Existing Question (2024),Proposed Question (2025),Type of Change,Reason for Change,Burden Change
1. 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?,1. 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?,-,,
"2. Please mark the box below for each type of health insurance that you have.
2a. Medigap, which may be identified on the front of your policy as Medicare Supplemental Insurance
2b. Employer, Union, or Retiree Health Coverage (insurance)
2c.
Veterans
Benefits, also known as VA benefits
2d.
Military Retiree Benefits, also known as Tricare
2e.
Medicaid, also known as State medical assistance, which is for some
persons with limited income and resources
2f.
Any Prescription Drug Plan
2g.
Other (Please write the name of the other health insurance you
currently have on the line below.)
2h.
I dont
have health insurance other than Medicare.","2. Please mark
the box below for each type of health insurance that you have.
2a.
Medigap, which may be identified on the front of your policy as
Medicare
Supplemental Insurance
2b. Employer, Union, or Retiree Health Coverage (insurance)
2c.
Veterans
Benefits, also known as VA benefits
2d.
Military Retiree Benefits, also known as Tricare
2e.
Medicaid, also known as State medical assistance, which is for some
persons with limited income and resources
2f.
Any Prescription Drug Plan
2g.
Other (Please write the name of the other health insurance you
currently have on the line below.)
2h.
I dont
have health insurance other than Medicare.",-,,
"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.
How likely are you to change doctors if you are dissatisfied with the
way you and your doctor communicate?,32. How likely are you to change
doctors if you are dissatisfied with the way you and your doctor
communicate?,-,,
34.
How likely are you to tell your doctor when you disagree with him or
her?,33. How likely are you to tell your doctor when you disagree
with him or her?,-,,
"35.
In the last 6 months, how often did you leave your doctors
office feeling that all of your concerns or questions were fully
answered?","34. In the last 6 months, how often did you
leave your doctors
office feeling that all of your concerns or questions were fully
answered?",-,,
"36.
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?","35. 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?",-,,
"37.
In the last 6 months, did you get information or help from Medicares
customer service?","36. In the last 6 months, did you get
information or help from Medicares
customer service?",-,,
"38.
In the last 6 months, how often did Medicares
customer service give you the information or help you needed?","37.
In the last 6 months, how often did Medicares
customer service give you the information or help you needed?",-,,
"39.
In the last 6 months, how often did Medicares
customer service staff treat you with courtesy and respect?","38.
In the last 6 months, how often did Medicares
customer service staff treat you with courtesy and respect?",-,,
"40.
In the last 6 months, did Medicare give you any forms to fill
out?","39. In the last 6 months, did Medicare give you any
forms to fill out?",-,,
"41.
In the last 6 months, how often were the forms from Medicare easy to
fill out?","40. In the last 6 months, how often were the
forms from Medicare easy to fill out?",-,,
"42.
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?","41. 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?",-,,
"43.
In general, how would you rate your overall health?","42.
In general, how would you rate your overall health?",-,,
"44.
In general, how would you rate your overall mental or emotional
health?","43. In general, how would you rate your overall
mental or emotional health?",-,,
45.
What language do you mainly speak at home?,44. What language do you
mainly speak at home?,-,,
"46.
In the last 6 months, did you spend one or more nights in a
hospital?","45. In the last 6 months, did you spend one or
more nights in a hospital?",-,,
"47.
In the last 6 months, how often was it easy to get the medicines your
doctor prescribed?","46. In the last 6 months, how often
was it easy to get the medicines your doctor prescribed?",-,,
48.
Do you have insurance that pays part or all of the cost of your
prescription medicines?,47. Do you have insurance that pays part or
all of the cost of your prescription medicines?,-,,
"49.
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 you delay or not fill a prescription because you felt
you could not afford it?",-,,
"50.
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?
50a.
Health condition
50b.
Disability
50c.
Age
50d.
Culture or religion
50e.
Language or accent
50f.
Race or ethnicity
50g.
Sex (female or male)
50h.
Sexual orientation
50i.
Gender or gender identity
50j.
Income""","49. 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?
49a.
Health condition
49b.
Disability
49c.
Age
49d.
Culture or religion
49e.
Language or accent
49f.
Race or ethnicity
49g.
Sex (female or male)
49h.
Sexual orientation
49i.
Gender or gender identity
49j.
Income""",-,,
"51.
Has a doctor ever told you that you had any of the following
conditions?
51a.
A heart attack?
51b.
Angina or coronary heart disease?
51c.
Hypertension or high blood pressure?
51d.
Cancer, other than skin cancer?
51e.
Emphysema, asthma or COPD (chronic obstructive pulmonary disease)?
51f.
Any kind of diabetes or high blood sugar?","50. Has a
doctor ever told you that you had any of the following conditions?
50a.
A heart attack?
50b.
Angina or coronary heart disease?
50c.
Hypertension or high blood pressure?
50d.
Cancer, other than skin cancer?
50e.
Emphysema, asthma or COPD (chronic obstructive pulmonary disease)?
50f.
Any kind of diabetes or high blood sugar?",-,,
"52.
Have you had a flu shot since July 1, 2023?","51. Have you
had a flu shot since July 1, 2024?",-,,
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.,52. 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.,-,,
"54.
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
"55.
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
56.
What is the highest grade or level of school that you have
completed?,53. What is the highest grade or level of school that you
have completed?,-,,
57.
Are you of Hispanic or Latino origin or descent?,54. Are you of
Hispanic or Latino origin or descent?,-,,
58.
What is your race? Please mark one or more.,55. What is your race?
Please mark one or more.,-,,
59.
What sex were you assigned at birth?,56. What sex were you assigned
at birth?,-,,
60.
What is your current gender?,57. What is your current gender?,-,,
61.
Which of the following best represents how you think about
yourself?,58. Which of the following best represents how you think
about yourself?,-,,
"62.
How many people live in your household now, including yourself?","59.
How many people live in your household now, including yourself?",-,,
"63.
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.)
63a.
Bathing
63b.
Dressing
63c.
Eating
63d.
Getting in or out of chairs
63e.
Walking
63f.
Using the toilet","60. 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.)
60a.
Bathing
60b.
Dressing
60c.
Eating
60d.
Getting in or out of chairs
60e.
Walking
60f.
Using the toilet",-,,
"64.
Because of a physical, mental or emotional condition, do you have
difficulty doing errands alone such as visiting a doctors
office or shopping?","61. Because of a physical, mental or
emotional condition, do you have difficulty doing errands alone such
as visiting a doctors
office or shopping?",-,,
65.
Do you ever use the internet at home?,62. Do you ever use the
internet at home?,-,,
"66.
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. 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? ",-,,
67.
Did someone help you complete this survey?,64. Did someone help you
complete this survey?,-,,
"68.
How did that person help you? Please mark one or more.
68a.
Read the questions to me
68b.
Wrote down the answers I gave
68c.
Answered the questions for me
68d.
Translated the questions into my language
68e.
Helped in some other way","65. How did that person help
you? Please mark one or more.
65a.
Read the questions to me
65b.
Wrote down the answers I gave
65c.
Answered the questions for me
65d.
Translated the questions into my language
65e.
Helped in some other way",-,,
| File Type | text/plain |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |