Form CMS-R-246 Fee-For-Service (FFS) Survey
Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)
2025-FFS-Survey
Fee-For-Service (FFS) Survey
OMB: 0938-0732
Medicare Fee-for-Service CAHPS® Survey
2025 Medicare Experience Survey
MEDICARE EXPERIENCE SURVEY
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 Organization].
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:
Do you wear a hearing aid now?
Yes
No
If No, Go to
Question 3
1 to 3 years
More than 3 years
I don’t wear a hearing aid
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.
YOUR HEALTH INSURANCE COVERAGE
Our records show that you are now in Medicare, the health insurance program for people 65 years old or older or persons with certain disabilities.
Please answer the following questions in this survey as fully as possible regardless of whether you consider yourself in Medicare.
Some people who have Medicare also have other insurance to help pay for some of the costs of their health care. Do you have any other insurance that pays at least some of the cost of your health care?
Yes
No If No, Go to Question 3
Please mark the box below for each type of health insurance that you have.
Medigap, which may be identified on the front of your policy as “Medicare Supplemental Insurance”
Employer, Union, or Retiree Health Coverage (Insurance)
Veteran’s Benefits, also known as VA benefits
Military Retiree Benefits, also known as Tricare
Medicaid, also known as State medical assistance, which is for some persons with limited income and resources
Any Prescription Drug Plan
Other (Please write the name of the other health insurance you currently have on the line below.)
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
I don’t have health insurance other than Medicare.
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?
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
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
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 Worst personal doctor possible
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
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
GETTING HEALTH CARE FROM SPECIALISTS
When you answer the next questions, include the care you got in person, by phone, or by video.
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
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
MANAGING YOUR HEALTH CARE
How likely are you to change doctors if you are dissatisfied with the way you and your doctor communicate?
Very likely
Likely
Unlikely
Very unlikely
How likely are you to tell your doctor when you disagree with him or her?
Very likely
Likely
Unlikely
Very unlikely
In the last 6 months, how often did you leave your doctor’s office feeling that all of your concerns or questions were fully answered?
Never
Sometimes
Usually
Always
In the last 6 months, how often did you make sure you understood the results of any medical test or procedure such as x-ray, blood test, or EKG for heart conditions?
Never
Sometimes
Usually
Always
I did not have any medical tests or procedures in the last 6 months
In the last 6 months, did you get information or help from Medicare’s customer service?
Yes
No If No, Go to Question 39
In the last 6 months, how often did Medicare’s customer service give you the information or help you needed?
Never
Sometimes
Usually
Always
In the last 6 months, how often did Medicare’s customer service staff treat you with courtesy and respect?
Never
Sometimes
Usually
Always
In the last 6 months, did Medicare give you any forms to fill out?
Yes
No If No, Go to Question 41
In the last 6 months, how often were the forms from Medicare 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 Medicare?
0 Worst health plan possible
1
2
3
4
5
6
7
8
9
10 Best health plan possible
ABOUT YOU
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
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?
Yes No
A heart attack?
Angina or coronary
heart disease?
Hypertension or high blood
pressure?
Cancer, other than
skin cancer?
Emphysema, asthma, or COPD (chronic obstructive pulmo-
nary disease)?
Any kind of diabetes or high blood
sugar?
Have you had a flu shot since July 1, 2024?
Yes
No
Don’t know
Have you ever had one or more pneumonia shots? Two shots are usually given in a person’s lifetime and these are different from a flu shot. It is also called the pneumococcal vaccine.
Yes
No
Don’t know
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
What sex were you assigned at birth, on your birth certificate?
Female
Male
Prefer not to answer
What is your current gender?
Female
Male
Transgender woman
Transgender man
Non-binary
Gender fluid
I use a different term
Prefer not to answer
Which of the following best represents how you think about yourself?
Lesbian or gay
Straight, that is, not gay or lesbian
Bisexual
I use a different term
Prefer not to answer
How many people live in your household now, including yourself?
1 person
2 to 3 people
4 or more people
Because of a health or physical problem are you unable to do or have any difficulty doing the following activities? (Please mark one response for each activity.)
I am
unable Yes, I No, I do to do this have not have
a.
Bathing
b.
Dressing
c.
Eating
d.
Getting in or
out
of
chairs e.
Walking
f. Using
the toilet
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
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 FOR COMPLETING THIS SURVEY
Please return your completed survey in the postage-paid envelope to: [SURVEY ORGANIZATION RETURN ADDRESS FOR MAIL PROCESSING]
Please do not include any other correspondence.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | 2024 FFS Survey |
| Subject | 2024 Medicare FFS CAHPS Survey |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2024-07-22 |
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