Codes and Frequencies
For sample adults with Medicare coverage (HIMCAREE), MCARETYP reports the type of Medicare coverage. The universe for this variable has changed over time. Please see the Universe tab for more information.
Prior to 1993, MCARETYP is a recoded variable created by the National Center for Health Statistics (NCHS) and is included in the original NHIS public use data. MCARETYP, like other recoded health insurance variables in the NHIS data, is based on responses to a series of questions and back editing carried out by the NCHS. Beginning in 1993, MCARETYP is based on a single question in the survey.
People were asked their type of Medicare coverage only if they had Medicare coverage (HIMCAREE). The NCHS provides the following definition of "Medicare":
For persons who responded affirmatively to having Medicare, interviewers were instructed to ask for their Medicare card. If the respondent was able to provide the card, interviewers were instructed to categorize the respondent's Medicare coverage as Part A, Part B, or both Part A and Part B. The Centers for Medicare and Medicaid Services (CMS) provides succinct characterizations of both Part A Medicare coverage and Part B Medicare coverage:
- Part A Medicare Coverage: "Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits."
- Part B Medicare Coverage: "Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary."
In the survey for 1997 forward, interviewers first asked, "Are you covered by health insurance or some other kind of health care plan?"
Respondents were instructed to "Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills." In 1997-2003 the survey form instructed interviewers to only read the preceding statement "if necessary."
Individuals who had an affirmative response to the preceding question were asked, "What kind of health insurance or health care coverage do you have?" Respondents selected the appropriate response from a card listing various types of insurance coverage.
The choices included:
- Private health insurance (2004 forward)
- Private health insurance plan from employer or workplace (1997-2003)
- Private health insurance plan purchased directly (1997-2003)
- Private health insurance plan through a State or local government program or community program (1998-2003)
- Medicare (1997 forward)
- Medi-Gap (1997 forward)
- Medicaid (1997 forward)
- CHIP (Children's Health Insurance Program) (1999 forward)
- Military Health Care/VA (1997-2003)
- Military Health Care (CHAMPUS/TRICARE/CHAMP-VA) (1997-2018)
- Military related health care: TRICARE (CHAMPUS)/VA health care/CHAMP-VA) (2019 forward)
- Indian Health Service (1997 forward)
- State-sponsored health plan (1997 forward)
- Other government program (1997 forward)
- Single Service Plan (e.g., dental, vision, prescriptions) (1999-2018)
- No coverage of any type (2000 forward)
Respondents could pick more than one type of insurance and interviewers were instructed to mark all that applied.
Respondents were consistently instructed to exclude private plans that "only provide extra cash while hospitalized," and single service plans were also excluded.
In 1997-1998 respondents were also instructed to "EXCLUDE private plans that ... pay for only one type of service (nursing home care, accidents, or dental care)." Beginning in 1999, "Single Service Plan" was added as a possible response, and, consequently, the instructions were changed to read, "INCLUDE those [private plans] that pay for only one type of service (nursing home care, accidents, or dental care)."
In follow-up questions, interviewers recorded the names of up to four private health insurance plans. If the person was reported as covered by CHIP (beginning in 2000), by a state-sponsored health plan, or by another public program (other than Medicaid) that paid for health care, the interviewer recorded the name of that plan. The placement and wording of these questions about the names of specific government health care plans varied across years.
As already noted, people were asked their type of Medicare coverage only if they had already indicated that they had Medicare coverage.
Data Editing and Recoding
During the course of data editing, the NCHS discovered many errors in the responses to questions about insurance coverage. Often, respondents misclassified the type of insurance they had.
This might be shown, for example, by a mismatch between the verbatim name of an insurance plan and the type of insurance coverage the person selected from the categories on a card provided by the interviewer.
Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, the data are back edited, taking into account such factors as the proper classification of the verbatim names of insurance plans and responses to questions about why insurance coverage had stopped.
Because of the errors in the respondents' original (unedited) answers to questions about insurance coverage, the NCHS strongly advises analysts to use these recoded insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' original and unedited answers.
Only persons having an affirmative response to the recoded Medicare coverage variable, HIMCAREE, were included in the universe of MCARETYP.
The basic meaning and universe for this variable are consistent over time. However, comparability may be limited by changes in the questions used to gather the information used for back editing the data, and by changes in the back-editing procedures used by the NCHS. Additionally, the NHIS questionnaire was substantially redesigned in 2019 to introduce a different data collection structure and new content. For more information on changes in terminology, universes, and data collection methods beginning in 2019, please see the user note.
- 1980; 1982; 1984; 1986; 1989: Persons are who currently covered by Medicare but didn't know which Medicare plan they were covered under.
- 1983: Persons in quarters 3 and 4 who are currently covered by Medicare but didn't know which Medicare plan they were covered under.
- 1993: Persons in quarters 3 or 4 covered by Medicare last month.
- 1994-1996: Persons covered by Medicare last month.
- 1997-2018: Persons with Medicare coverage.
- 2019-2022: Sample adults age 18+ with Medicare coverage (HIMCAREE).
- 1980, 1982-1984, 1986, 1989, 1993-2022