hi
[p. 175]

SECTION FA- HEALTH CARE COVERAGE

ITEM FA1

Refer to household composition. Mark (X) for each person including those deleted in the HIS-1.

The next questions are about health insurance coverage and the kinds and amounts of income that people receive. For this family, that includes (read names, including Armed Forces members living at home).
The answers to these questions will add greatly to our knowledge about the health problems of the American people, the types of health care they receive, and whether they can afford the care that they need. The information will help in planning health care services and finding ways to lower costs of care.

There are several government programs that provide medical care or help pay medical bills.
People covered by Medicare have a card that looks like this. SHOW MEDICARE CARD.

1a. In (month), was anyone in the family, that is (read names), covered by Medicare?

b. Who was covered?
Mark (X) "Medicare" box in person's column.

c. Anyone else?

Ask 1d-g as appropriate for each person with "Medicare" in 1b.
d. May I please see the Medicare card(s) for -- (and --) to determine the type of coverage and to record the Health Insurance Claim Number. This number is needed to allow Medicare records to be easily and accurately located and identified for statistical research purposes. Providing the Health Insurance Claim Number is voluntary and collected under the authority of the Public Health Service Act. Whether the number is given or not, there will be no effect on benefits and no identifying information will be given to any other government or non-government agency.
Read if necessary: The Public Health Service Act is Title 42, United States Code, Section 242K.
Transcribe the number, then mark (X) the appropriate box.

Ask 1e-g for each person with "Card N.A" in 1d.
e. Was -- covered by Part A, that part of Medicare that pays for hospital bills?

f. Was -- covered by Part B, that part of Medicare that pays for doctor's bills?
Read if necessary: This is the Part B Medicare plan for which -- or some agency or program must pay a certain amount each month.

ITEM FA2
Refer to age

g. How long has -- been covered by Medicare?

[p. 176]

Section FA -- HEALTH CARE COVERAGE -- Continued

There is a program called Medicaid that pays for health care for persons in need. In this State it is also called (State name).
2a. Does anyone in the family NOW have a Medicaid or (state name) card?

b. Who is this? Mark (x) "Has Card" box in person's column.

c. Anyone else?

Ask 2d for each person with "Has Card" box marked in 2b.
d. May I please see -- (and --) card(s)? Mark (x) appropriate box in person's column. Record expiration date for each Medicaid card seen.

3a. In (month), was anyone in the family covered by Medicaid?

b. Who was covered?
Mark (X) "Medicaid" box in person's column.

c. Anyone else?

Ask 3d for each person with "Medicaid" box marked in 3b.
d. How long has -- had Medicaid coverage?

ITEM FA3

Refer to household composition and question 3a.

4a. During the past 12 months, has anyone in the family received health care that has been or will be paid for by Medicaid or (state name)?

b. Who received this care in the past 12 months?
Mark (X) "Received Medicaid Care" box in person's column.

c. Anyone else?

5a. In (month), was anyone in the family covered by any OTHER public assistance program (other than Medicaid) that pays for health care? Do NOT include use of public or free clinics if that is the only source of care.

b. Who was covered?
Mark (X) "Public assistance" box in person's column.

c. Anyone else?

[p. 177]

Section FA -- HEALTH CARE COVERAGE -- Continued

PERSON 1

6a. In (month), was anyone in the family covered by military health care, including armed forces retirement benefits, the VA (Department of Veterans' Affairs), CHAMPUS, or CHAMP-VA?

b. Was this CHAMPUS or CHAMP-VA?
Read if necessary: CHAMPUS is a program of medical care for dependents of active or retired military personnel. CHAMP-VA is medical insurance for dependents or survivors of disabled veterans?

c. Who was covered by CHAMPUS or CHAMP-VA?
Mark (X) "CHAMPUS/CHAMP-VA" box in person's column.

d. Anyone else?

e. In (month), was anyone in the family covered by any other military health care, including armed forces retirement benefits or the VA (Department of Veterans' Affairs)?

f. Who was covered by other military health care?
Mark (X) "Military" box in person's column.

g. Anyone else?

7a. In (month), was anyone in the family covered by the Indian Health Service?

b. Who was covered?
Mark (X) "IHS" box in person's column.

c. Anyone else?

8a. (Not counting the government health programs we just mentioned), In (month) was anyone in the family covered by a private health insurance plan?
Read if necessary: Besides government programs, people also get health insurance through their job or union, through other private groups, or directly from an insurance company. A variety of types of plans are available, including health maintenance organizations (HMOs).

b. It's important that we have the complete and accurate name of each health insurance plan. What is the COMPLETE name of the plan? If "DK", probe: Do you have something with the plan name on it?
Record up to 4 plan names in Sec. FB, Table H.I. Then ask 8c.

c. In (month), was anyone in the family covered by any OTHER private health insurance plan?

[p. 178]

Section FB -- PRIVATE PLAN AND COVERAGE DETAIL

PERSON 1

PLAN 1 NAME

2. In whose name is this plan?
Mark (X) "In name" box in person's column.

3a. Was this plan originally obtained through the workplace, that is through a present or former employer or union?
If "Yes", probe for employer or union.

b. Does the employer or union currently pay for all, some, or none of the cost of premiums for this health insurance plan?
Read if necessary: The cost of the plan refers to the premiums, which are regular payments for health insurance coverage only, not for health care services. Frequently, these payments are made by payroll deduction.

HAND CARD FR3. Read each category if telephone interview.
CARD FR3

4. In (month), how much did [you/your family] spend for health insurance premiums for (plan name)? Please include payroll deductions for premiums.

5a. Does this plan pay for a variety of health care services or does it pay for ONLY ONE type of services or care?

b. What type of service or care does the plan pay for?
Mark (X) only one type of service

GO TO 1a FOR NEXT HI PLAN; IF NO OTHER HI PLAN, GO TO 8a.

[p. 179]

PERSON 2

1a.

2.

PERSON 3

1a.

2.

PERSON 4

1a.

2.

PERSON 5

1a.

2.

6a. Is (plan name) an HMO (Health Maintenance Organization) or IPA (Individual Practice Association), or is it some other kind of plan?
Read if necessary: Health Maintenance Organizations, or HMO's and Individual Practice Associations, or IPA's, are plans whose members are required to use only those health care providers who work for or in association with the HMO or IPA. Sometimes there is an option to permit use of providers not associated with the Plan, but usually at greater cost to the enrollee. Generally, members do not have to submit claims for costs of medical care services.

b. Under this plan can you choose ANY doctor or MUST you choose one from a specific group or list of doctors?

c. Do you have the option of choosing a doctor from a preferred or select list at lower cost to you?

d. If you select a doctor who is not in the plan, will (plan name) pay for any part of the cost?

Ask if family has at least one person under the age of 18.
7a. Does (plan name) pay for any of the costs of well child care, that is visits when a child is NOT sick, but needs a check-up or immunization?

Ask if family has at least one female over the age of 39.
b. Does this plan pay for any part of the cost for mammograms?
Read if necessary: A mammogram is an X-ray taken only of the breasts by a machine that presses the breast against a plate.

GO TO 1a FOR NEXT PLAN; IF NO OTHER PLAN GO TO 8a.

[p. 180]

Section FB -- PRIVATE PLAN AND COVERAGE DETAIL -- Continued

8a. In the past 2 years, has anyone in the family been denied coverage, or had restricted or limited coverage, (under [this plan/any of the plans you just told me about]) because he or she already had a particular health condition, sometimes called a pre-existing condition?

b. Who is this?
Mark (x) "Pre-existing condition" box in person's column

c. Anyone else?

9a. In the past 2 years, has anyone in the family applied for health insurance and not been able to get it?

b. Who is this?
Mark (X) "Turned down" box in person's column

c. Anyone else?

Ask for each person with "Turned down" box marked in 9b.
d. Why was -- unable to get that health insurance? Anything else?
Mark (X) all that apply

10a. In the past two years or so, has anyone in the family decided to stay in one job rather than take another job mainly because of reasons related to health insurance?

b. Who is this?
Mark (X) "Stayed in job" box in person's column

c. Anyone else?

ITEM FB1
Refer to age and Wa/Wb in HIS-1
Mark (X) first appropriate box

ITEM FB2
Refer to 2 for ALL plans in HI.

11. Was health insurance offered by -- employer?

ITEM FB3
Refer to Age and "Cov." on HIS-1
Mark (X) first appropriate box

If no other persons in the family, Skip to 14 on page 40

[p. 181]

Section FB -- PRIVATE PLAN AND COVERAGE DETAIL -- Continued

HAND CARD FR4. Read each category if telephone interview. If "Not covered 65 and over," include "or Medicare".
CARD FR4

Ask if more than one box is marked in 12a, otherwise transcribe number of box marked without asking.
b. What is the MAIN reason -- was not covered in (month) by any health insurance (or Medicare)?
Record number from CARD FR4

c. When was the LAST time -- had health insurance?

HAND CARD FR5. Read categories if telephone interview.
CARD FR5

d. What was the MAIN reason -- stopped being covered by health insurance?
Mark (X) only one.

e. At the time that -- stopped being covered by health insurance, did -- try to find some other type of health insurance?

f. What was the MAIN reason -- was unable to find some other type of health insurance?

[p. 181]

Section FB -- PRIVATE PLAN AND COVERAGE DETAIL -- Continued

13a. In the past 12 months, was there any time that -- did NOT have ANY health insurance or coverage?

b. In how many of the past 12 months was -- without coverage?

HAND CARD FR5. Read each category if telephone interview
CARD FR5

HAND CARD FR6. Read each category if telephone interview
CARD FR6

ITEM FB4
About how often did the Respondent appear to answer the questions in Sections FA and FB accurately?

ITEM FB5
About how often did the Respondent appear to answer the questions in Sections FA and FB honestly?

ITEM FB6
Enter the person number of the Respondent. If more than one, enter the person number of the one who answered the most questions in Sections FA and FB.