[p.180]
Part B - Health Care Coverage
ITEM B1
Refer to household composition. Mark (x) for each person including those deleted in the HIS-1.
2[] AF living at home
3[] Deleted
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 covered by Medicare?
2[] No (2 on page 14)
9[] DK (2 on page 14)
b. Who was covered?
Mark (x) "Medicare" box in person's column and "Cov" on HIS-1
(enter 'Cov' box on HIS-1)
c. Anyone else?
[] No (1d)
Ask 1d-i 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.
___-____-______( ) ( )
2[] Part B- Medical only (B2)
3[] Both Part A and Part B (B2)
4[] Card N.A (1e)
Ask 1e-f for each person with "Card N.A" in 1d.
e. Was -- covered by Part A, that part of Medicare that pays for hospital bills?
2[] No
9[] DK
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.
2[] No
9[] DK
ITEM B2
Refer to age
2[] Age 67 or older (1h)
g. How long has -- been covered by Medicare?
2[] 6 months, but less than 1 year
3[] 1 year, but less than 2 years
4[] 2 years or more
9[] DK
h. Can -- go to ANY doctor who will accept Medicare or must -- choose from a specific group or list of doctors?
If doctor was assigned by the plan, mark box 2.
2[] Select from list/group (1i)
9[] DK (1d for NP with 1b, or 2)
i. What is the specific name if -- Medicare health plan?
___________
___________
(1d for NP with 1b,or 2)
[p.181]
Part B - 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. In (month), was anyone in the family covered by Medicare?
2[] No (B3)
9[] DK (B3)
b. Who was covered?
Mark (x) "Medicaid" in person's column and "Cov" on the HIS-1
(Mark "Cov" box on HIS-1)
c. Anyone else?
[] No (2d)
Ask 2d-f for each person with "Medicaid" marked in 2b.
d. How long has -- had Medicaid coverage?
Mark (x) only one.
2[] 6 months, but less than a year
3[] 1 year, but less than 2 years
4[] 2 years, but less than 5 years
5[] 5 years or more
6[] On and off for less than 2 years
7[] On and off for 2 years but less than 5 years
8[] On and off for 5 years or more
9[] DK
e. Can -- go to ANY doctor who will accept Medicaid or MUST -- choose from a specific group or list of doctors?
If doctor was assigned by the program, mark box 2.
2[] Select from list/group (2f)
9[] DK (2d for NP with 2b, or B3)
f. If -- needs to go to a different doctor or place for special care other than emergency care, does -- need approval or a referral from -- usual doctor(s)?
2[] No (2d for NP with 2b, or B3)
9[] DK (2d for NP with 2b, or B3)
ITEM B3
Refer to household composition and question 2a.
2[] Other (3)
3a. 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)?
2[] No (4)
9[] DK (4)
b. Who received this care in the past 12 months?
Mark (x) "Received Medicaid Care" box in person's column.
c. Anyone else?
[] No (4)
4a. 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.
2[] No (5 on page 16)
9[] DK (5 on page 16)
b. Who was covered?
Mark (x) "Public assistance" in person's column and "Cov" on HIS-1.
(Enter "Cov" box on HIS-1)
c. Anyone else?
[] No (5 on page 16)
[p.182]
Part B - Health Care Coverage - Continued
5a. 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 TRICARE, or CHAMP-VA?
2[] No (6)
9[] DK (6)
b. Was this CHAMPUS or TRICARE, or CHAMP-VA?
Read if necessary: CHAMPUS or TRICARE 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?
2[] No (5f)
9[] DK (5e)
c. Who was covered by CHAMPUS or TRICARE, or CHAMP-VA? Mark (x) "CHAMPUS/TRICARE/CHAMP-VA" in person's column and "Cov" on the HIS-1.
(Mark "Cov" box on HIS-1)
d. Anyone else?
[] No (5e)
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)?
2[] No (6)
9[] DK (6)
f. Who was covered by other military health care?
Mark (x) "Military" in person's column and "Cov" box on the HIS-1.
(Mark "Cov" box on HIS-1)
g. Anyone else?
[] No (6)
6a. In (month), was anyone in the family covered by the Indian Health Service?
2[] No (7)
9[] DK (7)
b. Who was covered?
Mark (x) "IHS" in person's column and "Cov" on the HIS-1.
(Mark "Cov" box on HIS-1)
c. Anyone else?
[] No (7)
7a. (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).
2[] No (Part C, question 8 on page 26)
9[] DK (Part C, question 8 on page 26)
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?
Ask 7c after recording each plan. Record up to 4 plan names in Part C, Table H.I
c. In (month), was anyone in the family covered by any OTHER private health insurance plan?
2[] No (Part C on page 18)
[p.183]
Part C - Private Plan and Coverage Detail
PERSON 1
Table H.I. - PLAN 1
Plan 1 Name
Now, I am going to ask some questions about the plan(s) you just told me about, (Starting with (plan name)).
1a. Who was covered under this plan?
Mark (x) "Private insurance" in person's column and "Cov" on the HIS-1
(Mark "Cov" box on HIS-1)
b. Anyone else?
[] No (2)
2. In whose name is this plan?
Mark (s) "In name" box in person's column and also on the HIS-1
2[] Person not in household
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.
Mark (x) only one
2[] Union ______ (3b)
3[] Through workplace, but DK whether employer or union (3b)
4[] No (4)
9[] DK (4)
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.
2[] Some (4)
3[] None (4)
9[] DK (4)
Hand Card FC1. Read each category if telephone interview.
CARD FC1
2. $1 - $9
3. $10 - $19
4. $20 - $49
5. $50 - $99
6. $100 - $199
7. $200 - $499
8. $500 or more
4. In (month), how much did [you/your family] spend for health insurance premiums for (plan name)? Please include payroll deductions for premiums.
Mark (x) only one.
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.
2[] $1-$9
3[] $10-$19
4[] $20-$49
5[] $50-$99
6[] $100-$199
7[] $200-$499
8[] $500 or more
9[] DK
5a. Does this plan pay for a variety of health care services or does it pay for ONLY ONE type of services or care?
2[] Only one type of service/care (5b)
9[] DK (6)
b. What type of service or care does the plan pay for?
Mark (x) only one type of service
02[] AIDS care
03[] Cancer treatment
04[] Catastrophic care
05[] Dental care
06[] Disability insurance (cash payments when unable to work for health reasons)
07[] Hospice care
08[] Hospitalization-only
09[] Long term care (nursing home care)
10[] Prescriptions
11[] Vision care
98[] Other-Specify ________
99[] DK
Go to 1a for next HI plan; if no other HI plan, go to 8 on page 26
[p.184]
Person 2
(Mark "Cov" box on HIS-1)
2. 1[] In name
(Mark "Cov" box on HIS-1)
2. 1[] In name
(Mark "Cov" box on HIS-1)
2. 1[] In name
(Mark "Cov" box on HIS-1)
2. 1[] In name
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.
2[] Other
9[] DK
b. Under this plan can you choose ANY doctor or MUST you choose one from a specific group or list of doctors?
2[] Select from group/list (6d)
9[] DK (7)
c. Do you have the option of choosing a doctor from a preferred or select list at lower cost to you?
2[] No (7)
9[] DK (7)
d. If you select a doctor who is not in the plan, will (plan name) pay for any part of the cost?
2[] No
9[] DK
7a. Does (plan name) pay for any part of the cost for dental care?
2[] No
9[] DK
Mark (x) box or ask:
7b. Does this plan 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?
1[] Yes (Go to 1a for next plan; if no other plan go to 8 on page 26)
2[] No (Go to 1a for next plan; if no other plan go to 8 on page 26)
9[] DK (Go to 1a for next plan; if no other plan go to 8 on page 26)
[p.185]
Part C - 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?
2[] No (9)
9[] DK (9)
b. Who is this?
Mark (x) "Pre-existing condition" in person's column
c. Anyone else?
[] No (9)
[] DK (9)
9a. In the past 2 years, has anyone in the family applied for health insurance and not been able to get it?
2[] No (10)
9[] DK (10)
b. Who is this?
Mark (x) "Turned down" in person's column
c. Anyone else?
[] No (9d)
[] DK (9d)
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
2[] Because of health risk(s), (such as smoking or overweight)
3[] Because of work, (such as construction worker, beautician, farm worker)
4[] Because premiums were too high
8[] Other- Specify
_______
9[] DK
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?
2[] No (C1)
9[] DK (C1)
b. Who is this?
Mark (x) "Stayed in job" in person's column
c. Anyone else?
[] No (C1)
[] DK (C1)
ITEM C1
Refer to age and Wa/Wb in HIS-1
Mark (x) first appropriate box
2[] Wa/Wb marked (C2)
8[] Other (NP, or C3 on page 28)
Refer to "In name" box on HIS-1.
8[] Other (11)
11. Was health insurance offered by -- employer?
2[] No (C1 for NP, or C3 on page 28)
9[] DK (C1 for NP, or C3 on page 28)
[p.186]
Part C - Private Plan and Coverage Detail
ITEM C3
Refer to Age and "Cov" on HIS-1. Mark (x) first appropriate box.
If no other person in family, go to 14 on page 30
2[] Not covered, under 65 (12)
3[] Not covered, 65+ (12)
Hand card FC2. Read each category if telephone interview.
CARD FC2
2. Wasn't offered by employer
3. Not eligible because part time worker
4. Family coverage not offered by employer
5. Benefits from former employer ran out
6. Can't obtain because of poor health, illness, or age
7. Too expensive/Can't afford
8. Dissatisfied with previous insurance
9. Don't believe in insurance
10. Have usually been healthy, haven't needed insurance
11. Covered by some other plan
12. Too old for coverage under family plan
13. Free/inexpensive source of care readily available
98. Other reason (Specify)
If "Not covered 65+," include "or Medicare".
12a. Many people do not have health insurance for various reasons. Which of these statements describes why -- is not covered by any health insurance (or Medicare)?
Anything else?
Mark (x) all that apply.
02[] Wasn't offered by employer
03[] Not eligible because part time worker
04[] Family coverage not offered by employer
05[] Benefits from former employer ran out
06[] Can't obtain because of poor health, illness, or age
07[] Too expensive/Can't afford
08[] Dissatisfied with previous insurance
09[] Don't believe in insurance
10[] Have usually been healthy, haven't needed insurance
11[] Covered by some other plan
12[] Too old for coverage under family plans
13[] Free/inexpensive source of care readily available
98[] Other reason- Specify
_________
99[] DK (12d)
Ask 12b 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 FC2
Ask 12c if box 11 is marked in question 12a; otherwise skip to 12d
c. Was -- covered by a state sponsored health plan, a private health insurance plan, or some other type of health plan?
Mark (x) only one.
2[] Private plan (C3 for NP or 14 on page 30)
3[] Other plan (C3 for NP or 14 on page 30)
9[] DK (C3 for NP or 14 on page 30)
d. When was the LAST time -- had health insurance? (Read categories if necessary)
Mark (x) only one.
2[] 6 months ago, but less than 1 year ago (12e)
3[] 1 year ago, but less than 3 years ago (12e)
4[] 3 or more years ago (C3 for NP or 14 on page 30)
5[] Never had health insurance (C3 for NP or 14 on page 30)
9[] DK (12f)
Hand card FC3. Read categories if telephone interview.
CARD FC3
2. Spouse/parent lost job or changed employers
3. Death of spouse or parent
4. Became divorced or separated
5. Became ineligible because of age
6. Employer stopped offering coverage
7 Cut back to part time
8. Benefits from employer/ former employer ran out
98. Other (specify)
e. What was the MAIN reason -- stopped being covered by health insurance?
Mark (x) only one
02[] Spouse/parent lost job or changed employers (12f on page 30)
03[] Death of spouse or parent (12f on page 30)
04[] Became divorced or separated (12f on page 30)
05[] Became ineligible because of age (12f on page 30)
06[] Employer stopped offering coverage (12f on page 30)
07[] Cut back to part time (12f on page 30)
08[] Benefits from employer/former employer ran out (12f on page 30)
98[] Other- Specify (12f on page 30)
_____
99[] DK (12f on page 30)
[p.187]
Part C - Private Plan and Coverage Detail
12f. At the time that -- stopped being covered by health insurance, did -- try to find some other type of health insurance?
2[] No (C3 on page 28 for NP, or 14)
9[] DK (C3 on page 28 for NP, or 14)
g. What was the MAIN reason -- was unable to find some other type of health insurance?
Mark (x) only one.
2[] Was rejected (C3 on page 28 for NP, or 14)
3[] Other reason- Specify (C3 on page 28 for NP, or 14)
______
9[] DK (C3 on page 28 for NP, or 14)
13a. In the past 12 months, was there any time that -- did NOT have ANY health insurance or coverage?
2[] No (C3 on page 28 for NP, or 14)
9[] DK (C3 on page 28 for NP, or 14)
b. In how many of the past 12 months was -- without coverage?
Mark (x) only one.
2[] 2-3 months
3[] 4-6 months
4[] More than 6 months
9[] DK
Hand card FC3. Read each category if telephone interview.
CARD FC3
2. Spouse/parent lost job or changed employers
3. Death of spouse or parent
4. Became divorced or separated
5. Became ineligible because of age
6. Employer stopped offering coverage
7 Cut back to part time
8. Benefits from employer/ former employer ran out
98. Other (specify
c. What was the MAIN reason -- was without coverage?
Mark (x) only one.
02[] Spouse/parent lost job or changed employers (C3 on page 28 for NP, or 14)
03[] Death of spouse or parent (C3 on page 28 for NP, or 14)
04[] Became divorced or separated (C3 on page 28 for NP, or 14)
05[] Became ineligible because of age (C3 on page 28 for NP, or 14)
06[] Employer stopped offering coverage (C3 on page 28 for NP, or 14)
07[] Cut back to part time (C3 on page 28 for NP, or 14)
08[] Benefits from employer/former employer ran out (C3 on page 28 for NP, or 14)
98[] Other- Specify (C3 on page 28 for NP, or 14)
______
99[] DK (C3 on page 28 for NP, or 14)
Hand Card FC4. Read each category if telephone interview.
CARD FC4
2. Less than $500
3. $500 - $1,999
4. $2,000 - $2,999
5. $3,000 - $4,999
6. $5000 or more
14. During the past 12 months, about how much did [you/your family] spend for medical care? Do NOT include the cost of over-the-counter remedies, the cost of health insurance premiums, or any costs for which you expect to be reimbursed.
Mark (x) only one.
2[] Less than $500
3[] $500-$1999
4[] $2000-$2999
5[] $3000-$4999
6[] $5000 or more
9[] DK
ITEM C4
About how often did the Respondent appear to answer the questions in Parts B and C accurately?
2[] Most of the time
3[] Some of the time
4[] Rarely or never
9[] DK
About how often did the Respondent appear to answer the questions in Part B and C honestly?
2[] Most of the time
3[] Some of the time
4[] Rarely or never
9[] DK
ITEM C6
Enter the person number of the Respondent. If more than one, enter the person number of the one who answered the most questions in Parts B and C.