Survey Text

2022 2015 2008 2001
2021 2014 2007 2000
2020 2013 2006 1999
2019 2012 2005 1998
2018 2011 2004 1997
2017 2010 2003 1996
2016 2009 2002
top
2022

No questionnaire text is available for this sample.


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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


top
2018
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2017
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2016
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2015
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2014
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2013
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2012
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2011
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2010
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2009
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2008
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2007
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2006
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2005
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2004
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2003
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2002
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2001
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
2000
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
1999
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
1998
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
1997
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
NOTE: HX06 IS ASKED ONLY IN ROUND 1.
----------------------------------------------------
HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
----------------------------------------------------
----------------------------------------------------
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
----------------------------------------------------
IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_28A
----------------------------------------------------
HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------
----------------------------------------------------
IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------
HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
----------------------------------------------------

top
1996
Survey form view entire document:  text  image
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.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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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HX06
====

[STR-DT]
There are two large public health insurance programs [with similar names] that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for disabled persons. The other program, [Medicaid/[STATE NAME FOR MEDICAID]], is a state program for low income persons or for persons on public assistance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a card that looks like this.
At any time since (START DATE), has anyone in the family been covered by Medicare?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICARE.
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DISPLAY 'with similar names' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES 'MEDICAID' OR A NAME SIMILAR TO MEDICARE (SUCH AS MEDI-CAL).
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DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA MINNESOTA NORTH DAKOTA ARKANSAS MISSISSIPPI OHIO COLORADO MISSIOURI OKLAHOMA CONNECTICUT MONTANA OREGON DELAWARE NEBRASKA PENNSYLVANIA FLORIDA NEVADA SOUTH CAROLINA ILLINOIS NEW HAMPSHIRE SOUTH DAKOTA INDIANA NEW JERSEY TEXAS KANSAS NEW MEXICO UTAH LOUISIANA NEW YORK VERMONT MAINE NORTH CAROLINA WEST VIRGINIA WYOMING

DISPLAY 'Medical Assistance' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE FOLLOWING:
ALASKA IDAHO MICHIGAN DISTRICT OF COLUMBIA IOWA RHODE ISLAND GEORGIA KENTUCKY VIRGINIA HAWAII MARYLAND WASHINGTON WISCONSIN

DISPLAY 'Arizona Health Care Cost Containment System' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ARIZONA.

DISPLAY 'Medi-Cal' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.

DISPLAY 'MassHealth' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.

DISPLAY 'TennCare' FOR 'STATE NAME FOR MEDICAID' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
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IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
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IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
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IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ONE OR MORE RU MEMBER = ) 65 YEARS OLD, GO TO LOOP_04
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IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBER = ) 65 YEARS OLD, GO TO BOX_12
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NOTE: HX06 IS ASKED ONLY IN ROUND 1.
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HX07
====

[STR-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, 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]
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ROSTER DEFINITION:
IF ROUND 1, THIS ITEM DISPLAYS THE COMPLETE RU-MEMBERS-ROSTER.
IF ROUND 2, THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
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HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
[MEDICARE] CLAIM NUMBER:
[Enter Large Number] ...................
REF ................................... -7
DK .................................... -8
EFFECTIVE DATE:
[Enter Month,Day,Year-2]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
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DISPLAY 'MEDICARE' IF HX26 IS CODED '1' (MEDICARE CARD).
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CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
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SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
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IF HX26 IS CODED '3' (SOME OTHER CARD), CONTINUE WITH HX28
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OTHERWISE, GO TO BOX_28A
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HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON)'s Medicare coverage start?
[Enter Month,Year-2] .................. [HX30]
REF ................................... -7
DK .................................... -8
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DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
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IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, 1996, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
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SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
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HX29OV
======
Did (PERSON) have Medicare coverage on January 1, 1996?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
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IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, 1996'.
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