Survey Text

2018 2010 2002 1994
2017 2009 2001 1993
2016 2008 2000 1989
2015 2007 1999 1986
2014 2006 1998 1984
2013 2005 1997 1983
2012 2004 1996 1982
2011 2003 1995 1980
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2018
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

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2017
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2016
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

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2015
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2014
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2013
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2012
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2011
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]
Question ID:FHI.092_00.000

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

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2010
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2009
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]
Question ID:FHI.092_00.000

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

top
2008
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2007
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2006
Survey form view entire document:  text  image

Question ID:FHI.090_00.000

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]

top
2005
Survey form view entire document:  text  image
Instrument Variable Name: MCNO
Question Text:
1 of 2 ? [F1]
I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Insurance Claim Number?
*Enter the claim number from the card.
This number is needed to allow Medicare records of the Centers for Medicare and Medicaid Services to be easily and accurately located and identified for statistical or research purposes. We may also need to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.
*Read if necessary: The Public Health Service Act is Title 42, United States Code, Section 242K.
0-999999996 0-999999996
999999997 Refused
999999999 Don't know
Universe Text: Family respondents with Medicare
Skip Instructions:
(0-99999996) [goto MCLET]
(R,D) [goto MCPART]

FHI.080_02.000

Instrument Variable Name: MCLET
Question Text:
2 of 2
*Enter the letters that appear after the claim number.
2 letters
97 Refused
99 Don't know
Universe Text: Family respondents with Medicare who reported a Medicare claim number
Skip Instructions:
goto MCPART

FHI.090_00.000

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) [goto MCCARD]
(R,D) [prefill MCCARD with a "2" and goto MCCHOICE]

FHI.092_00.000

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, goto MCRXCARD; else, goto MCCHOICE

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2004
Survey form view entire document:  text  image
Instrument Variable Name: MCNO
Question Text:
1 of 2 ? [F1]
I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Insurance Claim Number?
*Enter the claim number from the card.
This number is needed to allow Medicare records of the Centers for Medicare and Medicaid Services to be easily and accurately located and identified for statistical or research purposes. We may also need to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.
*Read if necessary: The Public Health Service Act is Title 42, United States Code, Section 242K.
0-999999996 0-999999996
999999997 Refused
999999999 Don't know
Universe Text: Family respondents with Medicare
Skip Instructions:
(0-99999996) [goto MCLET]
(R,D) [goto MCPART]

FHI.080_02.000

Instrument Variable Name: MCLET
Question Text:
2 of 2
*Enter the letters that appear after the claim number.
2 letters
97 Refused
99 Don't know
Universe Text: Family respondents with Medicare who reported a Medicare claim number
Skip Instructions:
goto MCPART

FHI.090_00.000

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) [goto MCCARD]
(R,D) [prefill MCCARD with a "2" and goto MCCHOICE]

FHI.092_00.000

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, goto MCRXCARD; else, goto MCCHOICE

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2003
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

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2002
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
2001
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
2000
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
1999
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
1998
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
1997
Survey form view entire document:  text  image

FHI.080

Earlier I recorded that you are covered by Medicare. May I please see your Medicare card to determine the type of coverage and to record the Health Ins. Claim Number?

FR: ENTER THE NUMBERS AND LETTERS.

This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need
to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to anyone, including any other government agency. 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 your benefits. This number will be held in strict confidence.

FR: IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_1
MCNO_2
Claim Number (only numbers):--
(any characters): -
(7) Refused
(9) Don't know

FHI.090

If person with Medicare coverage is not family respondent
Earlier I recorded that {subject name} is covered by Medicare. May I please see {subject name}'s Medicare card to determine the type of coverage?

[ELSE]

FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
MCPART
(1) Part A - Hospital Only (Check item FHICCI4)
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)

top
1996
Survey form view entire document:  text  image

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.

H.I.C. Number
___-____-______( ) ( )
1[] Part A- Hospital only (B2)
2[] Part B- Medical only (B2)
3[] Both Part A and Part B (B2)
4[] Card N.A (1e)

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1995
Survey form view entire document:  text  image

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.

H.I.C. Number
___-____-______( ) ( )
1[] Part A- Hospital only (B2)
2[] Part B- Medical only (B2)
3[] Both Part A and Part B (B2)
4[] Card N.A (1e)

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1994
Survey form view entire document:  text  image

Ask 1d-g as appropriate for each person with "Medicare" in 1b.
d. May I please see the Medicare card(s) for -- (and [other sample persons]) 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.

H.I.C Number __ - __- ____(__)__(__)
[] 1 Part A- Hospital only (B2)
[] 2 Part B- Medical only (B2)
[] 3 Both Part A and Part B (B2)
[] 4 Card N.A (1e)

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?

[] 1 Yes
[] 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.

[] 1 Yes
[] 2 No
[] 9 DK

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1993
Survey form view entire document:  text  image

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.

H.I.C. Number
___-____-_______( )_( )_
1 [] Part A- Hospital only
2 [] Part B- Medical only
3 [] Both Part A and Part B
4 [] Card N.A

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?

1 [] Yes
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.

1 [] Yes
2 [] No
9 [] DK

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1989
Survey form view entire document:  text  image

Ask for each person with "Covered" or "DK" in 1b
2. May I please see the Social Security Medicare card(s) for -- (and --) to determine the type of coverage and to record the Health Insurance Claim Number. Providing the Health Insurance Claim Number is voluntary and collected under the authority of the Public Health Service Act. There will be no effect on -- benefits and no 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 the appropriate box(es).

H.I.C. Number _ _ _ - _ _ - _ _ _ _ (_) (_)
1[] Hospital
2[] Medical
3[] Card N A

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1986
Survey form view entire document:  text  image

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.

1 [] Hospital
2 [] Medical
3 [] Card N.A.

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1984
Survey form view entire document:  text  image

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.

1 [] Hospital
2 [] Medical
3 [] Card N.A.

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1983

No questionnaire text is available for this sample.


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1982
Survey form view entire document:  text  image

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.

1 [] Hospital
2 [] Medical
3 [] Card N.A.

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1980
Survey form view entire document:  text  image

Ask for each person with "DK" in 2 and for each person under 65 with "Covered" in 1b.
3. May I please see the Social Security Medicare card(s) for -- (and--) to determine the (type/dates) of coverage?
Transcribe the information from the card or mark the "Card N.A." box.

1 [] Cov. Hosp.
2 [] Cov. Med.
3 [] Card N.A.