receives health
care, record the following
information:
• household member’s name
• date of the visit or phone call
• name of health care provider
• reason for the visit or
phone call
• charge and payment
information
• any medications prescribed

On the back of the
record keeper there
is space to record
your health care
providers’ contact
information.

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Name___________________________

Date of Visit _____________________

Provider Name___________________

Reason for Visit __________________

Total Charge ____________________

Payment by Family _______________

Payment by Other ________________

Prescriptions ____________________

Name___________________________

Date of Visit _____________________

Provider Name___________________

Reason for Visit __________________

Total Charge ____________________

Payment by Family _______________

Payment by Other ________________

Prescriptions ____________________

Name___________________________

Date of Visit _____________________

Provider Name___________________

Reason for Visit __________________

Total Charge ____________________

Payment by Family _______________

Payment by Other ________________

Prescriptions ____________________

Name___________________________

Date of Visit _____________________

Provider Name___________________

Reason for Visit __________________

Total Charge ____________________

Payment by Family _______________

Payment by Other ________________

Prescriptions ____________________

Summer 2023
Dear Resident:
You have a chance to continue playing a special role in national research on health care
through the Medical Expenditure Panel Survey (MEPS). It is the only survey of its kind to develop a
complete picture of the Nation's health care and has been collecting data continuously since 1996.
Analysts are already combining the information you gave in earlier interviews with information from
thousands of other MEPS households to produce up-to-date study results. You can see findings from
the study on the MEPS Participants’ Corner at http://www.meps.ahrq.gov.
To refresh your memory, here’s what you need to know about the next interview:
 We will call you soon to schedule an interview. Participation is voluntary.
 Having records available to look at during the interview can help in answering survey questions.
A “Tip Sheet” is enclosed to provide additional reminders about the kinds of questions and
records that are useful.
 As before, you will receive $50 as a thank-you to show our appreciation.
 Your privacy continues to be a MEPS priority. We keep all your information private. It’s the law 1.
 Have questions? Call Alex Scott toll free at 1-800-945-6377 or email [email protected].
 If your address or telephone number has changed since the last interview, please let us know
by completing and returning the enclosed change of address card.
On behalf of the Agency for Healthcare Research and Quality, thank you again for your continuing
participation in the Medical Expenditure Panel Survey. We look forward to talking with you soon.
Sincerely,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health Service Act
[42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by Section 944(c). Information
that could identify you will not be disclosed unless you have consented to that disclosure.
23-116

OMB #0935-0118

CONTACTING JOB AID
ROUND 1
REVIEW ELECTRONIC FACE SHEET BEFORE CONTACTING THE RU. RECORD NOTES
NEEDED FOR CONTACTING THE RU IN YOUR INTERVIEWER NOTEBOOK AND BE SURE TO
BRING NOTEBOOK PAGE WITH YOU.
THE INITIAL CONTACT MUST BE IN PERSON. MAKE SURE THAT YOUR MEPS I.D. BADGE IS
VISIBLE TO THE RESPONDENT.
Hello, my name is (NAME) from the Medical Expenditure Panel Survey that is being conducted for the
Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human
Services. We sent a letter explaining that (you have/your family has) been chosen to participate in the
Medical Expenditure Panel Survey.
HAND R THE “IMPORTANT INFORMATION ABOUT YOUR PARTICIPATION IN MEPS”
HANDOUT.
This sheet describes the purpose of this research, how the data are used, and how the confidentiality
of your information is protected. Please take a minute to read it and then I can answer any questions
that you have about the study.
IF SPEAKING WITH THE NHIS PRIMARY RESPONDENT: Are you the best person to provide
information on health care for your family?
IF SPEAKING WITH ANOTHER RU MEMBER: Who in your household would be the best person to
provide information on the health care for your family? ARRANGE TO SPEAK WITH PERSON BEST
ABLE TO PROVIDE HEALTH CARE INFORMATION.
ENTER AN EROC FOR EVERY CONTACT ATTEMPT (SEE BACK FOR RESULT CODES).
UPDATE RU CONTACT WITH ANY NEW INFORMATION OBTAINED AND CONFIRMED.
TRANSMIT ON YOUR LAPTOP.

IF RU WAS INSTITUTIONALIZED BEFORE JANUARY 1 OF THE CURRENT YEAR, RECORD DATE
OF INSTITUTIONALIZATION AND NAME, ADDRESS, AND PHONE NUMBER OF INSTITUTION IN
AN EROC

23-201

RESULT CODES – ROUND 1
Pending
21 - Not home
22 - Eligible R not available
23 - Entire RU moved, tracing
24 - Temporary refusal
25 - Callback (no appointment)
26 - Appointment
27 - Broken appointment

28 - Locating problem
29 - Unable to enter structure
30 - Language problem
31 - Second + Refusal
32 - Interview started – breakoff
33 - Other pending
34 RU moved too far to interview
MUST HAVE SUPERVISOR APPROVAL
R1 – Out of Scope
Final Non-response
80 - Entire RU merged with other RU
88 - Unavailable during field period
81 - Entire RU deceased before Jan. 1 of current year
89 - Too ill, no proxy
82 - Entire RU military before Jan. 1 of current year
90 - Physically/mentally incompetent, no proxy
83 - Entire RU institutionalized before Jan. 1 of current year
91 - Final refusal
84 - Entire RU left US before Jan. 1 of current year
92 - Final breakoff
93 - Unable to locate
94 - Entire RU military or left U.S. on or after Jan. 1 of
current year
95 - Entire RU institutionalized on or after Jan. 1 of current
year – no proxy
96 - Entire RU died after Jan. 1 of current year – no proxy
97 - Home office use
98 - RU moved too far to interview
99 - Final other nonresponse

ASSIGNED BY CAPI

Complete
60 - Complete with RU member
61 - Complete with proxy, All RU members deceased on or
after Jan. 1 of current year
62 - Complete with proxy, All RU members institutionalized
or deceased on or after Jan. 1 of current year
63 - Complete with proxy

R1 – Out of Scope
85 - Entire RU ineligible before Jan. 1 of current year,
multiple reasons
86 - Entire RU ineligible, non-key NHIS student
87 - Reenum complete, no eligible members, ineligible

23-201

OMB #0935-0118

CONTACTING JOB AID - SPANISH
ROUND 1
REVIEW ELECTRONIC FACE SHEET BEFORE CONTACTING THE RU. RECORD NOTES
NEEDED FOR CONTACTING THE RU IN YOUR INTERVIEWER NOTEBOOK AND BE SURE TO
BRING NOTEBOOK PAGE WITH YOU.
THE INITIAL CONTACT MUST BE IN PERSON. MAKE SURE THAT YOUR MEPS I.D. BADGE IS
VISIBLE TO THE RESPONDENT.
Buenos días/Buenas tardes. Mi nombre es (NAME) y trabajo para la Encuesta de Registro de Gastos
Médicos que se está llevando a cabo para la Agencia para la Investigación y la Calidad del Cuidado
de la Salud, la cual forma parte del Departamento de Salud y Servicios Humanos de Estados Unidos.
Le enviamos una carta explicándole que (usted/su familia) ha sido seleccionado(a) para participar en
la Encuesta de Registro de Gastos Médicos.
HAND R THE “INFORMACIÓN IMPORTANTE ACERCA DE SU PARTICIPACIÓN EN LA
ENCUESTA DE REGISTRO DE GASTOS MÉDICOS” HANDOUT.
En esta hoja se describe el propósito de este estudio, cómo se usará la información y cómo se
protegerá la confidencialidad de su información. Por favor, tómese un minuto para leerla y después le
puedo responder cualquier pregunta que tenga sobre el estudio.
IF SPEAKING WITH THE NHIS PRIMARY RESPONDENT: ¿Es usted la persona más indicada para
dar información sobre el cuidado de salud de su familia?
IF SPEAKING WITH ANOTHER RU MEMBER: ¿Quién en su hogar sería la persona más indicada
para dar información sobre el cuidado de salud de su familia? ARRANGE TO SPEAK WITH PERSON
BEST ABLE TO PROVIDE HEALTH CARE INFORMATION.
ENTER AN EROC FOR EVERY CONTACT ATTEMPT (SEE BACK FOR RESULT CODES).
UPDATE RU CONTACT WITH ANY NEW INFORMATION OBTAINED AND CONFIRMED.
TRANSMIT ON YOUR LAPTOP.

IF RU WAS INSTITUTIONALIZED BEFORE JANUARY 1 OF THE CURRENT YEAR, RECORD DATE
OF INSTITUTIONALIZATION AND NAME, ADDRESS, AND PHONE NUMBER OF INSTITUTION IN
AN EROC
23-201S

ASSIGNED BY CAPI

R1 – Out of Scope
85 - Entire RU ineligible before Jan. 1 of current year,
multiple reasons
86 - Entire RU ineligible, non-key NHIS student
87 - Reenum complete, no eligible members, ineligible

23-201S

OMB #0935-0118

CONTACTING JOB AID
ROUNDS 2 - 5
REVIEW ELECTRONIC FACE SHEET AND HOUSEHOLD HEALTH CARE SUMMARY BEFORE
CONTACTING THE RU.
RECORD NOTES NEEDED FOR CONTACTING THE RU IN YOUR INTERVIEWER NOTEBOOK.
Hello, my name is (NAME) from the Medical Expenditure Panel Survey that is being conducted for the
Agency for Healthcare Research and Quality. As you may remember, you were interviewed a few
months ago about your family’s health care and medical expenses.

(IF PREVIOUS ROUND

INTERVIEW WAS CONDUCTED BY ANOTHER INTERVIEWER, MENTION HIS/HER NAME.) A
letter was sent to you reminding you of the next interview.
I would like to schedule an appointment for another interview. If you’d like to have other household
members available during the interview to help out, let me know so we can schedule a time that works
for everyone.
To make it easier to answer the survey questions, please have records about your family’s health care
available when we conduct the interview.

ENTER AN EROC FOR EVERY CONTACT ATTEMPT (SEE BACK FOR RESULT CODES).
UPDATE RU CONTACT WITH ANY NEW INFORMATION OBTAINED AND CONFIRMED.
TRANSMIT ON YOUR LAPTOP.

IF NEW RESPONDENT, HAND R THE “IMPORTANT
PARTICIPATION IN MEPS” HANDOUT AND SAY:

INFORMATION ABOUT

YOUR

This sheet describes the purpose of this research, how the data are used, and how the confidentiality
of your information is protected. Please take a minute to read it and then I can answer any questions
that you have about the study.

23-202

RESULT CODES
Pending
21 - Not home
22 - Eligible R not available
23 - Entire RU moved, tracing
24 - Temporary refusal
25 - Callback (no appointment)
26 - Appointment
27 - Broken appointment
R2-9 – Out of Scope
70 - Entire RU merged with other RU

28 - Locating problem
29 - Unable to enter structure
30 - Language problem
31 - Second + Refusal
32 - Interview started – breakoff
33 - Other pending
34 - RU moved too far to interview
MUST HAVE SUPERVISOR APPROVAL
Final Non-response
88 - Unavailable during field period
89 - Too ill, no proxy
90 - Physically/mentally incompetent, no proxy
91 - Final refusal
92 - Final breakoff
93 - Unable to locate
94 - Entire RU military or left U.S.
95 - Entire RU institutionalized – no proxy
96 - Entire RU died – no proxy
97 - Home office use
98 - RU moved too far to interview
99 - Final other nonresponse

ASSIGNED BY CAPI

Complete
60 - Complete with RU member
61 - Complete with proxy, All RU members deceased
62 - Complete with proxy, All RU members institutionalized
or deceased
63 - Complete with proxy

R2-9 – Out of Scope
71 – Re-enum Complete, no eligible RU members, ineligible
72 – RU institutionalized prior round, still institutionalized

23-202

Form Approved
OBM# 0935-0118
Exp. Date 11/30/2025

December 20, 2023
Dear «RESPONDENTNAME»,
On behalf of the Department of Health and Human Services, I thank you for participating in the
Medical Expenditure Panel Survey (MEPS). By being a participant in this important national
research effort, you are fulfilling a valuable public service.
As a member of the quality assurance team, it is my responsibility to see that all interviews are
completed according to study procedures. The questions on the enclosed form refer to your most
recent MEPS interview. Please answer these questions for me, and feel free to offer any
comments you may have about the interview or the interviewer.
Thank you for your time and participation in this important survey. Please return the form using the
enclosed postage-paid envelope.
Sincerely,

Cheryl E. Douglas
MEPS Quality Assurance Team

Encl (2)

RUID: «PROJECTSUID»
FIID: «PROJECTSTAFFID»
Round: «Round»
23-305

Form Approved
OBM# 0935-0118
Exp. Date 11/30/2025

MEPS POST-INTERVIEW FORM
1. Approximately how long did your most recent MEPS interview take?
_____ HOURS AND _____ MINUTES
2. Were you interviewed in person or over the telephone?
IN PERSON

Comment: _________________________________

VIDEO (GO TO Q4)

__________________________________________

TELEPHONE (GO TO Q4)

__________________________________________

3. Did the interviewer use a laptop computer to record your answers?
YES

Comment: _________________________________

NO (Please comment.)

__________________________________________
__________________________________________

4. Were you asked about everyone living in your household?
YES

Comment: _________________________________

NO (Please comment.)

__________________________________________

NOT APPLICABLE

__________________________________________

5. Did you receive a monetary gift from the interviewer at the end of the interview?
YES

5a. How much did you receive? ________________________________

NO
6. Did you receive any token gifts for your participation?
YES

6a. What gifts did you receive? _________________________________

NO
7. Was your interviewer courteous and professional?
YES

Comment: _________________________________

NO (Please comment.)

__________________________________________
__________________________________________

8. Please add any comments you have about the interview or the person who interviewed you.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
RUID: «PROJECTSUID»
FIID: «PROJECTSTAFFID»
Round: «Round»
23-305

Tips for making your MEPS interview easier
Use records like these to make it easier to
answer the MEPS survey questions:
X Records covering health
care appointments for all
household members
• MEPS monthly planner
with your notes added
• A family calendar, or each
person’s own calendar
• Electronic calendars (e.g.,
cell phone, laptop, iPad)
• Appointment cards or email
reminders from a medical provider

X Records covering health care
received without an appointment
• Emergency room (ER) or walk-in clinic
discharge instructions or receipts
• Payment records (e.g., credit
card statements, debit card
records, checkbook log)
• Health care provider business cards
• Prescription medicine bottles
• Pharmacy print-outs

• Receipts

• Explanation of benefits (EOB) from
your health insurance provider

• Explanation of Benefits (EOB) from
your health insurance provider

• Lab referral or result records

• Computerized health care
records, including those from
your provider or patient portal

THANK YOU for gathering this information for all household members!
Your MEPS interviewer is happy to work with you using
these documents during the interview.

Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
23-453

What does MEPS count?
MEPS counts many things you might
not think of as “health care”…
X Diagnostic tests such as blood work,
X-rays, mammograms, MRI or CAT scans
X Vaccinations for children and adults
X Flu shots and allergy shots
X All types of preventive care,
including wellness visits
X Dental check-ups, and
orthodontic care (braces)
X Blood pressure checks and other
types of heart health monitoring
X Eye exams and prescription
glasses or contact lenses
X Counseling and other care from
psychologists or mental health specialists
X Physical, speech or occupational therapy

Of course, MEPS also counts…
X Hospital stays, even if just
part of a day or longer
X Care received at the Emergency
Room or Urgent Care Centers
X Care at walk-in clinics such as clinics at
work, or in a pharmacy (Minute Clinics)
X Sick visits to a doctor, nurse
or physician assistant
X Pre-natal care, and all other
obstetrician/gynecological care
X Pre-op care before surgery, the
surgery and the follow-up care
X Cancer treatments including
chemotherapy and radiation
X Dialysis and other long term treatments
X Oral surgery

X Chiropractic care, acupuncture,
homeopathic or other alternative care
X Prescription medicines including birth
control, insulin and diabetic supplies
X Care received at home by visiting
nurses or other home health aides
X Phone calls to medical providers
or labs to check test results

…and much more. Ask your interviewer if you are not sure what to include.

4330869793.0423

fim codeNO
C POSTAGE
RE 363

*6777.04.01.01.01*

NECESSARY
IF MAILED
IN THE
UNITED STATES

BUSINESS REPLY MAIL

FIRST CLASS PERMIT NO. 433 ROCKVILLE, MD
POSTAGE WILL BE PAID BY ADDRESSEE

Medical Expenditure Panel Survey
c/o Westat
1600 Research Blvd.
Rockville, MD 20897-5001

DATTAAFAAFFAAFADDAFADFFFFDAFFAFAAATAADDFTDTAADAFFFTDAFTAATAFTFTFT

Has your address or phone number changed? Please let us know by completing this
card and putting it in the mail. If you prefer, contact Alex Scott at 1-800-945-MEPS
(6377) or [email protected].
Your New Contact Information:
Name
Address
City State

Zip

Phone Number
What was your previous city and state (if different from above):
City

For office use only: Region

State

RUID

24-105

24-106

Winter 2024
Dear Resident,
Welcome to the Medical Expenditure Panel Survey, known as MEPS. MEPS is the only study that gives a
complete picture of how we use and pay for health care in the U.S.
Your household has been chosen to represent your community and the nation in this important study.
Now, more than ever, accurate data on health care and the impact of COVID-19 on households like
yours is very important. The cost of health care is a growing concern for many Americans. You have a
chance to make a difference. Help us understand how people pay for health care and how it can be
made more affordable.
As a MEPS participant, we’ll interview you five times over a two-year period. We’ll ask you questions
about how much you and your family spent on health care in the past year. Safeguarding your health is
our highest concern. We are monitoring COVID-19 on a weekly basis and will adjust our in-person
interviews as appropriate.
Here’s what you need to know about participating in MEPS.
 The U.S. Department of Health and Human Services conducts the study. Westat, a nationally
known research company, helps carry it out.
 We’ll call you soon to personally invite you to join MEPS.
 You’ll get $50 as a thank-you after each interview.
 We keep all your information private. It’s the law.
 You don’t have to participate. It’s your choice. But we hope you’ll agree to help.
 Have questions? Call Alex Scott toll-free at 1-800-945-6377 or email [email protected].
We’ve included a planner you can use to record information about your family’s health care and a
brochure that tells you about MEPS. There’s more information at www.meps.ahrq.gov.
We look forward to talking with you soon,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health
Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by
Section 944(c). Information that could identify you will not be disclosed unless you have consented to that disclosure.

24-110

Winter 2024
Dear Resident,
You have a chance to continue playing a special role in national research on health care through the
Medical Expenditure Panel Survey (MEPS). It is the only survey of its kind to develop a complete picture of
the Nation's health care and has been collecting data continuously since 1996.
Analysts are already combining the information you gave in earlier interviews with information from thousands
of other MEPS households to produce up-to-date study results. You can see findings from the study on the
MEPS Participants’ Corner at http://www.meps.ahrq.gov.
To refresh your memory, here’s what you need to know about the next interview:
 We will call you soon to schedule an interview.
 Having records available to look at during the interview can help in answering survey questions. A “Tip
Sheet” is enclosed to provide additional reminders about the kinds of questions and records that are
useful.
 A Monthly Planner for 2024 is also enclosed to help record information about your family’s healthcare.
 As before, you will receive $50 as a thank-you to show our appreciation.
 Your privacy continues to be a MEPS priority. We keep all your information private. It’s the law 1.
 Have questions? Call Alex Scott toll free at 1-800-945-6377 or email [email protected].
 If your address or telephone number has changed since the last interview, please let us know by
completing and returning the enclosed change of address card.
On behalf of the Agency for Healthcare Research and Quality, thank you again for your continuing participation
in the Medical Expenditure Panel Survey. We look forward to talking with you soon.

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health Service Act [42 U.S.C.
299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by Section 944(c). Information that could identify you
will not be disclosed unless you have consented to that disclosure.

24-110.SAQ

Winter 2024
Dear Resident,
You have a chance to continue playing a special role in national research on health care through the
Medical Expenditure Panel Survey (MEPS). It is the only survey of its kind to develop a complete picture of
the Nation's health care and has been collecting data continuously since 1996.
Analysts are already combining the information you gave in earlier interviews with information from thousands
of other MEPS households to produce up-to-date study results. You can see findings from the study on the
MEPS Participants’ Corner at http://www.meps.ahrq.gov.
To refresh your memory, here’s what you need to know about the next interview:
 We will call you soon to schedule an interview.
 Having records available to look at during the interview can help in answering survey questions. A “Tip
Sheet” is enclosed to provide additional reminders about the kinds of questions and records that are
useful.
 A Monthly Planner for 2024 is also enclosed to help record information about your family’s healthcare.
 Your health opinions matter to us! Select household members are receiving a survey booklet to answer
questions about their health and health opinions. Please give the completed booklet(s) to your MEPS
interviewer or mail the booklet(s) using the enclosed return envelope.
 As before, you will receive $50 as a thank-you to show our appreciation.
 Your privacy continues to be a MEPS priority. We keep all your information private. It’s the law 1.
 Have questions? Call Alex Scott toll free at 1-800-945-6377 or email [email protected].
 If your address or telephone number has changed since the last interview, please let us know by
completing and returning the enclosed change of address card.
On behalf of the Agency for Healthcare Research and Quality, thank you again for your continuing participation
in the Medical Expenditure Panel Survey. We look forward to talking with you soon.

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health Service Act [42 U.S.C.
299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by Section 944(c). Information that could identify you
will not be disclosed unless you have consented to that disclosure.

24-111

Winter 2024
Dear Resident,
Thank you for your participation in this important national study. Your contribution has been valuable! It’s just
about time for your final Medical Expenditure Panel Survey interview, which will ask only about
healthcare visits that occurred through December 31, 2023.
As before, your interviewer will be contacting you in the coming weeks to schedule the interview. If you prefer,
you can request an appointment by calling Alex Scott toll-free at 1-800-945-6377 or by sending an email to
[email protected]. To make scheduling your interview easier, we are now offering video interviews at a
time of your convenience. If your address or telephone number has changed since the last interview, please let
us know by completing and returning the enclosed change of address card.
Things to know for this final interview:
 It is helpful to have paper or electronic records (i.e. calendar, healthcare bills, receipts, or insurance
statements) available during the interview.
 The enclosed “Tip Sheet” has additional reminders about the kinds of questions the interviewer will ask
and the kinds of records that may be useful during the interview.
 As before, you will receive $50 as a thank-you to show our appreciation.
 Have questions? Call Alex Scott toll free at 1-800-945-6377 or email [email protected].
The information from your earlier interviews has already been combined with information from
thousands of other MEPS households across the country. You can read about recent findings from the
study at the MEPS website: http://www.meps.ahrq.gov.
Your participation in MEPS has been vital in our efforts to obtain complete and accurate information about our
healthcare system. On behalf of the Agency for Healthcare, we thank you for your valuable contribution to this
important research effort 1.
Sincerely,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health Service Act [42 U.S.C.
299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by Section 944(c). Information that could identify you
will not be disclosed unless you have consented to that disclosure.

24-111.SAQ

Winter 2024
Dear Resident,
Thank you for your participation in this important national study. Your contribution has been valuable! It’s just
about time for your final Medical Expenditure Panel Survey interview, which will ask only about
healthcare visits that occurred through December 31, 2023.
As before, your interviewer will be contacting you in the coming weeks to schedule the interview. If you prefer,
you can request an appointment by calling Alex Scott toll-free at 1-800-945-6377 or by sending an email to
[email protected]. To make scheduling your interview easier, we are now offering video interviews at a
time of your convenience. If your address or telephone number has changed since the last interview, please let
us know by completing and returning the enclosed change of address card.
Things to know for this final interview:
 It is helpful to have paper or electronic records (i.e. calendar, healthcare bills, receipts, or insurance
statements) available during the interview.
 The enclosed “Tip Sheet” has additional reminders about the kinds of questions the interviewer will ask
and the kinds of records that may be useful during the interview.
 Your health opinions matter to us! Select household members are receiving a survey booklet to answer
questions about their health and health opinions. Please give the completed booklet(s) to your MEPS
interviewer or mail the booklet(s) using the enclosed return envelope.
 As before, you will receive $50 as a thank-you to show our appreciation.
 Have questions? Call Alex Scott toll free at 1-800-945-6377 or email [email protected].
The information from your earlier interviews has already been combined with information from
thousands of other MEPS households across the country. You can read about recent findings from the
study at the MEPS website: http://www.meps.ahrq.gov.
Your participation in MEPS has been vital in our efforts to obtain complete and accurate information about our
healthcare system. On behalf of the Agency for Healthcare, we thank you for your valuable contribution to this
important research effort 1.
Sincerely,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

This survey is authorized under 42 U.S.C. 299a. Privacy is protected by the Privacy Act and Section 308(d) of the Public Health Service Act [42 U.S.C.
299c-3(c) and 42 U.S.C. 242m(d)]. The confidentiality of your responses to this survey is protected by Section 944(c). Information that could identify you
will not be disclosed unless you have consented to that disclosure.

Frequently Asked Questions
about your MEPS Prepaid Mastercard®
With the prepaid Mastercard, you can spend up to the amount on the card anywhere Debit Mastercard is
accepted. Below are responses to Frequently Asked Questions about using the prepaid card.
Can I use my prepaid card immediately, or does it need to be activated?
Your prepaid card will generally be activated within 24 hours of receiving the card.
How does the card work?
You can use the card to shop in stores, online, or over the phone anywhere that Debit Mastercard is
accepted but can charge only up to the amount available on the card.
Can I use the card as a debit card?
Yes. If you choose to use it as a debit card, the default PIN is the last four digits of the card number.
Can I use my card at a restaurant?
Yes, however you should confirm that the restaurant is able to charge a certain amount to the card prior
to dining. If the purchase is more than the amount on the card, you must inform your server/cashier to
charge only the available amount to the card. You will use a separate form of payment to pay the
remaining balance.
Can I use my card to “pay at the pump” at a gas station?
No, you cannot “pay at the pump” at a gas station. To use the card for a gas purchase, it must be given
to the attendant inside the station. If you do attempt to use the card to “pay at the pump,” the card may
be declined and a hold may be put on the preauthorized funds.
Where else can I use my card?
Your card can be used in stores and restaurants, similar to the way you would use your plastic debit or
credit card. You can even add them to your favorite retailer, service or fast-food mobile apps as a
method of payment.
When using my card, do I to select CREDIT or DEBIT?
You can select either CREDIT or DEBIT. If you select CREDIT, you should give the card to the cashier and
sign the receipt. The amount of the purchase will be deducted from the balance on the card.
If you select DEBIT, you should use the last four digits of the card as the default PIN. You may also
update the PIN, if needed at www.prepaidcardstatus.com. To use as a debit card, you must swipe the
card through the card reader, select DEBIT, enter the PIN, and confirm the transaction amount. The
amount of the purchase will be deducted from the balance.

24-212

Can I use the card for a purchase greater than the amount of the card?
Yes, however if the purchase is more than the balance on the card, you must ask the cashier to split the
transaction and to charge only the available amount to the card. You must use a separate form of
payment to pay the extra amount. The card will be declined if you attempt to use it for an amount over
the balance. Note that some merchants may not support split transactions.
Can I purchase merchandise on-line with my card?
To use the card for an online purchase, you must use the following address at checkout for billing:
MEPS, 1600 Research Boulevard, Rockville, MD 20850
Can I get cash back with my card?
No, you cannot use the card to obtain cash from an ATM, Point-of-Sale (POS) device, or by any other
means.
What should I do if I lose my card, or it gets stolen?
You should treat the card just as you would cash and store the card in a secure location. Anyone who
finds or steals the card can use the card to make a purchase. If you believe the card has been stolen, you
should call MEPS at 1-855-964-1354 for assistance to cancel a lost/stolen card and request a new one.
When a new card is received, it will be active and can be used right away.
Is the card reloadable?
No, the card is not reloadable, and you do not need to keep the card once the balance is spent. You will
receive a new debit card after each MEPS interview.
Are there any fees if I don’t use my card right away?
No fees will be deducted for inactivity. However, you should use the card before the expiration date.
Does the card expire and if so, when does it expire?
The expiration date is printed on the front of the card. The card expires on the last day of the month
listed.
What if the card expires and I haven’t used all of my money?
After the expiration date, the card will stop working and the value will be deducted.
How do I check the card balance or transaction history?
You can call the phone number listed on the back of the card or you can log into
www.prepaidcardstatus.com. You will need the card number and the security code on the back of the
card to be able to see the balance. There is no fee to check the balance or transaction history.

24-212

Medical Expenditure Panel Survey | Income
The cost of health care is a growing
concern for many Americans. Often
families’ health care expenses
are not fully covered by health
insurance, and the COVID-19
crisis makes the ability to pay for
health care even more uncertain.

THANK YOU for your
continued participation in
the Medical Expenditure
Panel Survey!

22.62

8.37

8.50
5.62
3.50

3.35

2.82
1.27

Less than
$10,000

$10,000 to $15,000 to $20,000 to $30,000 to $40,000 to $50,000 to
$14,999
$19,999
$29,999
$39,999
$49,999
$69,999

$70,000
and more

Income range

Graph 2.
Out-of-pocket expenses for health care
as a percent of income by age group, 2021
4.90

4.24
4

3.40

Percent of income

To help researchers and others
working on these problems, the
Medical Expenditure Panel Survey
examines how much medical costs
affect American families by asking
questions, including questions
about income. With your help,
we gain greater understanding
about the impact of the cost
of health care. We need to ask
questions about your income.

Percent of income

Not all people face financial health
care burdens equally. People with
low income tend to pay a much
larger share of their income for
health care than do people with
high income (Graph 1). Older people
tend to pay a higher percentage
of their income for medical care
than younger people (Graph 2).

Graph 1.
Out-of-pocket expenses for health care
as a percent of income range, 2021

2.69

1.95

1.87
1.59

18-24
years

25-34
years

35-44
years

45-54
years

55-64
years

65-74
years

75 years
and older

Age group

Source: The Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
24-214

MEPS_IncomeJobAid_EN.indd 1

9/21/23 9:14 AM

Common questions that others ask about the income
section of the Medical Expenditure Panel Survey

Q. Why will you ask questions
A.

about income?

To get a complete picture of the effects
of health care costs on American families,
we need to collect information on income.
This information can show how health
care affects an individual’s as well as
our nation’s economic well-being and
show how financial resources affect the
choice and use of health care services.
Approximately every six months we collect
information on a number of topics related to
health care use and cost. We will ask about
your health insurance coverage and medical
services received, including where those
services were received, who provides them,
and charges and payments for services.

Q. What will you do with this information?
A.

We have found that there is an association
between income and the use of health care.
Your answers to the questions on income will
be analyzed with your responses to other
questions, such as how often you see a doctor.
This will allow policy makers to compare the
relationship between personal finances and
an individual’s expenses for health care.

Q. Is this information confidential?
A.

Yes. All information collected by the Medical
Expenditure Panel Survey is protected by the
Privacy Act and Section 308(d) of the Public
Health Service Act [42 U.S.C. 299c-3(c) and
42 U.S.C. 242m(d)]. The confidentiality of
your responses to this survey is protected
by Section 944(c). Information that could
identify you will not be disclosed unless
you have consented to that disclosure.

Q. What will you ask me about?
A.

We will ask for the same type of information that
is recorded on your Federal income tax return,
such as taxable income from salaries or wages,
social security, pensions, investments, etc. In fact,
most of the information can be taken directly
from your 2023 Federal income tax return. There
are some additional questions on nontaxable
income such as worker’s compensation,
Supplemental Security Income (S.S.I.), public
assistance, and Veterans’ payments.

Q. Do I need records, such as my income tax
A.

records, to respond to these questions?

No. However, if you have completed your 2023
Federal income tax return, it will be very useful. If
you have not completed your 2023 tax return, it
might be helpful to use some of your household’s
financial records that are used to complete the
tax return, such as year-end bank statements,
financial summaries, pay stubs, W-2 forms, etc.

Q. What if I do not know an answer?
A.

Just do the best you can. If you do not know
an answer to a question, tell the interviewer
that you don’t know that information.

Q. Do I have to answer these questions?
A.

No. Your participation is voluntary. You may
refuse to answer any question or series of
questions. However, because information
about income is very important to help us
understand health care, we hope you will be
willing to provide us with this information.

Q. What should I do if I have more questions?
A.
If you or other members of your household have
any concerns about these questions, please
call Alex Scott, a survey representative, at this
toll-free number: 1-800-945-MEPS (6377).

MEPS_IncomeJobAid_EN.indd 2

9/21/23 9:14 AM

About the MEPS
Authorization Form
Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality
OMB #0935-0118
24-401

U.S. Department of Health and Human Services

1-800-945-MEPS (6377)
If you have questions about how to complete
these forms, please call Alex Scott, a survey
representative, at this toll-free number:
MEPS_AFBooklet2024_Cover_EN.indd 1

9/21/23 9:54 AM

Questions about participating in the
Medical Expenditure Panel Survey (MEPS)

Questions about the authorization forms

Q. I’ve already given you this information.

Q. How do I sign my authorization forms?
A.

Why do you need to contact
my health care providers?

We contact health care providers for
additional information about your health care
services and prescribed medicines. They are
also asked about the charges for their services
and whether those charges were paid for out
of pocket, by insurance, or by another source.
Their answers supplement the information
you have given and make MEPS data more
complete and useful to researchers.

Q. Will this affect my Medicare,
A.

Isn’t this a bother to them?

Your signature on an authorization form simply
gives your doctor, hospital, or pharmacy the
opportunity to participate in the study if they
choose. It allows them to make their own
decisions. Our experience indicates that most
health care providers are willing to participate
in important research such as MEPS. Usually,
an office staff person can provide the
requested information and the pharmacist
can produce a simple computer printout.

No. Signing or not signing this authoriza
tion form will not affect your eligibility
for any program benefits.

Q. How will you contact my doctor,

Q. My providers are very busy.
A.

Medicaid, VA benefits, or any other
public assistance I am receiving?

hospital, or pharmacy?

me for the time he or she spent
participating in this survey?

No. If a doctor, hospital, or pharmacy has
a policy of charging for the information we
request, MEPS will pay this charge directly.

As part of your household’s participation in this important survey, MEPS is asking for authorization
to contact your family’s health care providers to supplement the information given to us during
the in-person interviews. In order to contact the medical providers and pharmacies used by
members of your household, we need to have the enclosed authorization forms signed.
The information we receive from these providers will allow researchers to better understand how your family’s health
care needs are being met and paid for. For example, we will obtain additional information about services received from
medical providers, prescriptions filled or refilled from pharmacies, and sources that helped pay for your health care.
Any medical provider or pharmacy has the right to refuse to participate, just as you do. However,
our experience has been that most doctors, hospitals, and pharmacies are very willing to provide
this information if they know that the patient has signed an authorization form.
Thank you for your support of this important research effort.

Most providers will be contacted by telephone.
Usually, a clerk in your doctor’s office or
hospital will be able to provide the information
we request. Pharmacies often have a simpler
approach — they print out a computerized
summary of medications prescribed for you.

Q. Will my doctor (or pharmacist) bill
A.

In an effort to go paperless, reduce
burden, and maximize security, we
provide two options for electronically
signing MEPS authorization forms.
Household members who are present
during the interview may sign their
forms electronically on the laptop.

Household members who are not present
during the interview may use DocuSign.
DocuSign is an electronic method for
signing forms and documents at your
convenience using a smartphone, tablet, or
computer. If it is determined that you are
eligible to use DocuSign, you will receive
an email or text message with a link to
your pre-filled forms and easy instructions
to sign where indicated. (See DocuSign
authorization form instructions.)
Paper forms may be signed if DocuSign is
not an option or if you prefer not to sign
the authorization forms electronically.
If paper forms are left to be signed by
someone not present during the interview,
your interviewer will schedule a time to
return and pick up the signed forms. (See
paper authorization form instructions.)

Q. If I have technical issues signing
A.

…information released to
MEPS is protected by the
Public Health Service Act…

Q. How is my signature
A.

protected after I sign?
There are built-in security measures
to maintain data confidentiality and
prevent unauthorized access.

the form, who do I contact?

If you have any questions about
the authorization form, please call
Alex Scott at 1-800-945-MEPS (6377)
or email at [email protected].

Q. Why does this form have an
A.

expiration date that is past the
period of time you are interested in?
This is only to allow enough time for contact
with all of the health care providers in this
survey. Large surveys such as this take time.

Sincerely,

Joel W. Cohen
Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality

MEPS_AFBooklet2024_Inside_EN.indd 2-3

9/21/23 10:11 AM

Paper authorization form instructions

DocuSign authorization form instructions

Please follow these instructions as you review and sign paper authorization forms in black ink.

Please follow these instructions to sign authorization forms in DocuSign. The link to your authorization
form(s) will be sent via email and/or text message. For text messaging, please first respond to the
text from DocuSign confirming that you are willing to receive links to forms via text message.

A
f Check the name
and address of the
hospital, pharmacy,
or other medical
provider.
f If any information is
not correct, please
make changes and
initial each correction.

B
f Read the statement.
f On the form that you
sign, these dates will
represent the 2-year
reference period for
which we are collecting
data, based on the
year you began MEPS.

A
X
E

P
M

E
L

f If any information
is incorrect, please
make changes and
initial each correction.

f Check the information on the form,
including name and address of
the hospital, pharmacy, or other
provider. Contact Alex Scott at
1-800-945-MEPS (6377) with
any changes.

B
f Read this section.

C
f Check the patient’s name, date of
birth, and alternate names/spellings.

& E

f Click the “Sign” button in
the highlighted section.

f If your records might
be filed under another
name (a maiden
name or alternate
spelling), please
complete Item 3.

f Click the “Start” button
to review the forms.

If any information is incorrect,
check “To skip this form, check this
box” at the bottom of the page.

f Check the patient’s
name and date of
birth.

f Check the box next to “I agree
to use electronic records and
signatures” and click the
“Continue” button.

f Confirm your legal name and initials,
or “Draw” your signature.
f Click the “Adopt and Sign” button.
f Once each form is signed,
click the “Finish” button.

f Who should sign the form?
IF PATIENT IS:

THEN FORM SHOULD BE SIGNED BY:

a. Age 18 or older

Only patient for Items 4 and 5, unless one of d-f below applies

b. Age 14 through 17

Patient and parent or guardian (Items 4-9)

c. Age 13 or younger

Parent (Items 6-9)

d. Unable to sign name but able to make mark

Witness (Items 6-9)

e. Deceased

Proxy (Items 6-9)

f. Unable to sign name or make mark

Proxy (Items 6-9)

f Paper authorization forms have been left for: _________________________________________

MEPS_AFBooklet2024_Inside_EN.indd 4-5

Special instructions for the parent/guardian of a teen age 14 through 17:
The signing parent/guardian will receive authorization forms for the teen to the contact
information on file for that parent/guardian. Two emails will be sent to the parent/guardian
(one for the parent/guardian, and one for the teen). Forms should be signed only by the
person addressed on the first page of the DocuSign authorization form file.
If you have any questions or technical issues, please call Alex Scott at
1-800-945-MEPS (6377) or email [email protected].

f DocuSign forms will be sent to:_____________________________________________________

9/21/23 10:11 AM

Confidentiality is primary

Q. Who must sign the authorization forms?
A.
Authorization forms for adults must be
signed by the person who received the
services from the provider or pharmacy
named in Box A of the authorization form.
For teens age 14 through 17, both the teen
who received the services and a parent/
guardian must sign the form. For children
age 13 or younger, only a parent or guardian
must sign the authorization form.

Q. What if I change my mind?
A.

You can revoke an authorization at any time
by contacting the MEPS study. You can
contact the study by telephone by calling
1-800-945-MEPS (6377). You can contact
the study by mail at the following address:
Medical Expenditure Panel Survey
Attn: Alex Scott
c/o Westat
1600 Research Blvd., Room RE 363
Rockville, MD 20850
If you decide to revoke an authorization,
we will stop any efforts to contact that
provider. If the provider already has given
us information about you, we will erase that
information from the study records — unless
it is already incorporated into research
files in which you cannot be identified.

Protecting your personal health information

Q. Why do you need this form?
A.

Your providers cannot release information
about you to a study like MEPS without your
written authorization. The Health Insurance
Portability and Accountability Act, or HIPAA
for short, sets guidelines for the authorization
forms that must be signed to allow a provider
to release health care information. The MEPS
authorization form follows these guidelines.

Q. How do you protect my information?
A.

Just like the information you have already
given to the MEPS interviewer, any information
your provider gives us will be protected by
the Privacy Act and Section 308(d) of the
Public Health Service Act [42 U.S.C. 299c-3(c)
and 42 U.S.C. 242m(d)]. The confidentiality
of your responses to this survey is protected
by Section 944(c). Information that could
identify you will not be disclosed unless
you have consented to that disclosure.

Q. My children have advised me not

doctor (or pharmacist) about me?
To allow medical and pharmacy staff to
identify your records, we will provide
your name, date of birth, and the signed
authorization form. We also will share
other information such as your address or
name of the policyholder for your health
insurance, if needed, to help a doctor or
hospital identify the correct records.

Q. Why do you need to contact
A.

my psychiatrist? That
information is too personal.

Should they choose to participate in the
study, psychiatrists, like other doctors, will
be asked about the costs, dates, diagnoses,
and type of service they provide. They will
not be asked about treatment details.

The HIPAA law creates additional protection
for personal health information held by
medical providers and pharmacies. But
HIPAA protections end when the information
is released to others. When information
is released to MEPS, the requirements
of the Public Health Service Act provide
continuing assurance of confidentiality.

This information provides a
critical link to understanding
how we use and pay for
health care in the US.

MEPS_AFBooklet2024_Inside_EN.indd 6-7

Q. What information will you tell my

to sign anything. Why should I?

A vital part of the research is directed at
understanding the special health care needs
of older Americans. Many research groups
use the results of this survey in their attempts
to improve access to medical care for older
people. We understand that your children only
want to protect you. If they have a particular
concern that we could address, the interviewer
will be happy to talk to them or they can
call Alex Scott at 1‑800‑945‑MEPS (6377).

Research groups use the
results of this survey in
their attempts to improve
access to medical care for
older people, veterans,
minorities, and children.

If you have questions about how to complete
these forms, please call Alex Scott, a survey
representative, at this toll-free number:
1-800-945-MEPS (6377)

9/21/23 10:11 AM

MEPS_Postcard_English_2023.indd 1

9/21/23 9:34 AM

Agency for Healthcare Research and Quality
Medical Expenditure Panel Survey
c/o Westat
1600 Research Blvd., Room RE 363
Rockville, Maryland 20850

You may remember getting a letter a little while ago about the
Medical Expenditure Panel Survey (MEPS). We just wanted to let
you know that we haven’t forgotten about you!
The COVID-19 coronavirus affects every aspect of our lives, the
health and safety of our families, and the cost and quality of our
medical care. The impact of COVID-19 highlights the importance
of accurate data on health care in our country. You have a chance to
play a special role in national research on health care by taking part
in the Medical Expenditure Panel Survey (MEPS) sponsored by the
Agency for Healthcare Research and Quality (AHRQ).
Your MEPS interviewer will be in touch soon to set up your
interview. You can also call Alex Scott toll-free at 1-800-945-6377
or send an email to [email protected] to ask for a time that
works best for you.

Case ID
Respondent Name
Address
City, State Zip

At the end of the interview, you will receive a gift of $50 to show
our appreciation.
Thank you for taking part in this important research effort!

MEPS_Postcard_English_2023.indd 2

9/21/23 9:34 AM

Agency for Healthcare Research and Quality
Medical Expenditure Panel Survey
c/o Westat
1600 Research Blvd., Room RE 363
Rockville, MD 20850

<> <>
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<>, <>, <>-<>

First Class Mail
U. S. Postage
PAID
Suburban MD
Permit No. 6379

Your reply is requested

Time is Running Out !
<>,
Don’t miss your opportunity to participate in the
MEPS Your Health and Health Opinions Survey.
Please complete the online survey soon to ensure
your voice is heard!

Thank
You!

Log in to the website below and enter your PIN to
complete the survey.
www.MEPSDOCS.org/survey
Your PIN is: <>
Questions? Email [email protected]
or call 1-855-964-1354.
If you have already responded, thank you!

Multimode SAQ
Email and Text Message Content

EMAIL INVITATION (MEPS-EMAIL-INV)
Sender: [email protected]

Subject line: Invitation to participate in the MEPS Your Health and Health Opinions
Survey
Dear [FIRST NAME],
Your household recently participated in the Medical Expenditure Panel Survey (MEPS).
As a follow-up to MEPS, you are invited to participate in the Your Health and Health
Opinions Survey. This online survey is an important addition to your household’s
participation in MEPS. It will help us understand how people feel about their health and
health care.
The survey should only take about 7 minutes to complete. Please visit the website
below to begin the survey.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
While your participation in this online follow-up study is voluntary, your answers will be
combined with others around the country to help us study the connections between
people’s lives and the health services they receive. Your answers will be kept
confidential as required by law.
If you have questions, email [email protected] or call 1-855-964-1354.
Thank you and we look forward to receiving your response.

EMAIL REMINDER 1 (MEPS-EMAIL-REM1)
Sender: [email protected]

Email subject line: MEPS Your Health and Health Opinions Survey – Reminder
Dear [FIRST NAME],
Recently we invited you to participate in the MEPS Your Health and Health Opinions
Survey. If you have already responded, thank you! Otherwise, please go online in the
next few days to complete the short 7-minute survey.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
Your participation is voluntary, but it is important to help us understand how people feel
about their health and health care.
Your answers will be kept confidential as required by law.
If you have questions, email [email protected] or call 1-855-964-1354.
Thank you and we look forward to receiving your response.

EMAIL REMINDER 2 (MEPS-EMAIL-REM2)
Sender: [email protected]

Email subject line: There’s still time! Complete your MEPS web survey
Dear [FIRST NAME],
There’s still time to respond to the MEPS Your Health and Health Opinions Survey! If
you have already responded to the survey, thank you. If not, we are sending this
reminder in the hopes that you will participate in this short 7-minute survey.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
This online survey is voluntary, but will help us better understand how people feel about
their health and health care. Your answers will be kept confidential as required by law.
If you have questions, email [email protected] or call 1-855-964-1354.
Thank you, and we look forward to receiving your response.

EMAIL PARTIAL COMPLETE REMINDER 1 (MEPS-EMAIL-PAR1)
Sender: [email protected]

Email subject line: It’s not too late to finish your MEPS web survey!
Dear [FIRST NAME],
Our records show that you started to fill out the MEPS Your Health and Health Opinions
Survey, but you have not finished it. Your experiences are very important to us and your
answers can only be counted if you finish and submit the survey.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
If you have questions, email [email protected] or call 1-855-964-1354.
Thank you and we look forward to receiving your response.

EMAIL PARTIAL COMPLETE REMINDER 2 (MEPS-EMAIL-PAR2)
Sender: [email protected]

Email subject line: Final Chance: MEPS Your Health and Health Opinions Survey
Dear [FIRST NAME],
Our records show that you started to fill out the MEPS Your Health and Health Opinions
Survey, but you have not yet finished it. We are nearing the end of the data collection
period and would like to include your responses.
Your answers will only be counted if you finish and submit the survey in the next few
days.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
We appreciate your help to get us past the finish line!

TEXT INVITATION (MEPS-TEXT-INV / MEPS-TEXTBP-INV / MEPSTEXTSP-INV)
Please complete your MEPS Health and Health Opinions Survey at
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
Reply STOP to cancel. Msg&Data rates may apply.

TEXT REMINDER 1 (MEPS-TEXT-REM1 / MEPS-TEXTBP-REM1 /
MEPS-TEXTSP-REM1)
It’s time to complete your MEPS Health and Health Opinions Survey at
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
Reply STOP to cancel. Msg&Data rates may apply.

TEXT REMINDER 2 (MEPS-TEXT-REM2 / MEPS-TEXTBP-REM2 /
MEPS-TEXTSP-REM2)
Don’t forget! Fill out your MEPS Health and Health Opinions Survey at:

www.mepsdocs.org/survey
Your PIN: XXXXXXXX

Reply STOP to cancel. Msg&Data rates may apply.

TEXT PARTIAL COMPLETE REMINDER 1 (MEPS-TEXT-PAR1 /
MEPS-TEXTBP-PAR1 / MEPS-TEXTSP-PAR1)
Don’t forget! Finish your MEPS Health and Health Opinions Survey at
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
Reply STOP to cancel. Msg&Data rates may apply.

TEXT PARTIAL COMPLETE REMINDER 2 (MEPS-TEXT-PAR2 /
MEPS-TEXTBP-PAR2 / MEPS-TEXTSP-PAR2)
Final Reminder: Finish your MEPS Health and Health Opinions Survey at
www.mepsdocs.org/survey
Your PIN: XXXXXXXX
Reply STOP to cancel. Msg&Data rates may apply.

<> 2023

<>
<>
<>
<>
<>
DEAR <>,

Please complete a survey for the Medical Expenditure Panel Survey (MEPS).

Why did you
receive this
letter?

Your household recently participated in the Medical Expenditure Panel Survey
(MEPS). As a follow-up to MEPS, you are invited to participate in the Your Health
and Health Opinions Survey. A paper copy of the questionnaire is enclosed and
should only take about 7 minutes to complete. It will help us understand how
people feel about their health and health care.

What do you
need to do?

Please complete the survey and use the enclosed envelope to return the survey
as soon as possible. If you misplace the envelope, you can mail the survey to:
MEPS
c/o Westat
1600 Research Blvd. Room GA51
Rockville, MD 20850
If you’d prefer, you can complete this survey online by visiting the website below.
www.mepsdocs.org/survey
Your PIN: XXXXXXXX

How does
this help?

This survey asks questions about your health, your opinions about health, and
health care you have recently received. This survey is an important addition to
your household’s participation in MEPS. Your participation is voluntary, and your
answers will be kept confidential as required by law. For questions, call Alex
Scott toll-free at 1-800-945-MEPS (6377) or email [email protected].

Thank you for your participation!

File Type	application/pdf
File Modified	2024-01-03
File Created	2023-12-20