Existing Question (2024),Proposed Question (2025),Type of Change,Reason for Change,Burden Change
1. Our records show that in 2023 your health services were covered by the plan named on the back page. Is that right?,1. Our records show that in 2024 your health services were covered by the plan named on the back page. Is that right?,-,,
2. Please write below the name of the health plan you had in 2023 and complete the rest of the survey based on the experiences you had with that plan. (Please print),2. 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),-,,
"3. In the last 6 months, did you have an illness, injury, or condition that needed care right away?","3. In the last 6 months, did you have an illness, injury, or condition that needed care right away?",-,,
"4. In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?","4. In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?",-,,
"5. In the last 6 months, did you make any in-person, phone, or video appointments for a check-up or routine care?","5. In the last 6 months, did you make any in-person, phone, or video appointments for a check-up or routine care?",-,,
"6. In the last 6 months, how often did you get an appointment for a check-up or routine care as soon as you needed?","6. In the last 6 months, how often did you get an appointment for a check-up or routine care as soon as you needed?",-,,
"7. 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?","7. 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?",-,,
"8. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?",,Item dropped,Item was dropped from the composite measure in 2024; removing the item from the survey aligns survey content with measure content.,Yes
"9. 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?","8. 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?",-,,
"10. In the last 6 months, how often was it easy to get the care, tests or treatment you needed?","9. In the last 6 months, how often was it easy to get the care, tests or treatment you needed?",-,,
"11. 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?","10. 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?",-,,
"12. 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?","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?",-,,
"13. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?","12. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?",-,,
"14. In the last 6 months, how often did your personal doctor listen carefully to you?","13. In the last 6 months, how often did your personal doctor listen carefully to you?",-,,
"15. In the last 6 months, how often did your personal doctor show respect for what you had to say?","14. In the last 6 months, how often did your personal doctor show respect for what you had to say?",-,,
"16. In the last 6 months, how often did your personal doctor spend enough time with you?","15. In the last 6 months, how often did your personal doctor spend enough time with you?",-,,
"17. 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?","16. 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?",-,,
"18. 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? ","17. 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? ",-,,
"19. In the last 6 months, did your personal doctor order a blood test, x-ray or other test for you?","18. In the last 6 months, did your personal doctor order a blood test, x-ray or other test for you?",-,,
"20.
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
doctors
office follow up to give you those results?","19. 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
doctors
office follow up to give you those results?",-,,
"21.
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?","20. 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?",-,,
"22.
In the last 6 months, did you take any prescription medicine?","21.
In the last 6 months, did you take any prescription medicine?",-,,
"23.
In the last 6 months, how often did you and your personal doctor talk
about all the prescription medicines you were taking?","22.
In the last 6 months, how often did you and your personal doctor talk
about all the prescription medicines you were taking?",-,,
"24.
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?","23. 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?",-,,
"25.
In the last 6 months, did you need help from anyone in your personal
doctors
office to manage your care among these different providers and
services?","24. In the last 6 months, did you need help
from anyone in your personal doctors
office to manage your care among these different providers and
services?",-,,
"26.
In the last 6 months, did you get the help you needed from your
personal doctors
office to manage your care among these different providers and
services?","25. In the last 6 months, did you get the help
you needed from your personal doctors
office to manage your care among these different providers and
services?",-,,
"27.
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?","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?",-,,
"28.
In the last 6 months, did you make any appointments with a
specialist?","27. In the last 6 months, did you make any
appointments with a specialist?",-,,
"29.
In the last 6 months, how often did you get an appointment with a
specialist as soon as you needed?","28. In the last 6
months, how often did you get an appointment with a specialist as
soon as you needed?",-,,
30.
How many specialists have you talked to in the last 6 months?,29. How
many specialists have you talked to in the last 6 months?,-,,
"31.
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?","30. 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?",-,,
"32.
In the last 6 months, how often did your personal doctor seem
informed and up-to-date about the care you got from
specialists?","31. In the last 6 months, how often did your
personal doctor seem informed and up-to-date about the care you got
from specialists?",-,,
"33.
In the last 6 months, did you get information or help from your
health plans
customer service?","32. In the last 6 months, did you get
information or help from your health plans
customer service?",-,,
"34.
In the last 6 months, how often did your health plans
customer service give you the information or help you needed?","33.
In the last 6 months, how often did your health plans
customer service give you the information or help you needed?",-,,
"35.
In the last 6 months, how often did your health plans
customer service staff treat you with courtesy
and
respect?","34. In the last 6 months, how often did your
health plans
customer service staff treat you with courtesy
and
respect?",-,,
"36.
In the last 6 months, did your health plan give you any forms to fill
out?","35. In the last 6 months, did your health plan give
you any forms to fill out?",-,,
"37.
In the last 6 months, how often were the forms from your health plan
easy to fill out?","36. In the last 6 months, how often
were the forms from your health plan easy to fill out?",-,,
"38.
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?","37. 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?",-,,
"39.
A co-pay is the amount of money you pay at the time of a visit to a
doctors
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)?","38. A co-pay is the amount of
money you pay at the time of a visit to a doctors
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)?",-,,
"40.
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)?","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)?",-,,
"41.
In general, how would you rate your overall health?","40.
In general, how would you rate your overall health?",-,,
"42.
In general, how would you rate your overall mental or emotional
health?","41. In general, how would you rate your overall
mental or emotional health?",-,,
43.
What language do you mainly speak at home?,42. What language do you
mainly speak at home?,-,,
"44.
In the last 6 months, did you spend one or more nights in a
hospital?","43. In the last 6 months, did you spend one or
more nights in a hospital?",-,,
"45.
In the last 6 months, how often was it easy to get the medicines your
doctor prescribed?","44. In the last 6 months, how often
was it easy to get the medicines your doctor prescribed?",-,,
46.
Do you have insurance that pays part or all of the cost of your
prescription medicines?,45. Do you have insurance that pays part or
all of the cost of your prescription medicines?,-,,
"47.
In the last 6 months, did you delay or not fill a prescription
because you felt you could not afford it?","46. In the last
6 months, did you delay or not fill a prescription because you felt
you could not afford it?",-,,
"48.
In the last 6 months, did anyone from a clinic, emergency room, or
doctors
office where you got care treat you in an unfair or insensitive way
because of any of the following things about you?
48a.
Health condition
48b.
Disability
48c.
Age
48d.
Culture or religion
48e.
Language or accent
48f.
Race or ethnicity
48g.
Sex (female or male)
48h.
Sexual orientation
48i.
Gender or gender identity
48j.
Income","47. In the last 6 months, did anyone from a
clinic, emergency room, or doctors
office where you got care treat you in an unfair or insensitive way
because of any of the following things about you?
47a.
Health condition
47b.
Disability
47c.
Age
47d.
Culture or religion
47e.
Language or accent
47f.
Race or ethnicity
47g.
Sex (female or male)
47h.
Sexual orientation
47i.
Gender or gender identity
47j.
Income",-,,
"49.
Has a doctor ever told you that you had any of the following
conditions?
49a.
A heart attack?
49b.
Angina or coronary heart disease?
49c.
Hypertension or high blood pressure?
49d.
Cancer, other than skin cancer?
49e.
Emphysema, asthma or COPD (chronic obstructive pulmonary disease)?
49f.
Any kind of diabetes or high blood sugar?","48. Has a
doctor ever told you that you had any of the following conditions?
48a.
A heart attack?
48b.
Angina or coronary heart disease?
48c.
Hypertension or high blood pressure?
48d.
Cancer, other than skin cancer?
48e.
Emphysema, asthma or COPD (chronic obstructive pulmonary disease)?
48f.
Any kind of diabetes or high blood sugar?",-,,
50.
Do you have serious difficulty walking or climbing stairs?,49. Do you
have serious difficulty walking or climbing stairs?,-,,
51.
Do you have difficulty dressing or bathing?,50. Do you have
difficulty dressing or bathing?,-,,
"52.
Because of a physical, mental, or emotional condition, do you have
difficulty doing errands alone such as visiting a doctors
office or shopping?","51. Because of a physical, mental, or
emotional condition, do you have difficulty doing errands alone such
as visiting a doctors
office or shopping?",-,,
"53.
Have you had a flu shot since July 1, 2023?","52. Have you
had a flu shot since July 1, 2024?",-,,
54.
Have you ever had one or more pneumonia shots? Two shots are usually
given in a persons
lifetime and these are different from a flu shot. It is also called
the pneumococcal vaccine.,53. Have you ever had one or more pneumonia
shots? Two shots are usually given in a persons
lifetime and these are different from a flu shot. It is also called
the pneumococcal vaccine.,-,,
"55.
Do you now smoke cigarettes or use tobacco every day, some days, or
not at all?",,Item dropped,This is an NCQA HEDIS measure and is
being retired.,Yes
"56.
In the last 6 months, how often were you advised to quit smoking or
using tobacco by a doctor or other health provider?",,Item
dropped,This is an NCQA HEDIS measure and is being retired.,Yes
57.
What is the highest grade or level of school that you have
completed?,54. What is the highest grade or level of school that you
have completed?,-,,
58.
Are you of Hispanic or Latino origin or descent?,55. Are you of
Hispanic or Latino origin or descent?,-,,
59.
What is your race? Please mark one or more.,56. What is your race?
Please mark one or more.,-,,
"60.
How many people live in your household now, including yourself?","57.
How many people live in your household now, including yourself?",-,,
61.
Do you ever use the internet at home?,58. Do you ever use the
internet at home?,-,,
"62.
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? ","59. 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? ",-,,
63.
Did someone help you complete this survey?,60. Did someone help you
complete this survey?,-,,
"64.
How did that person help you? Please mark one or more.
64a.
Read the questions to me
64b.
Wrote down the answers I gave
64c.
Answered the questions for me
64d.
Translated the questions into my language
64e.
Helped in some other way","61. How did that person help
you? Please mark one or more.
61a.
Read the questions to me
61b.
Wrote down the answers I gave
61c.
Answered the questions for me
61d.
Translated the questions into my language
61e.
Helped in some other way",-,,
| File Type | text/plain |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |