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Health Insurance Page
Medicare is a Social Security health insurance program for disabled persons and for persons 65 years old and over. People covered by Medicare have a card that looks like this. Show card
1a. Is anyone in this family covered by Medicare?
[] N (4)
[] DK
b. Is -- covered? Mark box in person's column.
2 [] Not Cov.
9 [] DK
Ask for each person with "Covered" in 1b.
2a. Is -- covered by that part of Social Security Medicare which pays for hospital bills? Mark box in person's colum.
2 [] No
9 [] DK
b. Is -- covered by that part of Medicare which pays for doctor's bills, that is, the Medicare plan for which he or some agency must pay a certain amount each month? Mark box in person's column.
2 [] No
9 [] DK
Ask for each person with "DK" in 2 and for each person under 65 with "Covered" in 1b.
3. May I please see the Social Security Medicare card(s) for -- (and--) to determine the (type/dates) of coverage?
Transcribe the information from the card or mark the "Card N.A." box.
2 [] Cov. Med.
3 [] Card N.A.
4a. We are interested in all kinds of health insurance plans except those which pay only for accidents. (Not counting Medicare) Is anyone in the family covered by hospital insurance, that is, a health insurance plan which pays any part of a hospital bill?
[] N (4d)
b. What is the name of the plan? (Record in Table H.I.) ________
c. Is anyone in the family covered by any other hospital insurance plan?
[] N
d. Is anyone in the family covered by any (other) health insurance plan which pays any part of a doctor's or surgeon's bill?
[] N (5)
e. What is the name of the plan? (Record in Table H.I., reask 4d.)
TABLE H.I.
[Questions for Plan 2 and Plan 3 are identical for Plan 1 and are thus omitted.]
PLAN 1-4
5a. Was this (name) plan obtained through an employer or union?
[] 2 N
[] 9 DK
b. Was it obtained through some other group?
[] 2 N
[] 9 DK
c. Does this plan pay any part of hospital expenses?
[] 2N
[] 9 DK
d. Does this plan pay any part of doctor's or surgeon's bills for operations?
[] 2 N
[] 9 DK
6a. Is -- covered under this (name) plan?
2 [] Not Cov. (NP)
b. During the past 12 months did -- receive medical care which as been or will be paid for by this plan?
[] 2 N
[] 9 DK
For each person review 1,2, 3 and 6 for each plan and determine if "covered" by either Medicare or insurance, or "Not covered."
2 [] Not cov. (NP)
Ask for each person "Not covered,"
Many people do not carry health insurance for various reasons. Hand card N
CARD N
2. Unemployed, or reasons related to unemployment.
3. Can't obtain insurance because of poor health, illness, or age.
4. Too expensive, can't afford health insurance.
5. Dissatisfied with previous insurance.
6. Don't believe in insurance.
7. Have been healthy, not much sickness in the family, haven't needed health insurance.
8. Military dependent, (CHAMPUS), veterans' benefits.
9. Some other reasons - Specify
7a. Which of those statements describes why -- is not covered by any health insurance plan? Any other reason?
Circle all reasons given
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9 -- Specify ________
Mark box or ask:
b. What is the main reason -- is not covered by any health insurance plan?
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9 -- Specify _______