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

2026 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

DBQ-DEBT

Question Text/Description

Code List

Routing

DEBT QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C010
SPALIVE=1
SEASON=SUMMER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after IAQ.

SPENDINC

SPENDINC

code one

Over the past year, would you say that [your/(SP'S)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)'s] spending
exceeded [your/their] [joint] income, that it was about the same as [your/their] [joint] income, or that [you/(SP)] [or
(01) SPENDING EXCEEDED INCOME
(SP)/(SPOUSE FIRSTNAME LASTNAME)] spent less than [your/their] [joint] income?
(02) SPENDING SAME AS INCOME
(03) SPENDING WAS LESS THAN INCOME
[IF NEEDED: Spending should not include any investments [you have/(SP) has] [you /(SP) or (SP)/(SPOUSE
(-8) DON’T KNOW
FIRSTNAME LASTNAME) have] made.]
(-9) REFUSED

MEDIGRID-MEDIPROV

IF DEBTS ARE BEING REPAID ON NET, TREAT THIS AS SPENDING LESS THAN INCOME.

The next few questions will now ask about any debt [you/(SP)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)]
may have.

MEDIPROV

MEDIGRID

grid

Please think about any money [you/(SP)] [or your spouse/or their spouse] currently [owe/owes] or debt [you/(SP)]
(01) YES
[or your spouse/or their spouse] [have/has] due to medical or dental bills. This may include bills for [your
(02) NO
own/(SP)'s] medical or dental care or someone else’s care, such as a child, spouse, or parent.
(-8) DON'T KNOW
(-9) REFUSED
[Do you/Does (SP)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)]] currently have...

MEDIGRID-MEDICARD

Any medical or dental bills [you are/(SP) is/you or your spouse are/SP or their spouse are] paying off over time
directly to a provider?

MEDICARD

MEDIGRID

grid

Any medical or dental bills [you have/(SP) has] [you or your spouse have/(SP) or their spouse have] put on a
credit card, and [are/is] paying off over time?
[IF NEEDED: Please include consumer and medical credit cards.]

MEDILEND

MEDIFAM

MEDIOTH

PROV_AMT

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

MEDIGRID-MEDILEND

grid

(01) YES
Any debt [you owe/(SP) owes] [you or your spouse owe/(SP) or their spouse owe] to a bank, collection agency, or (02) NO
other lender that includes debt or loans used to pay medical or dental bills?
(-8) DON'T KNOW
(-9) REFUSED

MEDIGRID-MEDIFAM

grid

Any debt [you owe/(SP) owes] [you or your spouse owe/(SP) or their spouse owe] to a family member or friend
for money [you/(SP)] [you or your spouse/(SP) or their spouse] borrowed to pay medical or dental bills?

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

MEDIGRID-MEDIOTH

MEDIGRID

grid

Any other medical or dental bills that [you are/(SP) is] [you or your spouse are/(SP) or their spouse) are] unable
to pay?

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX DEBT1

BOX DEBT1

routing

IF MEDIPROV=1/YES, GO TO PROV_AMT,
ELSE GO TO BOX DEBT2.

PROV_AMT

quantity unit

You mentioned that [you have/(SP) has] [you or your spouse have/(SP) or their spouse have] medical or dental
bills [you are/(SP) is/they are] paying off over time directly to a provider. About how much [do you/does (SP)] [or
(SP)/(SPOUSE FIRSTNAME LASTNAME)] currently owe?

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX DEBT2
(-8) PROV_SPA
(-9) PROV_SPA

MEDIGRID

MEDIGRID

Page 1 of 4

2026 MCBS Community Questionnaire

Variable Name

PROV_SPA

CARD_AMT

MR Screen Name

Question Type

PROV_SPA

code one

BOX DEBT2

routing

CARD_AMT

quantity unit

DBQ-DEBT

Question Text/Description

SHOW CARD DB1
Please look at this card and tell me which is closest.

Code List

Routing

(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX DEBT2

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX DEBT3
(-8) CARD_SPA
(-9) CARD_SPA

(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX DEBT3

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX DEBT4
(-8) LEND_SPA
(-9) LEND_SPA

(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX DEBT4

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX DEBT5
(-8) FAM_SPA
(-9) FAM_SPA

(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX DEBT5

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX DEBT6
(-8) OTH_RNG
(-9) OTH_RNG

IF MEDICARD=1/YES, GO TO CARD_AMT,
ELSE GO TO BOX DEBT3.
You mentioned that [you have/(SP) has/you or your spouse have/(SP) or their spouse have] medical or dental
bills [you have/(SP) has/you or your spouse have/(SP) or their spouse have] put on a credit card, and [you
are/(SP) is/they are] paying off over time. About how much [do you/does (SP)] [or (SP)/(SPOUSE FIRSTNAME
LASTNAME)] currently owe?
Please include any interest and fees accrued in the total balance.

CARD_SPA

LEND_AMT

CARD_SPA

code one

BOX DEBT3

routing

LEND_AMT

quantity unit

SHOW CARD DB1
Please look at this card and tell me which is closest.

IF MEDILEND=1/YES, GO TO LEND_AMT,
ELSE GO TO BOX DEBT4.
You mentioned that [you have/(SP) has/you or your spouse have/(SP) or their spouse have] debt owed to a
bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills. About
how much [do you/does (SP)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)] currently owe?
Please do not include any debt held on a credit card.

LEND_SPA

FAM_AMT

FAM_SPA

OTH_AMT

SHOW CARD DB1

LEND_SPA

code one

BOX DEBT4

routing

IF MEDIFAM=1/YES, GO TO FAM_AMT,
ELSE GO TO BOX_DEBT5.

quantity unit

You mentioned that [you have/(SP) has/you or your spouse have/(SP) or their spouse have] debt owed to a
family member or friend for money borrowed to pay medical or dental bills. About how much [do you/does (SP)]
[or (SP)/(SPOUSE FIRSTNAME LASTNAME)] currently owe?

FAM_AMT

Please look at this card and tell me which is closest.

SHOW CARD DB1

FAM_SPA

code one

BOX DEBT5

routing

IF MEDIOTH=1/YES, GO TO OTH_AMT,
ELSE GO TO BOX DEBT6.

OTH_AMT

quantity unit

You mentioned that [you have/(SP) has/you or your spouse have/(SP) or their spouse have] other medical or
dental bills that [you are/(SP is)/they are] unable to pay. About how much [do you/does (SP)] [or (SP)/(SPOUSE
FIRSTNAME LASTNAME)] currently owe?

Please look at this card and tell me which is closest.

Page 2 of 4

2026 MCBS Community Questionnaire

Variable Name

OTH_RNG

MEDIWHO

MR Screen Name

Question Type

OTH_RNG

code one

BOX DEBT6

routing

MEDIWHO

code one

DBQ-DEBT

Question Text/Description

SHOW CARD DB1
Please look at this card and tell me which is closest.

Code List

Routing

(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX DEBT6

IF RESPONDENT HAS DEBT (MEDIPROV=1 or MEDICARD=1 or MEDILEND=1 or MEDIFAM=1 or
MEDIOTH=1), GO TO MEDIWHO.
ELSE GO TO CREDDEBT.

Thinking about the medical or dental bills that led to [your/(SP'S)/your or your spouse's/(SP) or their spouse's]
medical debt, were these bills for [your/(SP's)] own care, someone else’s care, or both [your/(SP's)] care and
someone else’s care?

(01) SP'S OWN CARE
(02) SOMEONE ELSE'S CARE
(03) BOTH SP'S AND SOMEONE ELSE'S CARE
(-8) DON'T KNOW
[IF NEEDED: "Someone else's care" may include care for [you/your spouse/(SP's) spouse], a child , or a parent.] (-9) REFUSED

MEDISRCE

SHOW CARD DB2

MEDISRCE

MEDBILLS

MEDISRCE

MEDBILLS

select all

code one

(01) DOCTOR VISITS OR LAB FEES OR DIAGNOSTIC
TESTS SUCH AS X-RAYS OR MRIS
Were any of the bills that caused [your/(SP's)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)'s] medical debt due
(02) EMERGENCY CARE OR AMBULANCE
to...
SERVICES
(03) HOSPITALIZATION OR OUTPATIENT SURGERY
SELECT ALL THAT APPLY
(04) PRESCRIPTION DRUGS
(05) LONG TERM CARE SERVICES OR SUPPORT,
doctor visits or lab fees or diagnostic tests such as x-rays or MRIs
MEDBILLS
EITHER IN HOME OR IN A NURSING HOME OR
emergency care or ambulance services
RESIDENTIAL FACILITY
hospitalization or outpatient surgery
(06) MEDICAL EQUIPMENT
prescription drugs
(07) DENTAL CARE
long term care services or support, either in home or in a nursing home or residential facility
(91) OTHER
medical equipment
(-8) DON'T KNOW
dental care
(-9) REFUSED
or some other event?

Which of the following comes closer to describing the bills that contributed to [your/(SP's)] [or (SP)/(SPOUSE
FIRSTNAME LASTNAME)'s] medical debt?

SHOW CARD DB3
MEDTIME

MEDTIME

code one

Approximately how long ago did [this incident occur/the treatment that led to [your/(SP's)] [or (SP)/(SPOUSE
FIRSTNAME LASTNAME)'s] medical debt begin]?

Besides what you've already told me about, [do you/does (SP)] [or (SP)/(SPOUSE FIRSTNAME LASTNAME)]
owe any money for credit card bills?
CREDDEBT

CREDDEBT

code one

EXCLUDE CREDIT CARD BILLS THAT WERE PAID IN FULL OR REIMBURSED. DO NOT INCLUDE ANY
AMOUNT CURRENTLY COUNTED TOWARDS MEDICAL DEBT BALANCE.
[IF NEEDED: This item is asking specifically about money owed for credit card bills that cannot be paid off by the
due date on the statement. If the bills were paid off by the statement due date, do not include those bills.]

(01) bill for a one time or short-term medical expense,
such as a single hospital stay or treatment for an
accident
(02) bills that build up over time, such as treatment for
chronic illness like diabetes or cancer
(-8) DON'T KNOW
(-9) REFUSED

(01) MEDTIME
(02) MEDTIME
(-8) CREDDEBT
(-9) CREDDEBT

(01) WITHIN THE LAST YEAR
(02) BETWEEN ONE AND TWO YEARS AGO
(03) BETWEEN THREE AND FOUR YEARS AGO
(04) FIVE YEARS AGO OR MORE
(-8) DON'T KNOW
(-9) REFUSED

CREDDEBT

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) CRED_AMT
(02) BOX ENDDBQ
(-8) BOX ENDDBQ
(-9) BOX ENDDBQ

Page 3 of 4

2026 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

DBQ-DEBT

Question Text/Description
What is the total amount of credit card debt [you currently owe/(SP) currently owes] [you/(SP) or (SP)/(SPOUSE
FIRSTNAME LASTNAME) currently owe]?

CRED_AMT

CRED_AMT

quantity unit

Please include any interest and fees accrued.
EXCLUDE CREDIT CARD DEBT FOR BUSINESS EXPENSES THAT WILL BE PAID OR REIMBURSED. DO
NOT INCLUDE ANY AMOUNT CURRENTLY COUNTED TOWARDS MEDICAL DEBT BALANCE.

CRED_SPA

CRED_SPA

code one

BOX ENDDBQ

routing

SHOW CARD DB4
Please look at this card and tell me which is closest.

Code List

Routing

(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED

(01) BOX ENDDBQ
(-8) CRED_SPA
(-9) CRED_SPA

(01) LESS THAN $1,000
(02) $1,000 TO LESS THAN $5,000
(03) $5,000 TO LESS THAN $10,000
(04) $10,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED

BOX ENDDBQ

GO TO RXQ.

Page 4 of 4