Download:
pdf |
pdfMedicare Fee-for-Service CAHPS® Survey
2025 Medicare Experience Survey
MEDICARE EXPERIENCE SURVEY
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 Organization].
Answer all the questions by putting an “X” in the box to the left of your answer, like this:
Yes
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
1. Do you wear a hearing aid now?
Yes
No If No, Go to Question 3
2. How long have you been wearing a hearing aid?
Less than one year
1 to 3 years
More than 3 years
I don’t wear a hearing aid
3. In the last 6 months, did you have any headaches?
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 11/30/2027). 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.
1
YOUR HEALTH INSURANCE
COVERAGE
YOUR HEALTH CARE IN THE
LAST 6 MONTHS
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.
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.
Please answer the following questions in this
survey as fully as possible regardless of
whether you consider yourself in Medicare.
3.
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?
Yes
No If No, Go to Question 5
4.
Yes
No If No, Go to Question 3
2.
In the last 6 months, did you have an
illness, injury, or condition that needed
care right away?
In the last 6 months, when you needed
care right away, how often did you get
care as soon as you needed?
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.)
5.
Never
Sometimes
Usually
Always
In the last 6 months, did you make any inperson, phone, or video appointments for
a check-up or routine care?
Yes
No If No, Go to Question 7
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?
___________________________
I don’t have health insurance other
than Medicare.
2
Never
Sometimes
Usually
Always
7.
8.
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?
None
1 time
2
3
4
5 to 9
10 or more times
Yes
No If No, Go to Question 26
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?
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?
9.
YOUR PERSONAL DOCTOR
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?
0 Worst health care possible
1
2
3
4
5
6
7
8
9
10 Best health care possible
12. In the last 6 months, how often did your
personal doctor explain things in a way
that was easy to understand?
In the last 6 months, how often was it easy
to get the care, tests, or treatment you
needed?
None If None, Go to Question 26
1 time
2
3
4
5 to 9
10 or more times
Never
Sometimes
Usually
Always
3
Never
Sometimes
Usually
Always
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?
13. In the last 6 months, how often did your
personal doctor listen carefully to you?
Never
Sometimes
Usually
Always
14. In the last 6 months, how often did your
personal doctor show respect for what you
had to say?
18. In the last 6 months, did your personal
doctor order a blood test, x-ray or other
test for you?
Never
Sometimes
Usually
Always
Yes
No If No, Go to Question 21
15. In the last 6 months, how often did your
personal doctor spend enough time with
you?
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 doctor’s office follow up to
give you those results?
Never
Sometimes
Usually
Always
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?
Never
Sometimes
Usually
Always
Never
Sometimes
Usually
Always
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?
0 Worst personal doctor possible
1
2
3
4
5
6
7
8
9
10 Best personal doctor possible
4
Never
Sometimes
Usually
Always
GETTING HEALTH CARE FROM
SPECIALISTS
21. In the last 6 months, did you take any
prescription medicine?
Yes
No If No, Go to Question 23
When you answer the next questions,
include the care you got in person, by phone,
or by video.
22. In the last 6 months, how often did you
and your personal doctor talk about all the
prescription medicines you were taking?
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?
Never
Sometimes
Usually
Always
Yes If Yes, Please include your
personal doctor as you answer
these questions about specialists
No
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?
Yes
No If No, Go to Question 26
27. In the last 6 months, did you make any
appointments with a specialist?
24. 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 32
28. In the last 6 months, how often did you
get an appointment with a specialist as
soon as you needed?
Yes
No If No, Go to Question 26
25. 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?
Never
Sometimes
Usually
Always
29. How many specialists have you talked to in
the last 6 months?
Yes, definitely
Yes, somewhat
No
5
None If None, Go to Question 32
1 specialist
2
3
4
5 or more specialists
MANAGING YOUR
HEALTH CARE
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. How likely are you to change doctors if
you are dissatisfied with the way you
and your doctor communicate?
0 Worst specialist possible
1
2
3
4
5
6
7
8
9
10 Best specialist possible
Very likely
Likely
Unlikely
Very unlikely
33. How likely are you to tell your doctor
when you disagree with him or her?
31. In the last 6 months, how often did your
personal doctor seem informed and up-todate about the care you got from
specialists?
Very likely
Likely
Unlikely
Very unlikely
34. 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
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
Never
Sometimes
Usually
Always
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?
6
Never
Sometimes
Usually
Always
I did not have any medical tests or
procedures in the last 6 months
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?
36. In the last 6 months, did you get
information or help from Medicare’s
customer service?
Yes
No If No, Go to Question 39
37. In the last 6 months, how often did
Medicare’s customer service give you the
information or help you needed?
Never
Sometimes
Usually
Always
38. In the last 6 months, how often did
Medicare’s customer service staff treat
you with courtesy and respect?
ABOUT YOU
Never
Sometimes
Usually
Always
42. In general, how would you rate your
overall health?
39. In the last 6 months, did Medicare give
you any forms to fill out?
Yes
No If No, Go to Question 41
Excellent
Very good
Good
Fair
Poor
43. In general, how would you rate your
overall mental or emotional health?
40. In the last 6 months, how often were the
forms from Medicare easy to fill out?
0 Worst health plan possible
1
2
3
4
5
6
7
8
9
10 Best health plan possible
Never
Sometimes
Usually
Always
7
Excellent
Very good
Good
Fair
Poor
49. 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?
44. What language do you mainly speak at
home?
English
Spanish
Chinese
Korean
Tagalog
Vietnamese
Some other language
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
jh. Income
↓
Please print:____________
45. In the last 6 months, did you spend one
or more nights in a hospital?
Yes
No
46. In the last 6 months, how often was it
easy to get the medicines your doctor
prescribed?
Yes
No
50. Has a doctor ever told you that you had
any of the following conditions?
Never
Sometimes
Usually
Always
a. A heart attack?
b. Angina or coronary
heart disease?
c. Hypertension
or high blood
pressure?
d. Cancer, other than
skin cancer?
e. Emphysema, asthma,
or COPD (chronic
obstructive pulmonary disease)?
f. Any kind of diabetes
or high blood
sugar?
47. Do you have insurance that pays part
or all of the cost of your prescription
medicines?
Yes
No
Don’t know
48. In the last 6 months, did you delay or
not fill a prescription because you felt
you could not afford it?
Yes
No
51. Have you had a flu shot since July 1, 2024?
Yes
No
My doctor did not prescribe any
medicines for me in the last 6
months
Yes
No
Don’t know
8
56. How many people live in your
household now, including yourself?
52. 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.
1 person
2 to 3 people
4 or more people
Yes
No
Don’t know
57. 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.)
53. 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
a.
b.
c.
d.
I am
unable
Yes, I
No, I do
to do this have
not have
activity difficulty difficulty
Bathing
Dressing
Eating
Getting in
or out of
chairs
e. Walking
f. Using the
toilet
54. Are you of Hispanic or Latino origin or
descent?
Yes, Hispanic or Latino
No, not Hispanic or Latino
58. Because of a physical, mental, or
emotional condition, do you have
difficulty doing errands alone such as
visiting a doctor’s office or shopping?
55. 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
Yes
No
59. Do you ever use the Internet at home?
Yes
No
9
60. 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?
62. 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
Yes
No
61. Did someone help you complete this
survey?
Yes
No Thank you. Please
return the completed survey
in the postage-paid envelope.
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.
10
| File Type | application/pdf |
| File Title | 2024 FFS Survey |
| Subject | 2024 Medicare FFS CAHPS Survey |
| Author | CMS |
| File Modified | 2025-04-08 |
| File Created | 2025-04-08 |