HX05
====
[STR-DT]
My records indicate that (READ NAMES BELOW) [(are/is)] [either] [65 years old or older] [or] [joined the household since our last interview].
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
(Has (READ NAME ABOVE)/Have any of these people) been covered by Medicare since (START DATE)?
YES .................................... 1
NO ..................................... 2 [LOOP_04]
REF ................................... -7 [LOOP_04]
DK .................................... -8 [LOOP_04]
PRESS F1 FOR DEFINITION OF MEDICARE.
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DISPLAY '(are/is)' AND '65 years old' IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START DATE OR IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR ) 65 PREVIOUS ROUND.
DISPLAY 'joined the household since our last interview' IF ANY NEW RU MEMBERS ADDED TO THE RU THIS ROUND.
DISPLAY 'either' AND 'or' IF ANY NEW RU MEMBERS ADDED TO THE RU THIS ROUND AND IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START DATE OR ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR ) 65 PREVIOUS ROUND.
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ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ANY ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER WHO IS NOT ALREADY FLAGGED AS RECEIVING MEDICARE AND HAS TURNED 65 SINCE START DATE
OR
- PERSON IS AN RU MEMBER WHO IS NOT ALREADY FLAGGED AS RECEIVING MEDICARE (NOT SELECTED AT HX07 DURING PREVIOUS ROUND) AND WHO WAS = OR ) 65 (OR IN AGE CATEGORY 9) DURING THE PREVIOUS ROUND
OR
- PERSON IS A NEW RU MEMBER
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IF HX05 IS CODED '1' (YES) AND ONLY ONE RU MEMBER ELIGIBLE FOR HX05, SELECT THAT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
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IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
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HX10
====
[STR-DT]
[Some people are covered by a program called [Medicaid/[STATE NAME FOR MEDICAID]]. This is a state program for persons with low incomes and persons on public assistance. It sometimes covers persons with very large medical bills or those in nursing homes.]
[SHOW CARD HX-3.]
[People covered by [Medicaid/[STATE NAME FOR MEDICAID]] usually have a (piece of paper/card) that looks like this.]
[During the last interview, we recorded that no one in the family was covered by [Medicaid/[STATE NAME FOR MEDICAID]].]
Has anyone in the family been covered by [Medicaid/[STATE NAME FOR MEDICAID]] at any time since (START DATE)?
YES .................................... 1
NO ..................................... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX-14]
PRESS F1 FOR DEFINITION OF MEDICAID.
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DISPLAY FIRST PARAGRAPH ('Some .... homes.') ONLY IF ROUND 1. OTHERWISE, USE A NULL DISPLAY.
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DISPLAY SECOND PARAGRAPH (INCLUDING REFERENCE TO SHOW CARD) ONLY IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED ISSUES A CARD OR PIECE OF PAPER TO MEDICAID RECIPIENTS. THIS INCLUDES ALL STATES EXCEPT TENNESSEE. IF THE INTERVIEW IS BEING CONDUCTED IN TENNESSEE, USE A NULL DISPLAY.
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DISPLAY THIRD PARAGRAPH ('During... MEDICAID]].') ONLY IF NOT ROUND 1. OTHERWISE, USE A NULL DISPLAY.
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DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX ON HX06.
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IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX11 AND GO TO
LOOP_05
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IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX11
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HX12
====
[STR-DT]
[During the last interview, we recorded that no one in the family was covered by CHAMPUS, TRICARE or CHAMPVA.]
At any time since (START DATE), has anyone in the family been covered by CHAMPUS, TRICARE or CHAMPVA?
YES .................................... 1
NO ..................................... 2 [BOX_16]
REF ................................... -7 [BOX_16]
DK .................................... -8 [BOX_16]
PRESS F1 FOR DEFINITION OF CHAMPUS/CHAMPVA.
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DISPLAY FIRST PARAGRAPH ('During .... CHAMPVA.') IF NOT ROUND 1. OTHERWISE, USE A NULL DISPLAY.
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IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AT HX13 AUTOMATICALLY BY CAPI AND GO TO LOOP_06
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IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX13
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HX14
====
[STR-DT]
[During the last interview, we recorded that no one in the family was covered by any other state sponsored program which provided hospital and physician benefits.]
At any time since (START DATE), has anyone in the family had any type of health insurance obtained through any state or local government agency which provided hospital and physician benefits?
YES .................................... 1
NO ..................................... 2 [BOX_19]
REF ................................... -7 [BOX_19]
DK .................................... -8 [BOX_19]
PRESS F1 FOR DESCRIPTION OF INSURANCE TYPES TO INCLUDE.
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DISPLAY FIRST PARAGRAPH ('During .... benefits.') IF NOT ROUND 1. OTHERWISE, USE A NULL DISPLAY.
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IF HX14 IS CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AT HX15 AUTOMATICALLY BY CAPI AND GO TO LOOP_07
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IF HX14 IS CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX15
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NOTE: 'GOVT-HOSPITAL/PHYSICIAN' SHOULD BE USED FOR THE ESTABLISHMENT NAME IN THE CONTEXT HEADER (WHERE APPROPRIATE).
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HX23
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
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DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
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IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
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OTHERWISE, GO TO BOX_33
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NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
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OE03
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
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ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
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----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)
DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).
DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
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HP04
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
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ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
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ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:
1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
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DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
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DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.
DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.
DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
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NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
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IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
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IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
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OTHERWISE, CONTINUE WITH HP05
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HQ04
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
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DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------