CMS-10710.GenIC#4 (REVISION) - Healthcare.gov Web Satisfaction Survey (Redline Instrument)

Q1 Which of these best describes you?

1. An individual or family who currently does NOT have Marketplace health insurance, but is interested in getting Marketplace insurance

2. An individual or family who currently has Marketplace health insurance (Non-OE) OR An individual or family interested in re-enrolling or renewing Marketplace health insurance (During OE)

3. A small business employee

4. A small business employer

5. A CMS call center representative

6. A CMS certified assister or navigator

7. A CMS certified broker or agent

8. An insurance company representative

9. Other (Specify)

Skip To: Q3 If Which of these best describes you? = 3-9

Ask Q2 series if Q1 = 1 or 2

Q2 Do you currently have health insurance?

1. Yes

2. No

3. Don’t know

4. Refused

Q2A Have you ever had health insurance through the Health Insurance Marketplace?

1. Yes

2. No

3. Don’t know

4. Refused

Q2B Who are you interested in getting insurance for?

1. Only for myself

2. For myself and others

3. Only for others, not myself

4. Other (specify)

Ask ALL

Q3 What is the main reason you came to HealthCare.gov today? If you came for more than one reason, please select the main one.

1. Find information about Marketplace health insurance (like how it works, what’s covered, or cost information)

2. Create an account

3. View plans and prices BEFORE filling out an application -- (See Plans and Prices)

4. Start, continue, or update an application

5. Shop and compare plans AFTER filling out an application

6. Enroll in or re-enroll a plan

7. Other (Specify)

Skip To: Q3A2 if Q3 = 7

Ask if Q3 = 1-6

Q3A1 You selected [insert Q5 response] as the main reason you came to HealthCare.gov. Were you able to successfully complete the activity you came to do during your visit today?

1. Yes

2. No

3. Don’t know

4. Not Applicable

Skip To: Q4

Ask if Q3 = 7

Q3A2 Were you able to successfully complete the activity you came to do during your visit today?

1. Yes

2. No

3. Don’t know

4. Not Applicable

Ask ALL

Q4 Overall, how easy or difficult was it to do that activity?

1. Very easy

2. Somewhat easy

3. Neutral

4. Somewhat difficult

5. Very difficult

6. Not applicable – did not attempt an activity

Ask Q5A if Q3 = 1

Q5A1 Did you find the information you were looking for on HealthCare.gov?

1. Yes

2. No

3. Not applicable

Skip To: Q6

Ask Q5B series if Q3 = 4 or 5

Q5B1 Did you submit your application for health insurance on HealthCare.gov by pressing the SUBMIT APPLICATION button?

1. Yes

2. No

Skip To: Q6 if Q5b = 2

Q5B2 After you submitted your application, did the website give you information showing if you are eligible to get help paying for insurance?

1. Yes

2. No

3. I don't know

Skip To: Q6 if Q5B2 = 2 or 3

Ask if Q5B2 = 1

Q5B3 Did the Eligibility Notice say that someone in your household qualifies for any of these? (Check all that apply)

1. A health plan with extra savings through reduced deductibles or copayments (called cost-sharing reduction plans)

2. A health plan with a premium tax credit to lower your monthly premium

3. A health plan, but no cost-sharing reduction and no tax credit

4. A state insurance program for people with low income, such as Medicaid or CHIP

5. I don’t know

Ask if Q5B2 = 1

Q5B4 Overall, how easy or difficult was it to understand your Eligibility Notice?

1. Very easy

2. Somewhat easy

3. Neutral

4. Somewhat difficult

5. Very difficult

6. I didn’t read the Eligibility Notice

Skip To: Q6

Ask if Q3 = 5 or 6

Q5C How confident are you that the information you saw on HealthCare.gov will help you select the right health plan for you?

1. Very confident

2. Somewhat confident

3. Neutral

4. Not very confident

5. Not at all confident

6. I don’t know

7. Not applicable

Skip To: Q6

Ask if Q3 = 3 or 5

Q5D When you were comparing health plans or choosing your plan, did you notice that the website showed star ratings to indicate the quality of each health plan?

1. Yes

2. No

3. I don't know

Skip To: Q6 If Q5D = 2 or 3

Ask Q5D series if Q5D = 1

Q5D1 How important were the star ratings in helping you decide what health plan to choose?

1. Very important

2. Somewhat important

3. Neutral

4. Not very important

5. Not at all important

6. I don't know

Q5D2 How confident are you that the star ratings helped you select a high-quality health plan?

1. Very confident

2. Somewhat confident

3. Neutral

4. Not very confident

5. Not at all confident

6. I don't know

Ask Q6 Series of ALL

Q6A How satisfied are you with the information provided on HealthCare.gov?

1. Very satisfied

2. Somewhat satisfied

3. Neither satisfied nor dissatisfied

4. Not very satisfied

5. Not at all satisfied

6. I don't know

Q6B How satisfied are you with how well the HealthCare.gov website worked today?

1. Very satisfied

2. Somewhat satisfied

3. Neither satisfied nor dissatisfied

4. Not very satisfied

5. Not at all satisfied

6. I don't know

Q6C How satisfied are you with your overall experience on HealthCare.gov?

1. Very satisfied

2. Somewhat satisfied

3. Neither satisfied nor dissatisfied

4. Not very satisfied

5. Not at all satisfied

6. I don't know

Ask if Q6A, Q6B, or QcC =4 or 5

Q6D How can we improve your overall experience on HealthCare.gov? Please be specific.

OPEN ENDED ________________________________________________________________

Ask ALL

Q7 How likely are you to recommend HealthCare.gov to family or friends who need health insurance?

1. Very likely

2. Somewhat likely

3. Neutral

4. Not very likely

5. Not at all likely

6. Not applicable

Ask ALL

Q8 How likely will you be to return to HealthCare.gov if you need information in the future?

1. Very likely

2. Somewhat likely

3. Neutral

4. Not very likely

5. Not at all likely

6. Not applicable

Q1 Based on my experience using HealthCare.gov, I trust that the Health Insurance Marketplace is working in the best interest of the American public.

1 Yes

2 No

Q2a (for those who select Yes) What about using HealthCare.gov made the difference? (Select all that apply)

              I found what I needed

              It was easy to complete what I came to the site to do

              I found what I needed on this site quicky

              I was able to find plans that meet my needs

              None of the above

             

Q2b. (for those who select No) What about using HealthCare.gov could have been better?

              I did not find what I needed

              It was difficult to complete what I came to the site to do

              It took too long to find what I needed on this site

              I was not able to find plans that meet my needs

None of the above

Q3. What can we do to improve your experience on HealthCare.gov?

              [Open ended question]

• OMB Control No. 0938-1382 (exp. 12/31/2026)

• Estimated burden time: 4 minutes

• All responses to this survey are voluntary.

• Send comments about this survey to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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 12/31/2026). 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.