Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

END-END QUESTIONNAIRE

Question Type

Question Text/Description

Code List

Routing

(01) CONTINUE

EX1A - EXTHANK

(01) CONTINUE

BOX EN2

END QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C003), administer after DIQ.
If (INTTYPE in(C001, C002, C004, C005, C006, C007, C010) administer after CPS.
If 11th round interview, administer after PXQ.

EXINTRO

EXTHANK

BOX EN1

IF SP IS IN THE 11TH ROUND INTERVIEW OR R IS DECEASED (SPAISTATUS in (3,4)) GO TO EX1.
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE (INTTYPE=C003), GO TO ETY2 - THANK_SUPP.
ELSE IF (SP IS THE RESPONDENT), GO TO ETY1 - THANK_SP.
ELSE GO TO ETY3 - THANK_PROXYPLANNER.

EX1

As I mentioned earlier, this is [your/(SP's)] final interview with this study. We have learned much from
[your/(SP's)] participation in the MCBS. Data from the study have already been used to inform Congress of the
problems Medicare beneficiaries might face regarding their access to health care. [Your/(SP's)] participation in
this study has given the United States government a much clearer picture of [your/(SP's)] health care needs and
those of more than 62 million Medicare participants.

I thank you sincerely for all the time and effort that you have put into this study. You have made a very important
contribution to the Medicare program and all of its beneficiaries by sharing [your/(SP's)] health care experiences
with us. [Even though [you/(SP)] will no longer be a participant in our survey, [your/(SP's)] health care needs will
continue to be covered through the Medicare program.] I'd like to express to [you/you and (SP)] appreciation on
behalf of the Centers for Medicare and Medicaid Services. Both NORC at the University of Chicago and the
Centers for Medicare and Medicaid Services wish [you/you and (SP)] the very best for the future.

EX1A

[RESPONDENT MAY KEEP THE CALENDAR]

BOX EN2

EXSTUDY

EX1B

IF SP IS DECEASED (SPAISTATUS in (3,4)) GO TO END1-INTLANG. ELSE GO TO EXSTUDY.

yes/no

(01) YES
We sometimes conduct short surveys to improve the way information is collected for the MCBS. Would [you/(SP)] (02) NO
(-8) DK
be willing to be contacted in the future about one of these short surveys?
(-9) RF

END1-INTLANG

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2024 MCBS Community Questionnaire

END-END QUESTIONNAIRE

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

THANK_SP

ETY1

no entry

[I would like to thank you for keeping the planner for this interview.] I would [also] appreciate it if you would
[continue to] record health care visits and keep information about medical expenses for the next interview. Thank
(01) CONTINUE
you for your time and cooperation during this interview.
CIRCLE TODAY'S DATE IN THE PLANNER AS A REFERENCE FOR THE RESPONDENT. EXPLAIN
PLANNER SECTIONS AS NECESSARY.

END1-INTLANG

THANK_SUPP

ETY2

no entry

Please keep any medical bills, receipts, Medicare statements, and insurance statements that would be connected
to [your/(SP)'s] health care visits and other medical expenses so that we can talk about them during the next
(01) CONTINUE
interview. I'd like to thank you for your time and cooperation and I look forward to seeing you soon.

END1-INTLANG

THANK_PROXYPLANN
ETY3
ER

no entry

I would like to make sure you are aware of the planner we use to record health care visits as well as the folder for
keeping information about medical expenses for the next interview.
(01) CONTINUE
CIRCLE TODAY'S DATE IN PLANNER AS A REFERENCE FOR THE RESPONDENT. EXPLAIN PLANNER
SECTIONS IN DETAIL TO RESPONDENT.

THANK_PROXY

THANK_PROXY

ETY4

no entry

I would like to thank you for your time and cooperation during this interview. We may be contacting you in the
future for further information.

(01) CONTINUE

END1-INTLANG

INTLANG

END1

code 1

WAS THIS INTERVIEW CONDUCTED MOSTLY IN ENGLISH OR
SPANISH?

(02) ENGLISH
(03) SPANISH

(02) END2 - SAVECASE
(03) END2 - SAVECASE

(01) CONTINUE
(-7) Empty

BOX END

THE INTERVIEW IS OVER. PRESS ENTER OR CLICK [CLOSE] TO RETURN TO CM FIELD.
SAVECASE

END2

no entry

BOX END

routing

IF COMMUNITY CONTACT DATA COLLECTION (CCDC) MODULE HAS NOT BEEN COMPLETED (CCDC
INSTRUMENT STATUS IS "NO ACTION" OR "BREAKOFF") THEN DISPLAY "THE COMMUNITY CONTACT
DATA COLLECTION (CCDC) MODULE HAS NOT YET BEEN COMPLETED FOR THIS CASE. IF POSSIBLE,
PLEASE COMPLETE THAT MODULE WITH THE [RESPONDENT/PROXY] DIRECTLY FOLLOWING THE
INTERVIEW."

CASE IS COMPLETE.

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