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[p.52]

Section M. HEALTH INSURANCE

Read to respondent(s):
Medicare is a Social Security health insurance program for disabled persons and for persons 65 years old and older. People covered by Medicare have a card that looks like this. Show card.

1a. Is anyone in this family, that is (read names), now covered by Medicare?

b. Is -- now covered?

Ask for each person with "Covered" in 1b.
2a. Is -- covered by the part of Social Security Medicare which pays for hospital bills? Mark box in person's column.

b. Is -- now covered by that part of Medicare which pays for doctor's bills? This is the Medicare plan for which -- or some agency must pay a certain amount each month?
Mark box in person's column.

Ask for each person with "DK" in 2a and/or b:
3. May I please see the Social Security Medicare card(s) for -- (and --) to determine the type of coverage?
Transcribe the information from the card or mark the "Card N.A." box.

We are interested in all kinds of health insurance plans except those which pay only for accidents.
4a. (Not counting Medicare) Is anyone in the family covered by a health insurance plan which pays any part of a hospital, doctor's or surgeon's bill?

b. What is the name of the plan? (Record in Table H.I.)

c. Is anyone in the family now covered by any other health insurance plan which pays any part of a hospital, doctor's, surgeon's or dentist's bill?

TABLE H.I.

PLAN 1-5 NAME

5a. Is this (name) plan a Health Maintenance Organization or HMO?

b. Was this (name) plan obtained through an employer or union?

c. Is it now carried through an employer or union?

6a. Does this (name) plan pay any part of hospital expenses?

b. Does this plan pay any part of doctor's or surgeon's bills for operations?

c. Does it pay for any DENTAL services other than oral surgery?

7. Is -- covered under this (name) plan?
Mark box in person's column.

M1
Review 1 and 7 for each person and determine if "Covered" by either Medicare and/or insurance, or "Not covered."

Ask for each person "Not covered" in M1. If "Not covered 65 and over," include "or Medicare."
8a. (Many people do not carry health insurance for various reasons.)

Hand Card M.

[Card M not found in flashcards]

Which of these statements describes why -- is not covered by any health insurance (or Medicare)? Any other reason? Circle all responses given.

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 (Specify) ____

Mark box if only one reason. If "Not covered 65 and over" in M1, include "or Medicare."
b. What is the MAIN reason -- is not covered by any health insurance (or Medicare)?

Ask only if persons under age 20 in family:
9a. Does anyone in this family now receive assistance through the "Aid to Families with Dependent Children" Program, sometimes called "AFDC" or "ADC"?

b. Does -- now receive AFDC or ADC?

10a. Does anyone in this family now receive the "Supplemental Security Income" of "SSI" gold-colored check?

b. Does -- now receive this check?

[p. 56]

11a. There is a national program called Medicaid which pays for health care for persons in need. (In this State it is also called (name).)
During the past 12 months, has anyone in this family received health care which has been or will be paid for by Medicaid (or (name))?

b. Has -- received this care in the past 12 months?

12a. Does anyone in the family now have a Medicaid (or (name)) card which looks like this?
Show Medicaid card(s).

b. Does -- now have this card?

Ask for each person with "Yes " in 12b:
c. May I please see -- (and --) card(s)?
Mark appropriate box(es) in person's column.

13a. Is anyone in the family now covered by any other public assistance program that pays for health care?

b. Is -- now covered?

14a. Does anyone in the family now receive military retirement payments from any branch of the Armed Forces or a pension from the Veterans Administration? Do not include VA disability compensation.

b. Does -- now receive military retirement or a VA pension?

Ask for each person with "Yes" in 14b:
c. Which does -- receive -- the Armed Forces retirement, the VA pension or both?
Mark box in person's column.

15a. Is anyone in the family now covered by CHAMPUS, which is a program of medical care for dependents of military personnel?

b. Is -- now covered by CHAMPUS?

c. Is anyone in the family now covered by CHAMP-VA, which is medical insurance for dependents or survivors of disabled veterans?

d. Is -- now covered by CHAMP-VA?

16a. Is anyone in the family now covered by any other program that provides health care for military dependents or survivors of military persons?

b. Is -- now covered?

[p. 58]

M2
Refer to "AF" box above person's column.

17a. Does -- have a disability related to -- service in the Armed Forces of the United States?

b. Does -- now receive compensation for this disability from the Veteran's Administration?

c. Has -- ever applied for a service-connected disability rating from the Veterans' Administration?

d. Was it approved or denied?

18a. During the past 12 months, that is since (12 month date) a year ago, have (read names of related HH members 18 or over) been laid off from a job or lost a job?

b. Who was this? ____
Mark "Laid off/lost job" box in person's column.

c. Anyone else?

Ask 18d, e, and f for each person with "Laid off/lost job" in 18b.
d. How many times has -- been laid off or lost a job during the past 12 months? ____

e. In what month was -- laid off or did -- lose a job ([the last time/the time before that])?

f. For ANYTIME during [that/those] job layoff(s) or job loss(es), did -- receive unemployment insurance benefits?

19a. Because of (name of persons in 18b) job layoff(s) or job loss(es), did anyone in the family lose any health insurance coverage that had been carried through [that/those] job(s)?

b. Who was this? ____
Mark "Lost coverage" box in person's column.

c. Anyone else?

M3
Refer to 19b and mark appropriate box.

20a. For ANYTIME during (that/those) job layoff(s) or job loss(es), was -- without any type of health insurance coverage? (Do not include health care programs such as Medicare, AFDC, or military benefit programs, as health insurance coverage.)

b. For how long was -- without some type of health insurance coverage? (How many months is that?)

21a. For ANYTIME during [that/those] job layoff(s) or job loss(es), was -- covered by any health care program, such as Medicaid, AFDC, or a military benefit program?

b. For how long was -- covered by some health care program? (How many months is that?)