Form CMS-R-246 Medicare Advantage Plan Survey
Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)
2025-MA-Only-Survey
Medicare Advantage (MA) Survey
OMB: 0938-0732
Medicare Advantage and Prescription Drug Plan (MA & PDP) CAHPS® Survey
2025 Medicare Advantage Plan Survey
2025 Medicare Experience Survey MEDICARE SURVEY INSTRUCTIONS
This survey asks about you and the health care you received in the last six months. Answer each question thinking about yourself and the times you got health care in person, by phone or by video call. Please take the time to complete this survey. Your answers are very important to us. Please return the survey with your answers in the enclosed postage-paid envelope to [Survey Vendor].
If you changed your Medicare plan for 2025, answer the questions thinking about your experiences in the last 6 months of 2024.
Answer all the questions by putting an “X” in the box to the left of your answer, like this:
Be sure to read all the answer choices given before marking your answer.
You are sometimes told not to answer some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this: [If No, Go to Question 3]. See the example below:
EXAMPLE
Yes
No If
No, Go to Question 3
Less than
one year
1 to 3 years
More than 3 years
I don’t wear a hearing aid
Yes
No
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. This applies to both mandatory and voluntary collections of information. The valid OMB control number for this information collection is 0938-0732 (expires TBD). The time required to complete this information collection is estimated to average 15 minutes, 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 C1-25-05, Baltimore, Maryland 21244-1850.
Our records show that in 2024 your health services were covered by the plan named on the back page. Is that right?
Yes If Yes, Go to Question 3
No
Please write below the name of the health plan you had in 2024 and complete the rest of the survey based on the experiences you had with that plan.
(Please print)
Your Health Care in the Last 6 Months
These questions ask about your own health care from a clinic, emergency room, or doctor’s office. This includes care you got in person, by phone, or by video.
In the last 6 months, did you have an illness, injury, or condition that needed care right away?
Yes
No If No, Go to Question 5
In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?
Never
Sometimes
Usually
Always
In the last 6 months, did you make any in-person, phone, or video appointments for a check-up or routine care?
Yes
No If No, Go to Question 7
In the last 6 months, how often did you get an appointment for a check-up or routine care as soon as you needed?
Never
Sometimes
Usually
Always
In the last 6 months, not counting the times you went to an emergency room, how many times did you get health care for yourself in person, by phone, or by video?
None
1 time
2
3
4
5 to 9
10 or more times
Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months?
11. In the last 6 months, how many times did you have an in-person, phone, or video visit with your personal doctor about your health?
None If None, Go to
Question 26
0 Worst health care possible
1
2
3
4
5
6
7
8
9
10 Best health care possible
In the last 6 months, how often was it easy to get the care, tests, or treatment you needed?
Never
Sometimes
Usually
Always
Your Personal Doctor
A personal doctor is the one you would talk to if you need a check-up, want advice about a health problem, or get sick or hurt. Do you have a personal doctor?
Yes
No If No, Go to Question 26
1 time
2
3
4
5 to 9
10 or more times
In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?
Never
Sometimes
Usually
Always
In the last 6 months, how often did your personal doctor listen carefully to you?
Never
Sometimes
Usually
Always
In the last 6 months, how often did your personal doctor show respect for what you had to say?
Never
Sometimes
Usually
Always
In the last 6 months, how often did your personal doctor spend enough time with you?
Never
Sometimes
Usually
Always
Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?
0
1
2
3
4
5
6
7
8
9
10 
Best personal doctor possible
In the last 6 months, when you talked with your personal doctor during a scheduled appointment, how often did he or she have your medical records or other information about your care?
Never
Sometimes
Usually
Always
In the last 6 months, did your personal doctor order a blood test, x-ray or other test for you?
Yes
No If No, Go to Question 21
In the last 6 months, when your personal doctor ordered a blood test, x-ray or other test for you, how often did someone from your personal doctor’s office follow up to give you those results?
Never
Sometimes
Usually
Always
In the last 6 months, when your personal doctor ordered a blood test, x-ray or other test for you, how often did you get those results as soon as you needed them?
Never
Sometimes
Usually
Always
In the last 6 months, did you take any prescription medicine?
Yes
No If No, Go to Question 23
In the last 6 months, how often did you and your personal doctor talk about all the prescription medicines you were taking?
Never
Sometimes
Usually
Always
Getting Health Care From Specialists
When you answer the next questions, include the care you got in person, by phone, or by video.
26. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. Is your personal doctor a specialist?
Yes If Yes, Please include your personal doctor as you answer these questions about specialists
In the last 6 months, did you get care from more than one kind of health care provider or use more than one kind of health care service?
Yes
No If No, Go to Question 26
In the last 6 months, did you need help from anyone in your personal doctor’s office to manage your care among these different providers and services?
Yes
No If No, Go to Question 26
In the last 6 months, did you get the help you needed from your personal doctor’s office to manage your care among these different providers and services?
Yes, definitely
Yes, somewhat
No
No
In the last 6 months, did you make any appointments with a specialist?
Yes
No If No, Go to Question 32
In the last 6 months, how often did you get an appointment with a specialist as soon as you needed?
Never
Sometimes
Usually
Always
How many specialists have you talked to in the last 6 months?
None If None, Go to
Question 32
1 specialist
2
3
4
5 or more specialists
We want to know your rating of the specialist you talked to most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?
0 Worst specialist possible
1
2
3
4
5
6
7
8
9
10 Best specialist possible
In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from specialists?
Never
Sometimes
Usually
Always
I do not have a personal doctor
I have not talked with my personal doctor in the last 6 months
My personal doctor is a specialist
Your
Health
Plan
In the last 6 months, did you get information or help from your health plan’s customer service?
Yes
No If No, Go to Question 35
In the last 6 months, how often did your health plan’s customer service give you the information or help you needed?
Never
Sometimes
Usually
Always
In the last 6 months, how often did your health plan’s customer service staff treat you with courtesy and respect?
Never
Sometimes
Usually
Always
In the last 6 months, did your health plan give you any forms to fill out?
Yes
No If No, Go to Question 37
In the last 6 months, how often were the forms from your health plan easy to fill out?
Never
Sometimes
Usually
Always
Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?
0 Worst health plan possible
1
39. Your health plan benefits are the types of health care and services you can get under the plan. In the last 6 months, did your health plan offer you extra benefits because you have a health condition (like high blood pressure)?
-
2
Yes
3
No
4
I am not sure
5
I do not have a health
6
condition
7
I was offered extra benefits for
8
another reason
9
10
Best health plan possible
About Y
ou
38. A co-pay is the amount of money
you pay at the time of a visit to a doctor’s office or clinic. In the last 6 months, did your health plan offer to lower the amount of your co-pay because you have a health condition (like high blood pressure)?
Yes
No
I am not sure
I do not have a co-pay
I do not have a health condition
I was offered a lower co-pay for another reason
In general, how would you rate your overall health?
Excellent
Very good
Good
Fair
Poor
In general, how would you rate your overall mental or emotional health?
Excellent
Very good
Good
Fair
Poor
What language do you mainly speak at home?
English
Spanish
Chinese
Korean
Tagalog
Vietnamese
Some other language
Please print:
In the last 6 months, did you spend one or more nights in a hospital?
Yes
No
In the last 6 months, how often was it easy to get the medicines your doctor prescribed?
Never
Sometimes
Usually
Always
My doctor did not prescribe any medicines for me in the last 6 months
Do you have insurance that pays part or all of the cost of your prescription medicines?
Yes
No
Don’t know
In the last 6 months, did you delay or not fill a prescription because you felt you could not afford it?
Yes
No
My doctor did not prescribe any medicines for me in the last 6 months
In the last 6 months, did anyone from a clinic, emergency room, or doctor’s office where you got care treat you in an unfair or insensitive way because of any of the following things about you?
Yes No
-
a. Health condition
b. Disability
c. Age
d. Culture or religion
e. Language or accent ..
f. Race or ethnicity
g. Sex (female or male)
h. Sexual orientation
i. Gender or gender
identity
j. Income
Has a doctor ever told you that you had any of the following conditions?
52. Have you had a flu shot since July 1, 2024?
-
Yes
No
Yes
A heart attack?
Angina or coronary
No
Don’t know
heart disease?
c. Hypertension
53. Have you ever had one or more
or high blood
pneumonia shots? Two shots are
pressure?
usually given in a person’s lifetime
and
d. Cancer, other than
these are different from a flu shot.
It
skin cancer?
is also called the pneumococcal
e. Emphysema, asthma,
vaccine.
or COPD (chronic
obstructive pulmo-
Yes
nary disease)?
f. Any kind of diabetes
No
Don’t know
or high blood
sugar?
Do you have serious difficulty walking or climbing stairs?
Yes
No
Do you have difficulty dressing or bathing?
Yes
No
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?
Yes
No
What is the highest grade or level of school that you have completed?
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
Are you of Hispanic or Latino origin or descent?
Yes, Hispanic or Latino
No, not Hispanic or Latino
What is your race? Please mark one or more.
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or other Pacific Islander
White
How many people live in your household now, including yourself?
1 person
2 to 3 people
4 or more people
Do you ever use the internet at home?
Yes
No
May the Medicare Program follow up with you to learn more about your health care, or to invite you to a group discussion or interview on topics related to health care?
Yes
No
Did someone help you complete this survey?
Yes
No Thank you. Please
return the completed survey in the postage- paid envelope.
How did that person help you? Please mark one or more.
Read the questions to me
Wrote down the answers I gave
Answered the questions for me
Translated the questions into my language
Helped in some other way
Thank you.
Please return the completed survey in the postage-paid envelope. [SURVEY VENDOR RETURN ADDRESS FOR MAIL PROCESSING]
Contract Name:
[OPTIONAL]
You may also know your plan by one of the following:
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