?[F1]
What kinds of health insurance or health care coverage do you have? Is it...Private health
insurance, Medicare, Medicare supplement, Medicaid, Children's Health Insurance Program or CHIP,
military related health care including TRICARE, CHAMPUS, VA health care and CHAMP-VA, Indian
Health Service, a state-sponsored health plan, or an other government program?
* Enter all that apply, separate with commas.

01 - Private health insurance
02 - Medicare
03 - Medigap
04 - Medicaid
05 - Children's Health Insurance Program (CHIP)
06 - Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMPVA
07 - Indian Health Service
08 - State-sponsored health plan
09 - Other government program
10 - No coverage of any type
97 - Refused
99 - Don't Know

Sample Adults 18+ covered by any kind of health insurance or health care coverage or refused/don't know if they have insurance or health care coverage.

if more than 1 answer selected and (10 IN HIKIND_A) [goto ERR1_HIKIND_A]
elseif (GEN.AGE_FINAL[PX_A] ge 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A]=2) and 2 NOT IN HIKIND_A [goto MCAREPRB_A]
elseif (GEN.AGE_FINAL[PX_A] lt 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A].AGE65 IN (1,RF,DK,empty)) and HIKIND_A IN (10,RF,DK) [goto
MCAIDPRB_A]
else [goto SINCOVDE_A]

Check Text: ERR1_HIKIND_A
Check Description: Selecting no coverage and other categories hard edit
Check Text: {check ERR1_HIKIND_A}
Cannot mark "no coverage of any kind" and another type. Please correct.

?[F1]
What kinds of health insurance or health care coverage do you have? Is it...Private health insurance, Medicare, Medicare supplement, Medicaid, Children's Health Insurance Program or CHIP,
military related health care including TRICARE, CHAMPUS, VA health care and CHAMP-VA, Indian Health Service, a state-sponsored health plan, or an other government program?
Enter all that apply, separate with commas.

01 - Private health insurance
02 - Medicare
03 - Medigap
04 - Medicaid
05 - Children's Health Insurance Program (CHIP)
06 - Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMPVA
07 - Indian Health Service
08 - State-sponsored health plan
09 - Other government program
10 - No coverage of any type
97 - Refused
99 - Don't Know

Sample Adults 18+ covered by any kind of health insurance or health care coverage or refused/don't know if they have insurance or health care coverage.

if more than 1 answer selected and (10 IN HIKIND_A) [goto ERR1_HIKIND_A]
elseif (GEN.AGE_FINAL[PX_A] ge 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A]=2) and 2 NOT IN HIKIND_A [goto MCAREPRB_A]
elseif (GEN.AGE_FINAL[PX_A] lt 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A].AGE65 IN (1,RF,DK,empty)) and HIKIND_A IN (10,RF,DK) [goto
MCAIDPRB_A]
else [goto SINCOVDE_A]

Check Text: ERR1_HIKIND_A
Check Description: Selecting no coverage and other categories hard edit
Check Text: {check ERR1_HIKIND_A}
Cannot mark "no coverage of any kind" and another type. Please correct.

?[F1]
Are you covered by Medicare?

1 - Yes
2 - No
7 - Refused
9 - Don't Know

Sample Adults 65+ who have not indicated they had Medicare in HIKIND_A

1,2,RF,DK [goto SINCOVDE_A]

?[F1]
What kinds of health insurance or health care coverage do you have? Is it...Private health
insurance, Medicare, Medicare supplement, Medicaid, Children's Health Insurance Program or CHIP,
military related health care including TRICARE, CHAMPUS, VA health care and CHAMP-VA, Indian
Health Service, a state-sponsored health plan, or an other government program?
* Enter all that apply, separate with commas.

01 - Private health insurance
02 - Medicare
03 - Medigap
04 - Medicaid
05 - Children's Health Insurance Program (CHIP)
06 - Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMPVA
07 - Indian Health Service
08 - State-sponsored health plan
09 - Other government program
10 - No coverage of any type
97 - Refused
99 - Don't Know

Sample Adults 18+ covered by any kind of health insurance or health care coverage or refused/don't know if they have insurance or health care coverage.

if more than 1 answer selected and (10 IN HIKIND_A) [goto ERR1_HIKIND_A]
elseif (GEN.AGE_FINAL[PX_A] ge 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A]=2) and 2 NOT IN HIKIND_A [goto MCAREPRB_A]
elseif (GEN.AGE_FINAL[PX_A] lt 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A].AGE65 IN (1,RF,DK,empty)) and HIKIND_A IN (10,RF,DK) [goto
MCAIDPRB_A]
else [goto SINCOVDE_A]

Check Text: ERR1_HIKIND_A
Check Description: Selecting no coverage and other categories hard edit
Check Text: {check ERR1_HIKIND_A}
Cannot mark "no coverage of any kind" and another type. Please correct.

?[F1]
Are you covered by Medicare?

1 - Yes
2 - No
7 - Refused
9 - Don't Know

Sample Adults 65+ who have not indicated they had Medicare in HIKIND_A

1,2,RF,DK [goto SINCOVDE_A]

What kinds of health insurance or health care coverage do you have? Is it...Private health insurance, Medicare, Medicare supplement, Medicaid, Children's Health Insurance Program or CHIP, military related health care including TRICARE, CHAMPUS, VA health care and CHAMP-VA, Indian Health Service, a state-sponsored health plan, or an other government program?
Enter all that apply, separate with commas.

1 Private health insurance
2 Medicare
3 Medigap
4 Medicaid
5 Children's Health Insurance Program (CHIP)
6 Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMP- VA
7 Indian Health Service
8 State-sponsored health plan
9 Other government program
10 No coverage of any type
97 Refused
99 Do not Know

Sample Adults 18+ covered by any kind of health insurance or health care coverage or refused/do not know if they have insurance or health care coverage.

if more than 1 answer selected and (10 IN HIKIND_A) [goto ERR1_HIKIND_A] elseif (GEN.AGE_FINAL[PX_A] ge 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A]=2) and 2 NOT IN HIKIND_A [goto MCAREPRB_A] elseif (GEN.AGE_FINAL[PX_A] lt 65 or (GEN.AGE_FINAL[PX_A] IN (RF,DK) and
Roster.HHC.tblAGE.blkPerson[PX_A].AGE65 IN (1,RF,DK,empty)) and HIKIND_A IN (10,RF,DK) [goto MCAIDPRB_A]
else [goto SINCOVDE_A]

Check Description: Selecting no coverage and other categories hard edit
Check Text: check ERR1_HIKIND_A

Cannot mark "no coverage of any kind" and another type.

Please correct.

Are you covered by Medicare?

1 Yes
2 No
7 Refused
9 Do not Know

Sample Adults 65+ who have not indicated they had Medicare in HIKIND_A

1,2,RF,DK = [goto SINCOVDE_A]

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}: Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of coverage?
{if subject eq respondent}: * Read if necessary. What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

(1-3) [go to MCCARD]
(R,D) [prefill MCCARD with a "2" and go to MCCHOICE]

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1] What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [go to HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, go to MCAREPRB; else, if HIKIND ne 10 go to SINCOV; else, go to HICHANGE]
(11) [if HIKIND = 1-10, go to ERR_HIKIND; else, if AGE ge 65 go to MCAREPRB; else, go to MCAIDPRB]

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13 People covered by Medicare have a card that looks like this. [fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

What kind of health insurance or health care coverage {do/does} {you/subject name} have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized.

FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES. PLEASE REFER TO FLASHCARDS F10, AND F11 FOR YOUR STATE.

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community program
4. Medicare
5. Medi-Gap
6. Medicaid
7. Children's Health Insurance Program (CHIP/SCHIP)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single service plan (e.g., dental, vision, prescriptions)
14. No coverage of any type
*EXCLUDE private plans that only provide extra cash while hospitalized.

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any type

(Anything else?)

What kind of health insurance or health care coverage {do/does} {you/subject name} have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized.

FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES. PLEASE REFER TO FLASHCARDS F10, AND F11 FOR YOUR STATE.

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community program
4. Medicare
5. Medi-Gap
6. Medicaid
7. Children's Health Insurance Program (CHIP/SCHIP)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single service plan (e.g., dental, vision, prescriptions)
14. No coverage of any type
*EXCLUDE private plans that only provide extra cash while hospitalized.

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any type

(Anything else?)

What kind of health insurance or health care coverage (do/does) (you/subject name) have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized.

FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES.
PLEASE REFER TO CARDS F9 AND F10 FOR YOUR STATE.

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any kind

(Anything else?)

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. CHIP (Children's Health Insurance Program)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single Service Plan (e.g., dental, vision, prescriptions)
14. No coverage of any type

[If MCHMO = 1]

What is the name of the HMO?

MCHMO_NA Name: ____________

What kind of health insurance or health care coverage (do/does) (you/subject name) have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized.

FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES.
PLEASE REFER TO CARDS F9 AND F10 FOR YOUR STATE.

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any kind

(Anything else?)

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. CHIP (Children's Health Insurance Program)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single Service Plan (e.g., dental, vision, prescriptions)
14. No coverage of any type

[If MCHMO = 1]

What is the name of the HMO?

MCHMO_NA Name: ____________

What kind of health insurance or health care coverage (do/does) (you/subject name) have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized.

FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES.
PLEASE REFER TO CARDS F9 AND F10 FOR YOUR STATE.

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any kind

(Anything else?)

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. CHIP (Children's Health Insurance Program)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single Service Plan (e.g., dental, vision, prescriptions)
14. No coverage of any type

[If MCHMO = 1]

What is the name of the HMO?

MCHMO_NA Name: ____________

What kind of health insurance or health care coverage {do/does} {you/subject's name} have? EXCLUDE private plans that only provide extra cash while hospitalized or pay for only one type of service (nursing home care, accidents, or dental care). (Anything else?)

FR: SHOW CARD F9.
MARK "X" ALL THAT APPLY.

1. Private health insurance plan from employer or workplace*
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. Military health care/VA
8.CHAMPUS/TRICARE/CHAMP-VA
9. Indian Health Service
10.State-sponsored health plan
11. Other government program

*EXCLUDE private plans that only provide extra cash while hospitalized or pay for only one type
of service (nursing home care, accidents, or dental care).

[ ]HIKINDA (01) Private health insurance plan from employer or workplace
[ ]HIKINDB (02) Private health insurance plan purchased directly
[ ]HIKINDC (03) Private health insurance plan through a State or local government program or community program
[ ]HIKINDD (04) Medicare
[ ]HIKINDE (05) Medi-GAP
[ ]HIKINDF (06) Medicaid
[ ]HIKINDG (08) Military health care/VA
[ ]HIKINDH (09) CHAMPUS/TRICARE/CHAMP-VA
[ ]HIKINDI (10) Indian Health Service
[ ]HIKINDJ (11) State-sponsored health plan
[ ]HIKINDK (12) Other government program

Check item FHICCI3: (Medicare Coverage) Loop through every non-deleted and non Armed Forces family member roster:
1. If the person in FHI.070 marked 5 and not 4, mark HIKINDD=X and go to FHI.080.
2. If the person in FHI.070 marked 4, go to FHI.080.
3. If the person in FHI.070 did not mark 4, go to Check item FHICCI4

What kind of health insurance or health care coverage {do/does} {you/subject's name} have? EXCLUDE private plans that only provide extra cash while hospitalized or pay for only one type of service (nursing home care, accidents, or dental care).

FR: ENTER EACH NUMBER THAT APPLIES. (Anything else?)

[ ] HIKINDA (01) Private health insurance plan from employer or workplace
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Medicare
[ ] HIKINDD (04) Medi-Gap
[ ] HIKINDE (05) Medicaid
[ ] HIKINDF (06) Military health care/VA
[ ] HIKINDG (07) CHAMPUS/TRICARE/CHAMP-VA
[ ] HIKINDH (08) Indian Health Service
[ ] HIKINDI (09) State-sponsored health plan
[ ] HIKINDJ (10) Other government program

Check item FHICCI3: (Medicare Coverage) Loop through every non-deleted and non Armed Forces family member roster:
1. If the person in FHI.070 marked 4 and not 3, go to FHI.080.
2. If the person in FHI.070 marked 3, go to FHI.080.
3. If the person in FHI.070 did not mark 3, go to Check item FHICCI4