SURVEY OF MEDICARE

BENEFICIARY SATISFACTION

1989

Richard P. Kusserow 
INSPECTOR GENERAL 
OCTOBER 1989
OAI-04-89-89040  EXECUTIVE SUMMARY 
PURPOSE 
beneficiares was conducted to assess beneficiar experience and 
This surey of Medicare 
satisfaction with the Medcar program. 
BACKGROUND 
In the past several year, the Medcar program has undergone legislative changes designed to 
maintan adequate coverage, yet curb unnecessar spending. Methods of payment to hospitas 
Congrss 
have changed, and reimbursements to physicians have been tightened. In 1988, 
passed the Catastrophic Health Car Coverage Act, the most far-reaching change to Medicare 
new benefits such as 
since its inception. The Act enhances existig coverage and adds 
hospice car and prescription drgs. 
Other reent changes to the Medcar program include special programs and procedurs the 
Deparent of Health and Human Services (HS) has instituted to improve beneficiar 
service. Among these are toll-fre telephone numbers and information about individual 
hospitas' patient care outcomes. 
Medcar program in

To assess experience and satisfaction with these changes and with the 
surey of Medcar beneficiares. A

general, the Inspector General of HHS has conducted a 
. questionnaie was mailed to 640 randomly selected beneficiares for whom Medicare Par B

lly 
claims were submitted in Calendar Year 1987. Paricipation in the surey was to 
response rate of 64.6 percent was achieved. 
voluntar. An overal 
FINDINGS 
This surey found that: 
Overall, beneficiares appear very satisfied with Medicare. 
Eighty-five percent can get information about their benefits when they need it. 
Ninety percent find the information they receive about Medcar to be helpful. 
Seventy-four percent think claims are paid quickly enough. 
Eighty-eight percent of the beneficiares who submit their own claims are satis
fied with the way Medicar processes them.  Sixty-five percent of the beneficiares either are not aware of or do not 
Act. 
understad the Catastrophic Health Car Coverage 
Seventy-two percent of the beneficiares indicate they do not have a way to 
neeed. 
cover the cost of long-term care should it be 
home reports. 
Few beneficiares know about hospita mortlity data and nursing  ................................ 
..............  ..... .......  .... ........................ ................. ......................... .....' .
........ ................................ ..... ................ 
TABLE OF CONTENTS 
EXECUTIVE SUMMARY 
.......................................................................................... 1

I NTR 0 D U CTIO N ............. 

Ba ckg ro u n d..................................................................... .......................... 1

................................................................. 2

Pu rpose ..... ................ ................ 

............................................................... 2

Meth ods ..................................... ..

................................................................................................... 3

FI N DIN G S . 

. 3

Beneficiaries Can Get Information When Needed

Beneficiaries Are Satisfied 
.................................................. 5

With the Processing of Claims 
Most Beneficiaries Do Not Understand  ................................. 6

Coverage Act 
the Catastrophic Health Care 

Beneficiaries Need Financial Assistance 
................................................................................. 9

For Long-Term Care 
......................... 9

Few Beneficiaries Know About Special Services 
...................................... 9

Second Opinion on the Need for Surgery 
Participating Physicians. ................ ........................... ......... ................ .... 9

Mortality Figures and Nursing Home Reports 

CO N CLU S ION 
APPENDICES 
.......................... A - 1

Appendix A: Methods and Sample Selection 

Respondents......

Appendix B: Analysis of Respondents vs. Non-
C -1

Responses to Medicare Beneficiary Survey ...........
Appendix C:  INTRODUCTION 
BACKGROUND 
Medicare Program 
age 65 and older and for cer-
Medcare is a Federal health insurace program for individuals  Medcare 
1966 by title XVIll of the Social Security Act,
tan disabled people. Authorize in 
Medcare paid benefits in excess of
beneficiaries. 
serves over 33 millon people, known as 

$79 bilion in Fiscal Year 1987. 
Par A (hospita insurance) helps pay for inpatient hospi-
The Medcare Program has two pars. 
car, and hospice

car in a skiled nursing facilty, skilled home health 
tal care, some inpatient  Par B (medical in-

receives this coverage. 
care. A person entitled to Medcare automatically  medcal services 
' services, outpatient hospita services, and other
surance) covers physicians
desirg this coverage pay a monthly premium.
and supplies. Par B is optional. Beneficiares
coinsurce requirements. Beneficiares must pay 
deductible and 
Both Par A and Par B have  insurce plan.

these either out-of-pocket or though coverage by another 

The Health Car Financing Admnistration (HCFA) within tpher oDgepra.r ment of Health and 
However, other organi
(HS) has responsibilty for the Medicare 
Human Services  es
s adinnistration. The Social Securty Administration (SSA)
zations share in the program  Par B 
collects the premiums for 
tablishes eligibilty, enrolls beneficiares in the program, and  ser
insurance companies contract with the Federal Government to "
coverage. Prvate health  Par A claims 
vice" claims for Medicar payments. Insurance companies that handle
carriers. 
Those handlng Par B clais are called 

called  intermediaries. 
Recent Changes 
has undergone legislative changes designed to 
Medicar program 
In the past several years, the  of payment to hospitas 
maintan adequate coverage, yet curb unnecessar spending. Methods 
have changed, and reimbursements to physicians have been tightened. 
In 1988, Congress passed the Catastrophic Health Care Coverage Act, the most far-reanchewin g
liabilty.
change to Medicare since its inception. The Act enhances existinAgc ct,o bveernaegfeic aianrde as dwdisl pay
drgs. Under the 
benefits such as hospice care and prescription 
premiums based on their income tax
higher Par B premiums and some wil pay supplemental  progrs and procedurs 
the Medcar program include speial 
Other reent changes to  Among these ar toll-
HCFA has instituted to improve service to Medcare beneficiares. 
' patient care out
numbers and information about individual hospitals
telephone informtion 
comes. 
PURPOSE 
sat
conducted to assess beneficiar experience and 
Ths surey of Medcare beneficiares was 
Medcar program. 
isfaction with the 
METHODS 
radomly selected 
54 questions was maled in June 1989 to 640 
A questionnaie composed of 
were submitte in Calendar Year 1987. Their 
beneficiares for whom Medcare Par B claims 
provides more informtion on 
parcipation in the study was totaly volunta. (Appendix A 
methodology. 
retued 
questionnais were 
A tota of 401 completed questionnaies were reeived. Six 
erroneously selecte for the surey. This reuced the 
undeliverable and 13 individuals were 
sample from 640 to 621. 
rate was 64.6 percent. 
The overal response  FINDINGS 
This surey of Medicare beneficiares found that: 
Medcar. 
Overall, beneficiares appear very satisfied with 
nee it
Eighty-five percent can get information about their benefits when they 
Medcare to be helpful. 
Ninety percent find the information they recive about 
Seventy-four percent think claims ,are paid quickly enough. 
clais ar satis-
Eighty-eight percent of the beneficiares who submit their own
fied with the way Medicare processes them. 
Sixty-five percent of the beneficiares either are not aware of or do not 
Ca 
Coverage Act. 
understad the Catastrphic Health 
Seventy-two percent of the beneficiares indicate they do not have a way to 
neeed. 
cover the cost of long-term care should it be 
services Medicare offers, such as hospital 
Few beneficiares know about special 
home reports. 
mortlity data and nursing 
goo
Approximately 62 percent of the beneficiares responding consider themselves to be in
coverage in addition to Medcare.
health. Eighty-two percent have medical 

WHEN NEEDED. 
BENEFICIARIES CAN GET INFORMATION 
progrm information to beneficiares 
Medicare administrators have a responsibilty to provide 
provides introduc
Admistration (SSA) 
and to answer their questions. The Social Securty 
other 
tory information, and each beneficiar receives a Medcare Handbook. Pamphlets and 
beneficiar periodcally as the program changes. In addition, 
information are mailed to each 
each Medicare carer has a toll-free telephone number (listed in the Medicar Handbook) 
questions about individual claims. 
which beneficiares can call with 
s level of satisfaction is often related to his or her experience with getting and 
A beneficiar 
five percent of the respondents say they 
understanding information about the program. Eighty-
can get information when they need it, and 73 percent of the respondents consider the program 
to be "understandable." More than one-third (36 percent) indicate they have never needed to  neeed help, only 
get speifc information about their coverage; however, of those who have 
13 percent were seldom or never able to get it. 
Alost all (90 percent) of the respondents who say they have reeived information about 
the wording easy to understand, the amount of infor
Medcare found it helpful. Most found 
Figu 
1 shows the specifc ratings. 
mation suffcient, and the lettering large enough to read 
FIGURE 1 
BENEFICIARIES FOUND MEDICARE INFORMATION HELPFUL 
PERCENT 
100 
89"1 
90"1 
FOUND  FOUND  FOUND  FOUND

INFORMATION  WORDING  AMOUNT OF  LETTERING

HELPFUL  EASY TO  INFORMATION  LARGE 
UNDERSTAND  SUFFICIENT  ENOUGH 
though the mail, yet separate from 
Most beneficiares prefer to receive program information 
they have their Social SecUrty 
their Social Security checks. (Severa beneficiares note that 
ditly 
checks  deposited to the ban. 
Medicar covers, the majority of the beneficiares 
When information is needed about what 
When asked about other sources for information 
fIrst call or visit the Social Security offce. 
contact their
most beneficiares say they would be likely to refer to the Medicare Handbook or 
carers.  Only a few of the respondents (9 percent) listed specific complaints about the informational 
material they receive. Some tyical comments were: 
They are written too techncaL.have to read it several times. 
Some are ambiguous. 
Not enough pertinent informtion." 
AR 
BENEFICIARIES  SATISFIED WITH THE PROCESSING OF CLAIMS. 
progr 
An importt aspect of the Medcare  is assurng that beneficiares receive appropriate

benefits. Clai for Medcar payment ar fied by either the medcal provider or the benefi

ciar. 
and skilled home health servces, ar fied by the medi

Par A claims, which include hospital 
have litte or no involve-

Medcare. Beneficiares 
cal provider, who is then paid diectly by 
payment Medcare has
ment in the claims process. They do, however, receive notice of the 
made to the provider. 
Sixty-seven percent of the respondents who indicated they have been in the hospital since 
for. Thee-quarers of 
their Medcar coverage began say they understad what Medicare paid 
Medicar pay-
home health services say they understand 
the beneficiares who had received 

ments for those servces. 
services, may be fied by either the beneficiar or the 
Par B claims, which include physician 
Par A claims, the 
provider. The Medicar payment may be made to either of them. As with 
of the payments made.
beneficiar receives an explanation 

clais, their involve
in the survey have had Par B 
Although all beneficiares parcipating 
fie the claims. Fifty-
ment with the claims process is based on whether they or the providers 
nine percent of the respondents to this surey say they fie claims themselves; physicians 
ques
routinely fie claims for the other 41 percent. Because of this difference, some survey 
own claims. 
fie their 
tions were asked of everyone, and some were directed to just those who 
think the payment policies; in general, are clear.
Sixty-nine percent of flthe respondents 
enough.

Almost three-fourths of the benefICiaries believe claims are paid quickly 

car-
free number to call their 
the beneficiares know of the toll-
all 
Slightly more than half of 
 Most (80 percent) of those 
, only half of those have used it 
ers to check on claims. However
founhs of the beneficiar
who have called the number are satisfied with the service. Over thee
ies ar aware they can appeal decisions made on their Medicare claims.  . "
Those beneficiares who fie their own claims (59 percent of all the respondents) were asked 
questions about their personal experiences with, the claims process. 
the way Medicare
benefICiaries are satisfied, in general, with 
Over  85  percent of these  228 
When asked to cite problems, 82 people responded. The problems 
processes their clams. 

they cited vared Some examples are: 
It takes too long. 
s hard to keep up with what s been paid and what han 
Sometimes they pay; next time they don 
inform
and they respond wanting the same 
We send the requested informtion, 
tion again. 
claims were then given a list of possible problems and 
The beneficiares who submit their own 
asked if they had ever experienced any of them. Their responses follow: 
indicated having had a problem understandig what Medicare 
Fift-one percent 
paid on individual cilaimns.  surnce.
to determne how much should be paid by
Thiry-eight percent had not been able 
their supplemental 
Seventy-eight percent have had trouble getting information on the status of their 
claims. 
(Wen they 
Twenty-six percent have had a problem mling out the claim form. 
do need assistance in this area, beneficiares most often go to their physicians 
offces for help. 
MOST BENEFICIARIES DO NOT UNDERSTAND THE CATASTROPHIC HEALTH

CARE COVERAGE ACr.

Medicar 
The Catastrophic Health Car Coverage Act of 1988 made substantial changes to the 
advocates, and HHS. The 
program and received much attention from the media, senior citizen 
HCFA conducted two mass mail-outs to beneficiares to inform them of the changes made by 
the Act. The fIrst, in September 1988, was a 12 page pamphlet describing the changes. Then 
each beneficiar a new Medcar Handbook which provided 
in December 1988, HCFA mailed 
the Handbook. 
a summar of the changes and incorporate them throughout  surey, 
months prior to this June. 1989 
Despite the information beneficiares had been sent six 
awar of the Act or said they did not understand 
65 percent of the beneficiares either were not 
four  Half of those 
Over one- (29 percent) of the respondents had not heard about the Act. 
11 percent of those who 
who had heard of it said they did not understand it very well. Only 
understoo the changes very well. 
were aware of the legislation thought they 
their general understanding of the Act, beneficiares were asked about their 
After askig about 
the increase in hospita coverage 
knowledge of five major changes. Only hal knew about 
Januar 1989. Just under hal knew of the supplementa premiums 
which became effective in 
Only one-third knew of the other changes to be 
which had also become effective in Januar. 
phased-in. Figu 2 shows the beneficiares' awareness of five changes brought about by the

Ca 
Coverage Act

Catatrophic Health 

FIGURE 2 
FEW BENEFICIARIES WERE AWARE

OF CATASTROPHIC HEALTH CARE CHANGES

CHANGE IN  51%

HOSPITAL

. DEDUCTIBLE

47%
SUPPLEMENTAL

PREMIUM

35% 
INCREASE IN 
HOME HEALTH

LIMIT ON PART B 
OUT-OF

POCKET

EXPENSES 
PRESCRIPTIONS  36% 
DRUG

COVERAGE

100 
PERCENT AWARE OF CHANGES
 The majority of those beneficiares who knew about the changes leared of them from the 
reeived in the mai. Only 17 percent of the respondents knew of 
meda or the HCFA material 
the toll-fr number that can be used to get more information about the Catastrophic Act. 
Medicar program, the responses were mixed. 
When asked if the changes improve the 
understoo the changes:
those who said they were aware of the Catastrophic Act and 
the progrm.
IMPROVED 
Forty percent thought the changes 

Typical comments of those beneficiares were: 
It helps people with little or no savings.

Definitely offers some peace of mind to all Medicare beneficiaries.

the program.
DID NOT IMPROVE 

Twenty-eight percent thought the changes 

Examples of their comments were: 
It penalizes seniors woo have saved to pay their own way in their retirement. 
The more saved and the more income, the greater the payment (liabilty). 
It penalizes those woo have been careful in financial matters, and gives to tOOse 
woo weren 
Thiry- if the Catastrophic changes improved
two percent  DID NOT KNOW 

Medicar. 
Examples of their comments were: 
OOwever, I wil be pay
l do not say that Catastrophic Health Care is not good; 
my Social Security becomes less of an in
ing towards it every month. Therefore, 
come for me to live on each month. 
and older can afford to pay the sup
65 
I question whether or not most people 

plemental premium which wil escalate each year.  FOR LONG-TERM CAR. 
BENEFICIARIES NEED FINANCIAL ASSISTANCE 
It appear that most beneficiares have not made adequate plans should they reuire lengthy 
nursing home care. Seventy-two percent of the respondents indicate they do not have a way 
tenn car if it is neeed. 
to cover the cost of custodallong-
percent of the respondents): 
Of those who say they could pay for nursing home car (28 
One-third (36 percent) say they would rely on private insurance, although six 
percent of these respondents indicate they do not cun-ently have private 
insurance. 
Medcaid, although 29 percent of them 
Eighteen percent say they would rely on 
indicate they do not curently have Medcaid coverage. 
The remaining 46 percent say they would rely on personal assets such as 
savings, income, and home equity. 
After we asked respondents to indicate whether they could pay, we asked all respondents if

(before today) they thought that Medicare would pay for long term nursing home care for

more than five months. One quarer of all respondents thought that Medicare wil pay for

it does not.

long term custodal car, although 
FEW BENEFICIARIES KNOW ABOUT SPECIAL SERVICES AVAILABLE. 
Second Opinion on the Needfor Surgery 
Medicar wil pay for a second opin
Over half (57 percent) of the beneficiares do not know 
aware, 60 percent are not famiiar with 
are 
ion prior to surgery. Furthermore, of those who 
 s name. Of 
where they can get a second doctor 
Medicare s Second Opinion Referrl Center 
the 230 respondents who have had surgery since being covered by Medicare, only 69 say they 
the name of the second doctor from their per
got a second opinion. Most (81 percent) got 
Referr Center. 
sonal physicians. Only one respondent has used the 
Partcipating Physicians

Over three-fourths of the respondents ar aware of Medicar s "paricipating physicians" who 
s approved amount. However, fewer than half the ben
agree to charge no more than Medicare 
eficiares know they can contact their carers to get the names of parcipating physicians  Neverteless, 68 per
their aras. Only 14 percent of them have ever sought this information.  futu. 
information in the 
cent of al the respondents indicate they would be liely to seek this 
Accordig to other responses: 
currntly go to parcipating 
Sixty-five (65) percent of the beneficiares 
physicians. 
parcipating physicians. 
Twelve (12) percent do not go to 
Twenty-thee (23) percent do not know if any of their physicians are 
paricipating physicians.

Mortality Figures and Nursing Home Reports 
car Med
The Deparent of Health and Human Services is concerned about the quality of 
Medcar publishes information to help them choose medcal care 
care beneficiares receive. 
facilties. This surey found that only a few respondents know about two such reports: 
by individual hospitas and 
(1) mortalty rates of Medcare beneficiares discharged 
(2) results of nuring home inspections. 
responded to questions about this information. 
The following char shows how beneficiares 
FEW ARE AWARE OF MEDICARE REPORTS 
Mortality  Nursing Home 
Rates  Inspections 
Respondents 
Awar Of 
10%  21% 
Information 
Those Aware Who 
Have Used 
Information 
Respondents 
Likely To Use 
54%  86% 
Information 
In Futur  . .
CONCLUSION

progr. They fmd the informa
satisfied with the Medcare 
Overal, beneficiares appear very  progr  to get infor
understandable, and they ar able 
tional materials mailed out helpful, the 
with claims processing and they feel that 
mation when they need it. They are also satisfied 
clai 
are paid quickly enough. 
However, most beneficiares: 
do not understand the Catastrphic Health Car Coverage Act; 
have not adequately planned for the cost of long-term care; 
do not seek second opinions prior to surgery; and 
do not know about hospital mortality data or nursing home reports.  APPENDIX A 
METHODS AND SAMPLE SELECTION 
The purpose of this surey was to assess beneficiar experience and satisfaction with the 
Medicare progr. Therefore, the sample universe neeed to be beneficiares who had used 
progr 
servces and benefits. 
millon individuals who 
The potential respondent universe was made up of approximately 30 
had received Par B Medcar benefits in Calenda Year 1987. A non-strtified simple radom 
surey of Medcare beneficiares had not 
sample of that universe was selected. Since a 
previously ben conducted, a response rate could not be prected. However, a 60 percent 
response rate was desired 
was 
Based upon previous experience with Social Securty client sureys, the sample size 
calculated to produce an estiate within 10 percent of the tre value at the 95 percent 
confidence level. To arve at the sample size, stadard equations were employed for 
varable. 
estimating sample size with a binar response 
A sample of 640 Health Insurance Claim (HC) numbers was drawn from HCFA's Par B

Those numbers were cross-matched with

Medicare Annual Data System (BMAD) fies. 
Social Securty s Master Beneficiar Record (MBR) fles to obtain the name and address

mc.

associated with each 
The 640 questionnaires were mailed on June 8 and resulted in 261 responses, of which 219 
. were completed and 42 were blan. (To avoid being included in follow-up contacts, the 
beneficiares were asked to return their questionnaires blank if they chose not to parcipate. 
A second mailing to the 379 non-respondents was done on June 22. The following week 
obtaied. 
telephone calls were made to the 240 non-respondents for whom numbers could be 
These follow-up efforts resulted in the receipt of 196 questionnaies, of which 182 were 
completed and 14 were blan.

A total of 401 completed questionnaires were received. Six (6) questionnaies were returned 
as undeliverable and 13 individuals were elToneously selected for the surey. This reduced 
the sample from 640 to 621. 
The overall response rate was 64.6 percent.  . .
APPENDIX B 
RESPONDENTS 
ANALYSIS OF RESPONDENTS VS. NON-
A consideration in sureys of ths tye is the bias which may be introduced into the results if 
determne if significant
the non-respondents are different from the respondents. To 
characteristics of the 401 respondents and the 220 
differences exist in this surey, specific  among data extracte 
charcteristics examned were 
compar. The 
non-respondents were 
from the Social Securty Master Beneficiar Record. 
METHOD OF ANALYSIS 
were analyzed to measur the extent to which respondent 
Responses to thee questions 
Medcar program. The questions asked about
characteristics correlate with opinions of the  clais processing. These

services, and 
the Medcare program in genera, asbuoruety iendfo. rEmaactiho noaf lt h
 e thr questions was analyze by age,

questions were asked of everyone 
gender, and time of response.

The specific questions selected to perform this analysis were: 
Is Medicar understandable? 
1.b.  Can you get information when you need it? 
1.d.  Are claims paid quickly enough? 
ANALYSIS BY AGE 
compard to age 72 for non-respondents. The

The average age for respondents was 78, 
age 49 or younger is comparable-approximately 2

distrbution of beneficiares who are 
percent for respondents and 3 percent for non-respondents.

younger were compared to those of beneficiares age 74 
Responses of beneficiares age 73 and 
responses to 
revealed no statisticaly signifcant difference in 
and older. The analysis by age 
any of the three questions.  ANALYSIS BY GENDER

were males and 54 
The analysis by sex showed that 46 percent of the sample populatio 
thirds of the men respondetdh, b ut only 59 percent of the women. In 
percent females. Two-
questions, there was no statistically 
female responses to the 
comparson of male and 
significant difference between the sexes. Therefore, the fact that the response rate for femaes 
was slightly lower than for males is not significant. A higher femae response rate would have 
resulte in virually the sam results. 
ANALYSIS BY TIME OF RESPONSE 
Surveys similar to this one indicate differences may exist bceetwrtene nt eenadrleyn caineds ,l aatne  "reeasrployn-lsaetse. 
Because late respondents and non-respondents may share  bias. 
levels may be a useful way to estiate possible non-response 

comparson of satisfaction 
satisfaction surve/ suggested

For example, an "early-late" comparson for a Social Securty 
that "the non-respondents, although not more negative, may be less enthusiastic than the

respondents.

There was no statistically 
In this surey, the IlTst 303 responses were compared to the last 98. 
significant difference in their responses to the three questions mentioned above. This suggests 
that there ar no signifcant diferences between respondents and non-respondents. 
FOLLOW-UP BY TELEPHONE 
Additional insight regarding non-respondents was gained in the course of follow-up contacts 
by telephone. Thiry-five beneficiares contacted by phone promised to complete the 
questionnais. Thir-seven who were called 
sent in their 
questionnaie; fewer than half ever 
survey. Their reasons included injury 
said they were unwiling or unable to paricipate in the 
Six 
or ilness, inadequate experience with and knowledge of Medicare, and lack of time. 
beneficiares did not speak English.

No telephone number was available for 91 of the non-respondents. A relatively small number 
instances where phone numbers 
of beneficiares have "non-published" phone numbers. In 15 
were available, no successful contact was made in spite of repeated attempts. 
The majority of questionnaires which were returned blank included no comment, while some
parcipation were

included a brief note of explanation. Typically, the wrtten reasons for non-

similar to those cited above.

1 Offce of Insptor General, United States Deparent of Health and Human Services.  Social Security 
1989. OAI-12-89-0020. August 1989. 
Client Satisfaction: Fiscal Year 
 APPENDIX C 
Response  Percentage 
Question	
Part 1: MEDICARE COVERAGE 
, do you think: 
1. In general
progr 
is understandable 
a. The Medicare 
2379

YES	
106

YES 
NO ANSWER: 
NO 	
nee it
b. You can get information about Medcare when you
320
NO ANSWER: 
understandable

c. Medcare payment policies are,
257

YES 
118 
NO ANSWER: 
d. Medcare pays your claims quickly enough 
280 
YES	
100 
NO ANSWER: 
your spouse have other medical insurance that covers your medical 
2. Do you or 
expenses in addition to what Medicare covers? 
MEDICAID 
PRIVATE INSURANCE 
249 
TO SUPPLEMENT MEDICARE 
0.3
CHAMPUS 
OTHR 
NO ANSWER:
 Response  Percentage 
Question 
feel at this time you are in good health? 
3. Do you 
149 
243 
YES 
NO ANSWER: 
been a patient in a hospital for at least one night since you have been 
4. Have you ever 
covered by Medicare? 
130 
NO (Skip to Q-
267 
YES 
NO ANSWER: 
were a patient at least one night in a 
Thinking about the most recent time you 
S. 
hospital, was it clear to you what Medicare paid for? 
177 
YES 
NO ANSWER: 
received medical services in your home from a health agency since you 
6. Have you ever 
1edicare? 
have been covered by.1 
347 
NO (Skip To Q-
YES 
NO ANSWER:

most recent time you received medical services in your home

7. Thinking about the 
from a home health agency, was it clear to you what Medicare paid for?

YES  Response  Percentage 
Question 
currently living in a nursing home? 
8. Are you 
374 
YES (Skip TO Q-12) 
NO ANSWER:

cost?
9. If you should ever need nursing home care, do you have a way to cover the 
236 
YES 
NO ANSWER:

Which of these
10. Listed below are some ways people might pay for nursing home care. 
would you rely on if you ever needed home care for more than 5 months? 
a. Personal savings 
126 
YES 
163 
NO ANSWER:  112 
b. Retiement income 
110 
YES 
175 
NO ANSWER:  116 
NO 

c. Prvate insurace that covers nursing home care 
YES
214
133 
NO ANSWER: 

d. Medcaid 
100 
YES 
183 
NO ANSWER:  118 
e. Equity in your home 
YES 
188 
NO ANSWER:  135 
f. Other  Response  Percentage 
Question 
term nursing home care. It currently 
11. Many people think Medicare will pay for long-
PAY for long-term 
doe not. Before today, did you think that Medicare WOULD 
nursing home care for more than 5 months? 
250 
YES 
NO ANSWER: 
from
Part 2: GETTING INFORMATION ABOUT MEDICARE 
the Federal
12. Do you recll getting any pamphlets or handbooks in the mail 
Government or notices enclosed with your Social Security check that describe the 
Medicare program? 
NO (Skip To Q-16)

289

YES 
NO ANSWER: 
, were most
13. Thinking about those pamphlets, handbooks, and notices with your check
of them: 
HELPFU  241 
GENERALLY 
HELPFU 
GENERALLY NOT 
NO ANSWER: 
14. Please write in the reason, if any, those pamphlets, handbooks, and notices were not 
helpful: 
NUBER OF PEOPLE RESPONDING  Response	 Percentage 
Question 
received, would you
15. Thinking about the pamphlets, handbooks, and notices you have 
say that:

a. The wording is easy to understad 
195 
YES	
YES
NO ANSWER:

NO
b. The amount of information covere is suffcient 
191 
NO ANSWER: 
c. The lettering is large enough to read 
238 
YES 
NO ANSWER: 
16. Listed below are ways the Government could use to tell people about changes in the 
method(s) do you prefer? 
Medicare program. Which 
PAMPHLETS OR HANDBOOKS 
THOUGH TH MAn.  222 
NOTICES WI 
SECURI CHECK 
SOCIA 
TH NEWSPAPER 
ANNOUNCEMENTS IN 
ANNOUNCEMENTS ON 
RAIO 
TELEVISION AND 
SPEECHES OR PRESENTATIONS 
BY MEDICARE REPRESENTVES 
OTHR  Response  Percentage 
Question 
specifc 
17. Next, we would like to ask about times when you have needed to get  How often were you able to get the
information about your own Medicare coverage. 

information you needed? 
TH  142 
MOST OF 
TH 
SOME OF 
SELDOM OR NEVER 
I HAVE NEVER NEEDED 
TO GET INORMTION  138 
NO ANSWER: 
you did need to get information about what Medicare can help pay, where would 
18. H 

you go first to get it? 
358 
NUMBER OF PEOPLE RESPONDING  Response  Percentage 
Question 
19. The following are some places people might go to get answers if they have questions 
YES 
about their Medicare coverage. Would you be likely to go to any of the following: 
NO 
clai
a. The insurance company that processes your Medicare
182
172 
NO ANSWER: 

b. The Medcare Handbook 
223 
YES 
133 
NO ANSWER: 
c. The Social Securty offce

282

YES 
NO ANSWER:

d. A friend or relative

YES

271 
NO ANSWER: 
e. An insurance salesperson

YES

312 
NO ANSWER: 
f. A senior citizens' group 
YES 
254 
NO ANSWER:  Response  Percentage 
Question 
Part 3: MEDICARE CLAIMS 
20. Do all of your doctors submit your Medicare claims for you so that you do 
not have to submit the claims yourself? 
TI 
ALL OF TH  (Skip to Q-26)  159

MOST OF TH  116

SOMETIS

SELDOM OR NEVER

NO ANSWER: 
21. Overall, how satisfied are you with the way Medicare has processed the claims you

have submitted?

VERY SATISFIED

GENERAY SATISFI  141

GENERALLY DISSATISFI

VERY DISSATISFID

22. What problems, if any, have you had with the way Medicare processes your claims? 
NUBER OF PEOPLE RESPONDING  115 
23. Do you get help fillng out your Medicare claim forms? 
TH TIM

ALL OF 
TH 

SOME OF 
NEVER

NO ANSWER:

. C
 Response  Percentage 
Question 
fillng out Medicare claim 
24. Listed below are some places people might go to get help 
likely to 
form. If you needed help in fillng out your Medicare form, would you be 
get help from any of the following? 
3. A frend or relative 
YES 
137 
NO ANSWER: 
b. Your doctor s office 
150 
YES 
NO ANSWER: 
c. A Social Securty offce 
YES  107 
101 
NO ANSWER: 
d. A senior citizens' center 
YES 
144 
YES 
NO ANSWER: 
e. The insurance company that processesyour Medicare claims
101 
NO ANSWER: 

f. Other 
NUBER OF PEOPLE RESPONDING  Response  Percentage 
Question 
25. The following are possible reasons why someone might be dissatisfied with Medicare 
been a problem for you? 
claims. Have any of the following 
clais 
a. Filng out Medcar 
YES 
160 
YES 
NO ANSWER:

clai
b. Gettng information on the status of your 
142 
77

YES 
NO ANSWER:

NO 
124 

c. Determning how much should be paid by other insurce you have
YES 
NO ANSWER: 

NO 
d. Understading what Medicare paid on your claims and why
107
104
NO ANSWER: 

in your Medicare Handbook that you can use to telephone 
26. There is a  toll-free number 

the insurance company to get information about your Medicare claims. Did you 
know about this toll- before today? 
free number 
181 
207 
YES 
NO ANSWER: 
free number to get information about Medicare claims? 
27. Have you ever used this toll-
NO (Skip To Q-30)  276

YES  105

NO ANSWER:
 Response  Percentage 
Question 
time you used this toll-free number, how satisfied were you
28. Thinking about the 
 last
with the service you received? 
VERY SATISFID

GENERALY SATISFIED 
GENERALLY DISSATISFI

VERY DISSATISFID

NO ANSWER: 
29. Listed below are possible reasons that someone would be dissatisfied with this 
you called 
la time 
toll-free service. Did you have any of the following problems the 
the toll-free number? 
a. Line was busy

YES

NO ANSWER: 
b. Put on "Hold" too long

YES

NO ANSWER: 
YES 
c. Answers given were not understandable
NO ANSWER: 
corrct

d. Answers given were not 
YES

NO ANSWER: 
e. Person answering call was not very courteous 
YES 
NO ANSWER:

f. Other

NUMBER OF PEOPLE RESPONDING
 Response  Percentage 
Question 
When
30. Sometimes people disagree with the decisions made on their Medicare claims. 
decisions. Did you know 
this happens, you may appeal or request a review of those 
that you could appel or request a review?
before today 

299 
YES 
NO ANSWER: 
Part 4: SPECIAL MEDICARE SERVICES. 
31. If your doctor recommends that you have surgery, Medicare wil help you pay to get 
Were you
the opinion of another doctor to make sure the surgery is really necesary. 
that Medicare would help to pay for you to get a second opinion
aware  before today 
before having surgery? 
225 
171 
YES 
NO ANSWER: 
that you could get the name of a second doctor from
32. Were you aware  before today 

Medicare s Second Opinion Referral Center? 
324 
YES 
NO ANSWER: 
33. Have you ever had surgery since you have been covered by Medicare? 
160 
NO (Skip To Q-37) 
230 
YES 
NO ANSWER: 
s opinion 
34. Thinking about the last time you had surgery, did you get a second doctor 
before having surgery? 
156 
NO (Skip To Q-37) 
YES 
NO ANSWER:  Response  Percentage 
Question 
s opinion? 
35. Did you or the doctor fie a Medicare claim for the second doctor 
YES 
NO ANSWER: 
36. Where did you get the name of the second doctor you got an opinion from? 
FROM YOUR DOCTOR

RELATI

FROM A FRIEND OR 
FROM MEDICARE' S SECOND

RERR 
CENTR 
OPINION 
OTHR 
NO ANSWER: 
37. Medicare bas "participating doctors" who have agreed to charge no more than 
80% of the approved amount and you 
Medicare s approved amount. Medicare pays 
are only responsible for paying the deductible and the 20% coinsurance.

"Participating bil Medicare for you.

" doctors  always 
s "participating" doctors

. Before today, had you ever heard about Medicare 
program?

298 
YES 
NO ANSWER: 
participating" doctor? 
38. Are any of your doctors a "
249

YES 
DON' T KNOW

NO ANSWER:
 Response  Percentage 
Question 
you could get information on whicb doctors are in
39. Were you aware  before today that 

Medicare s "participating" program? 
NO (Skip To Q-41)  211

YES  157

NO ANSWER: 
40. Have you ever used this information to select a doctor to visit? 
134

YES

NO ANSWER: 
use the information about 
41. Thinking about the future, bow likely are you to 
participating doctors to select a doctor to visit? Are you: 
LIKLY TO USE TH INFORMATION  251 
NOT LIKELY TO USE 
TH INFORMATION  120 
NO ANSWER: 
42. For people who are interested, the Medicare program bas information by individual 
hospital on hospital mortaliy (death) rates of Medicare patients. Were you aware 
Medicare Hospital Mortality 
that the Federal Government publishes "
before today 

Information?" 
NO (Skip To Q-44)  337 
YES 
NO ANSWER:  Response  Percentage 
Question 
" to choose a
43. Have you ever used the "Medicare Hospital Mortality Information
hospital? 
YES 
NO ANSWER: 
likely are you to use the mortality 
44. If in the future you need to be hospitalized, how 
hospital? (Assume you have a choice of going to 
(death rate) information to select a 
one of two hospitals and both are equally convenient and seemingly of equal quality. 
LIKLY TO USE TH INORMATION  196 
NOT LIKELY TO USE

TH INORMATION  167

NO ANSWER: 
45. Who selected your hospital the last time you were hospitalized? 
126

YOU 
212

YOUR DOCTOR 
FRrNDS

YOUR RELATIVES OR 
OTHR

TH 
HOSPITAL

HAVE NEVER BEEN IN 
inspections done
46. The Medicare program also publishes information on the results of 
were you aware that the Federal Government had
of nursing homes.  Before today, 

this type of information on nursing homes? 
NO (Skip To Q-48)  290

YES

NO ANSWER:  Response  Percentage 
Question 
home information to choose a nursing home? 
47. Have you ever used this nursing 
YES 
NO ANSWER: 
48. Now that you know about the nursing home information, are you likely to use the 
information if you should need to select a nursing home? 
LIKLY TO USE TH INFORMATION  316

NOT LIKLY TO

USE TH INORMTION

NO ANSWER: 

Part 5: CATASTROPHIC HEALTH CARE 
49. In 1988, Congres passed the Medicare Catastrophic Coverage Act to help cover 
that changes are being 
catastrophic health care costs. Were 
you aware  before today

made to the Medicare program to cover catastrophic health care costs? 
NO (Skip To Q-51)  111 
276 
YES 
NO ANSWER: 
SO. How well do you understand what the changes are? 
UNDERSTAND TH CHANGES

VERY WELL

UNERSTAND GENERALY

WHT TH CHANGES ARE

DON' T UNDERSTAND

TH CHANGES VERY WELL  140

NO ANSWER:  Response  Percentage 
Question 
51. Listed below are some of the changes the Medicare Catastrophic Coverage Act made 
were you aware of these changes.
Before today,

to the MediYcare program. 
 ES 
NO 
a. You will now pay a deductible for hospital charges only once a year and after that, 
covere services 
Medcare pays the cost of all other 
194
185
. NO ANSWER: 

Medicar wil increase the number of days you can receive
b. 
Stang in  1990, 
medical care in your own home

131

YES 
247 
NO ANSWER: 
YES 
each year after you have paid a specified amount of your share of 
c. StNarng in  O1990,  Par B (e.g. doctor and outpatient services), Medcare
approved charges under 
will pay l00%of the remaiing approved charges for the year 
110 
266
NO ANSWER: 
Medicar wil cover a few 
after you pay a deductible, 
d. Starng in  1990,  Medcare wil cover 
prescription drgs. In 1991, after you pay a deductible, 
drgs 
most prescription 
137 
YES 
239 
NO ANSWER:

YES 
NO 
Staing in 1989, you may be required to pay a supplemental premium 
for Medicare based on the amount of your federal tax liabilty
174
200
NO ANSWER: 
 Response  Percentage 
Question 
these changes. Did you 
52. Listed below are ways peple might have found out about 
the following? 
find out about the changes from any of 
a. From the newspaper, TV, or radio 
196 
YES 
147 
YES 
NO ANSWER:

NO
received in the mail 
b. From the Medcare pamphlets 
199
150
NO ANSWER: 
c. From your doctor

YES

304 
NO ANSWER: 
d. From a social security offce

YES

288 
NO ANSWER: 
From a frend or relative 
YES 
287 
NO ANSWER:

f. From an insurance salesperson

YES

305 
NO ANSWER:

g From a senior citizens' group

YES

282 
NO ANSWER: 
h Other

NUMBER OF PEOPLE RESPONDING  Response  Percentage 
Question 
53. There is a toU-free number which you can call for information about the changes 
aware of this number before today? 
related to catastrophic health care. Were you 
319 
YES 
NO ANSWER: 
54. Overall, do you believe that the changes related to catastrophic health care are an 
improvement to the Medicare program? 
YES  130 
DON' T KNOW  176 
NO ANSWER: 
Is there anything else you want to tell us about Medicare? 
POSIT

NEGATI 
MIXD 
OTHR 
NO ANSWER:  261 
NOTES: 
Not every respondent answered every question. Percentages are based on actual 
responses. The number of respondents not answering an individual question is not 
included in the calculation of percentages.

The sum of individual percentages may not equal 100 percent due to independent 
rounding.  . . 
.. .
. . ; ", .., . .' . '' - ,
tiLt GO 

. I

.f 
'0 
.tit 
lt"d:m . 
OFFICE OF INSPECTOR GENERAL 
YSISAND INSPECTIONS 

OFFICE  OF ANAL 
OCTOBER 1989  ,. '

. .
- - 
- .
. -- '. - '.- - - . - - -- : :' . ' - -:--" ' , - ' , 

qIc  oflnsPectorGenera(OIG) is .topr()Ilote theeffciency,  ffeCtive
:he missIon ofth

ofprogrsiIth 
SS1- 4JI1  ty, U11t  States  ParentofH alth  d:JJ1J  Ser 
WHS), ItdQe  tPispy dev lopinglletQ()s tO  tet andpreventft ud, \Vaste, and 
*b1ise.  q:eateby~tan1t  iri 1976, theJns  torGeneral keeps.both the Sect3and the Con
gre sfuUYald pllentlyinormed aboutprpgrats'Or management prQblemsandrecommengs 
cOritiyea.rlon. The OIGperfoI1l1sitsinssiqn hy conductig  vestigations, and iJ
audits, 
~tions irtlapprOxiatelyl 200sta strategicaly located around the countr. 
pI"ucedbytl1eOfce of Analysis and  of the thee 
This teportis  In~tions(OJ\, one 
nUljor" offces With the OIG.  Theother two ' are the Offce of Audit and We Offce of Investi- 
gations. InsPetions are conducted ill accordce with professional stadadsdevelope(lby 
OAL Thesejnspections artYicalyshort tenn studies designed to determe program effec
t:veIl  efftiency, aqdvulnel"bilties to frud or abuse. 
Thepproseofths inspection, enti!led" A Surey. of Medcare Beneficiar Satisfaction: 
1989,  isklassess beneficia experience with the Medcar progr. 
TlsiIs  tionwasperformedu.nder the dition of Linda Herzg, the Regional Inspector 
Gellerij of the Region IV Offce QfAnalysis and Inspetions. Parcipatig in the projeCt were: 
Atlanta Region  Headquarters 
Bar 
JBettoy Daevis,  
ToPrwojecnt Lseaedler  Steeley
Wm. Mark Krshat, MPH 
Doug Marhal  Vicki Chiton 
Peggy Daniel  Linda Moscoe 
Ar Jones, Ph. 
Paulette Roberts 
Kimberly Graves 
Elizabeth Roper 
JudyMorgan .