Department  of  Health and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
BENEFICIARY  AWARENESS  OF  HCFA

PUBLICATIONS

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>  OEI-04-93-00141  OFFICE  OF  INSPECTOR  GENERAL 
The  mission of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the integrity  of the Department  of Health  and Human  Services (HHS) 
programs  as well as the health  and welfare  of beneficiaries  served  by those  programs.  This 
statutory  mission  is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Office of Audit  Services,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The  OIG  also informs 
the  Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF  AUDIT  SERVICES 
The  OIGS Office of Audit  Services  (OAS)  provides  all auditing  setices  for HHS,  either  by 
conducting  audits with its own audit  resources  or by overseeing  audit work done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
carrying out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the  Department. 
OFFICE  OF  INVESTIGATIONS 
The  OIGS  Office of Investigations  (01)  conducts  criminal, civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud 
control  units which investigate  and prosecute  fraud  and patient  abuse  in the  Medicaid  program. 
OFFICE  OF  EVALUATION  AND  INSPECTIONS 
The  OIGS Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and 
program  evaluations  (called  inspections)  that  focus on issues of concern  to the  Department, 
the  Congress,  and the  public.  The  findings and recommendations  contained  in these  inspection 
reports  generate  rapid,  accurate,  and up-to-date  information  on the  efficiency, vulnerability, 
and effectiveness  of departmental  programs. 
OEIS Atlanta  Regional  Office prepared  this report  under  the  direction  of Jesse  J. Flowers, 
Regional  Inspector  General,  and Christopher  Koehler,  Deputy  Regional  Inspector  General. 
Principal  OEI  staff included: 
Atlanta Region  Headquarter

Betty Apt, Team Leader  Tom  Noplock,  ProgramSpecialist

James  Green,  Contractor  Brian  Ritchie,  Technical Support

Peggy Daniel,  ProgramAnalyst  Jennifer  Antico,  ProgramSpecialist

Jackie  Andrews,  ProgramAnalyst  Barbara  Tedesco,  Statistician

Joe  Townsel,  ProgramAnalyst

Tammy Bonney,  ProgramAna@st

To obtain  a copy of this report,  call the Atlanta  Regional  Office at (404) 331-5022.  Department  of  Health and Human  Services 
OFFICE  OF

INSPECTOR  GENERAL 
BENEFICIARY  AWARENESS  OF  HCFA

PUBLICATIONS

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>  OEI-04-93-O0141  EXECUTIVE  SUMMARY

PURPOSE 
To  determine  Medicare  beneficiary  awareness  of booklets  the  Health  Care  Financing 
Administration  publishes  to assist beneficiaries  with health  care  decisions. 
BACKGROUND 
The  Health  Care  Financing  Administration  (HCFA)  publishes  various  booklets 
designed  to help  Medicare  beneficiaries  make  informed  health  care  decisions.  The 
booklets  are  available  from  several  sources,  such as Social  Security  offices  and  senior 
citizen  organizations.  However,  the  department  has little  information  on the  extent 
that  beneficiaries  know the  booklets  are  available. 
As part  of our  1994 survey  to determine  beneficiary  satisfaction  with Medicare,  we 
asked  beneficiaries  about  their  awareness  of the Medicare  Handbook  and  seven  other 
HCFA  publications.  These  eight  publications  included  the  handbook  and  two booklets 
on selecting  Medigap  insurance  and  nursing  homes  we reported  on in 1993. 
FINDINGS 
Most  beneficiaries  were aware of the Medicare  Handbook 
Three-fourths  of the  beneficiaries  surveyed  in 1993 and  1994 said they  knew  about  the 
Medicare  Handbook.  Most  of them  thought  it was helpful,  easy to read  and 
understand,  and  contained  adequate  information. 
Awareness  of the Medigap guide increased since 1993 
The  percent  of beneficiaries  who were  aware  of HCFAS Guide  to Health  Insurance for 
People  with Medicare  increased  from  13 percent  in 1993 to 24 percent  in 1994. 
Awareness  of the nunsing home  guide  was about  the same  in 1993 and 1994 
The  percent  of beneficiaries  who were  aware  of HCFAS Guide  to Choosing  a Numing 
Home  decreased  slightly from  nine  percent  in 1993 to eight  percent  in 1994. 
Few beneficiaries  were aware of other HCFA  publications 
The  percent  of beneficiaries  aware  of five other  HCFA  publications  ranged  from  4 to 
14 percent. 
Fourteen  percent  of the  Medicare  beneficiaries  who  responded  to our  survey 
	
were  aware  of HCFAS Medicare  and  Other Health  Benefits. 
i  Nine  percent  of the  Medicare  beneficiaries  who responded  to our  survey were 
 
aware  of HCJ?AS Medicare  Coverage for  Second  Su~ical  Opinions. 
Nine  percent  of the  Medicare  beneficiaries  who responded  to our  survey were 
 
aware  of HCFAS Medicare  Hospice  Benefits. 
Six percent  of the  Medicare  beneficiaries  who responded  to our  survey were 
 
aware  of HCFAS Medicare  and  Coordinated  Care Plans. 
Four  percent  of the  Medicare  beneficiaries  who responded  to our  survey were 
 
aware- of HCFAS Medicare  Savings for  Qualified  Benej7ciaries. 
We  realize  that  awareness  of these  publications  may depend  on a beneficiarys  needs. 
Further,  these  publications  are  referenced  in HCFAS Medicare  Handbook  which  most 
beneficiaries  are  aware  of. 
RECOMMENDATION 
We  recommend  that  HCFA  continue  their  current  efforts,  as well as experiment  with 
new methods,  to develop  a more  effective  strate~  to increase  beneficiary  awareness  of 
their  publications. 
AGENCY  COMMENTS 
The  HCFA  Administrator  commented  on our  draft  report,  and  concurred  with  our 
findings.  He  reported  that  HCFA  has several  initiatives  underway  designed  to educate 
Medicare  beneficiaries  and  providers  about  Medicares  home  health  coverage.  For 
example,  HCFA  is developing  a new pamphlet  to be  distributed  to organizations  and 
health  care  providers  who  serve  beneficiaries.  The  Administrator  reported  HCFA  is 
also working  to improve  the  readability  and  distribution  of existing  publications. 
.. 
11  TABLE  OF  CONTENTS

PAGE 
EXECUTIVE  SUMMARY 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

FINDINGS 
Most  Beneficiaries  Were  Awareof  the A4edicareHandbook  . . . . . . . . . . . . . . . 5

 
Awareness  of HCFAS Medigap  Guide  Increased  Since  1993 . . . . . . . . . . . . . . .  5

 
Awareness  of HCFAS Nursing  Home  Guide  Was  About  the  Same

	
in 1993 and  1994  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...6

Few  Beneficiaries  Were  Aware  of Other  HCFAPublications  . . . . . . . . . . . . . .  6

 
RECOMMENDATION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

AGENCY  COMMENTS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

APPENDICES

Responsesto  1993 Survey  of Medicare  Beneficiaries  . . . . . . . . . . . . . . . . . . .  A-1

Responsesto  1994 Sumeyof  Medicare  Beneficiaries  . . . . . . . . . . . . . . . . . . .  B-1

HCFA  Comments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..C-l
 INTRODUCTION

PURPOSE 
To  determine  Medicare  beneficiary  awareness  of booklets  the  Health  Care  Financing 
Administration  publishes  to assist beneficiaries  with health  care  decisions. 
BACKGROUND 
Medicare  Program 
Medicare  is a Federal  health  insurance  program  for individuals  age  65and  older  and 
forcertain  categories  ofdisabled  people.  Authorizedin  1965 bytitle  XVIII  of the 
Social  Security  Act,  Medicare  paid  benefitsin  1993 totalling  $143 billionth 
approximately  36 million  beneficiaries  .1 The  Health  Care  Financing  Administration 
(HCFA)  within  the  Department  of Health  and  Human  Services  has responsibility  for 
the  Medicare  program. 
HCFA  I%blications 
HCFA  publishes  a handbook  for beneficiaries  that  explains  how the  Medicare 
program  works  and  what  the  benefits  are.  HCFA  also publishes  various  booklets 
designed  to help  beneficiaries  make  informed  health  care  decisions.  The  booklets 
provide  (1) guidance  on Medicare  coverage  for specific  services,  such  as hospice  and 
second  surgical  opinions,  and  (2) advice  on criteria  beneficiaries  should  consider  in 
selecting  services,  such as nursing  home  care  and  supplemental  health  insurance. 
The  handbook  is mailed  to new beneficiaries  when  they  enroll,  and  to all beneficiaries 
when  major  changes  are  made  to the  Medicare  program.  The  booklets  are  available 
upon  request  from  several  sources,  such as Social  Security  offices,  insurance  offices 
that  process  Medicare  claims  (called  carriers),  and  senior  citizen  organizations. 
However,  the  department  has little  information  on the  extent  that  beneficiaries  know 
the  booklets  are  available. 
Prevwus  survey 
In  1993, the  Office  of Inspector  General  conducted  a survey of Medicare  beneficiaries 
to determine  their  awareness  of the  handbook  and  two booklets  published  by HCFA. 
The  two booklets  provided  guidance  to beneficiaries  and  their  families  to help  them 
select  nursing  homes  and  health  insurance  to supplement  Medicare  coverage 
(Medigap  insurance). 
lHealth  Care Financing Administration, United States Department of Health and Human Services. 
HCFA  Statistics,  July 1994 
1  We  found  that  three-fourths  of the  beneficiaries  were  aware  of the  handbookz,  but 
few beneficiaries  (less than  15 percent)  knew  about  the  two booklets3.  However, 
most  beneficiaries  who  had  used  the  handbook  and  booklets  found  them  useful. 
METHODS 
1994  Swvqv 
In July  1994, we mailed  a questionnaire  to  1279 randomly  selected  Medicare 
beneficiaries  for whom  Part  B claims  had  been  filed  in Calendar  Year  1993.  Based  on 
previous  experience  with  similar  beneficiary  sumeys,  the  sample  size was calculated  to 
produce  an estimate  within  3.5 percent  of the  true  value  at the  95 percent  confidence 
level.  We  used  standard  equations  for estimating  sample  size with a binary  response 
variable. 
k  part  of our  1994 survey to determine  beneficiary  satisfaction  with Medicare,4  we 
asked  beneficiaries  about  their  awareness  of eight  HCFA  publications.  The  eight 
publications  included  the Medicare  Handbook,  which  all beneficiaries  receive,  and 
seven  other  publications  that  HCFA  requested  we include.  The  eight  booklets  are 
described  below. 
HCFAS Medicare  Handbook  explains  the  Medicare  program  and  benefits. 
 
HCFAS Guide  [o Health  Insurance for People  with Medicare  Coverage provides 
	
information  on (1) Medicare  coverage,  (2) types  of Medigap  policies,  and  (3) 
tips for  purchasing  Medigap  insurance. 
HCFAS Guide  to Choosing a Nursing Home  contains  information  on (1) factors 
	
to consider  in selecting  a nursing  home,  and  (2) Medicare  and  Medicaid 
coverage  of nursing  home  care. 
HCFAS Medicare  and  Other Health  Benej7ts explains  how Medicare  coordinates 
	
with  other  insurance  that  beneficiaries  may have,  such as Medigap,  employer 
health  plans,  and  Workmans  Compensation. 
HCFAS Medicare  Coverage for Second  Wgical  Opinions  provides  information 
	
on  (1) when  beneficiaries  should  get  second  surgical  opinions,  (2) how to find 
20 ffice of Inspector General, United States Department of Health and Human Services. Medicare 
Beneficial  Satisfaction:  1993.  0EI-04-92-O0480,  August 1993 
30 ffice of Inspector General, United States Department of Health and Human Services. Use 
of Nursing Home  and Medigap Guides.  OEI-04-92-00481,  May 1994 
40 ffice of Inspector General, United States Department of Health and Human Serviees. Medicare 
BenejkiaU  Satisfaction:  1994.  0EI-04-92-O0480,  December 1994 
2  physicians  togivesecond  surgical  opinions,  (3)and  Medicare  payments  for 
second  surgical  opinions. 
	 HCFAS Medicare  Hospice  Benefits  explains  (1)  hospice  services,  (2)  eligibility 
requirements,  and  (3)  Medicare  payments  for  hospice  services. 
HCFAS Medicare  and  Coordinated  Care Plans  contains  information  on 
	
managed  health  care  plans  (health  maintenance  organizations  and  competitive 
medical  plans)  that  contract  with HCFA  to provide  health  care  for Medicare 
beneficiaries, 
HCFAS Medicare  Savings for  Qual~ied  Beneficiaries  explains  how Medicare  can 
	
pay additional  medical  costs for certain  low-income  Medicare  beneficiaries. 
Beneficiary  participation  in the  survey was voluntary.  A total  of 1002 beneficiaries 
returned  completed  questionnaires,  for a response  rate  of 78 percent.  Given  the  size 
of our  sample  and  response  rate,  results  of our  survey are  protectable  to the  universe 
of 36 million  beneficiaries.  Appendix  A shows beneficiary  responses. 
Comparison  to Previous  Surveys 
We  compared  beneficiary  responses  to the  1993 survey to beneficiary  responses  to the 
1994 survey  on questions  about  the Medicare  Handbook.  We  also compared 
beneficiary  responses  on two other  publications--the  nursing  home  and  Medigap 
booklets. 
The  two booklets  on selecting  nursing  homes  and  Medigap  insurance  we previously 
reported  on in 1993.  We  could  not  determine  if the  difference  in responses  in 1993 
and  1994 were  statistically  significant  because  we worded  the  question  about 
beneficiary  awareness  differently  those  two years. 
In  1994, we asked  beneficiaries  about  their  awareness  of the  health  insurance  and 
nursing  home  guides  in a list of seven  publications.  Only those  beneficiaries  who were 
aware  of one  or more  of the  seven  publications  should  have  answered  the  question. 
Therefore,  we calculated  our  percentages  of beneficiary  awareness  and  unawareness  of 
the  guides  using the  number  of beneficiaries  who responded  to the  survey  (1002).  We 
interpreted  each  non-response  to the  question  as meaning  that  the  beneficiary  was not 
aware  of any of the  seven  publications  listed  in the  question.  That  interpretation  is 
consistent  with the  instructions  we gave  in the  questionnaire. 
In  1993, we asked  about  awareness  of the  health  insurance  and  nursing  home  guides 
in two separate  questions.  All beneficiaries  responding  to the  survey should  have 
answered  the  questions  to say they  either  were  aware  of the  booklets  or they were  not 
aware.  However,  some  beneficiaries  skipped  the  questions.  Since we did not  know 
whether  or not  they were  aware  of the  booklets  if they  skipped  the  question,  we 
calculated  the  percentages  aware  and  unaware  in our  report  Use of Nursing Home  and 
3  Medigap  Guides  (OEI-04-00481)  using  the  number  of people  who  answered  the 
question.  In order  to compare  1993 responses  to  1994 responses,  we recalculated 
percentages  for  1993 using the  number  of beneficiaries  responding  to the  survey 
(1053). 
See  appendix  A for beneficiary  responses  to the  1993 survey,  and  appendix  B for 
beneficial  responses  to the  1994 survey. 
We  conducted  this inspection  in accordance  with the  Quality Standards for Inspechons 
issued  by the  Presidents  Council  on Integrity  and  Efficiency. 
4
 FINDINGS

MOST  BENEFICIARIES  WERE  AWARE  OF MEDICARE  lL4.NDBOOK 
Three-fourths  of the  beneficiaries  surveyed  said they  knew  about  the Medicare 
Handbook,  Beneficiaries  responded  virtually  the  same  in both  the  1993 and  1994 
surveys. 
A little  over  40 percent  of the  beneficiaries  surveyed  had  used  the  handbook  in the 
previous  year.  Ofthebeneficiaries  whohadused  the  handbook: 
over  90 percent  thought  the  handbook  was helpful, 
 
over  90 percent  thought  the  print  was large  enough  to read, 
 
over  85 percent  thought  the  handbook  contained  adequate  information,  and 
 
over  80 percent  thought  the  wording  was easy to understand. 
 
In both  the  1993 and  1994 surveys, half of the  beneficiaries  surveyed  said  they would 
refer  to their  Medicare  Handbook  to get  information  about  their  Medicare  benefits. 
AWARENESS  OF THE  MEDIGAP  GUIDE  INCREASED  SINCE  1993 
Table  1 shows that  beneficiary  awareness  of the  Guide  to Health  Insurance for People 
wi~hMedicare  increased  11 percent  between  1993 and  1994. 
TABLE  1 
AWARENESS  OF  MEDIGAP  GUIDE 
PUBLICATION  1993  1994 
Guide  to Health  Insurance  for People

with  Medicare  13705  24%

Although  we could  not  determine  what  caused  the  increased  awareness  of the

Medigap  guide,  we recognize  that  HCFA  is developing  strategies  to make  beneficiaries

more  cognizant  of the  publication.  For  example,  staff from  HCFA  and  the  Social

50ur  report Use of Nursing Home  and Medigap  Guides (OEI-04-92-00481)  shows 14 percent because 
we calculated the percentage differently, as explained in the Methodology section of this report. 
5  Security  Administration  have  been  meeting  quarterly  to improve  coordination  and  the 
dissemination  of information  to beneficiaries. 
AWARENESS  OF  THE  NURSING  HOME  GUIDE  WAS ABOUT  THE  SAME IN 
1993 AND  1994 
Table  2 shows that  less than  10 percent  of beneficiaries  surveyed  knew  about  the 
Guide  to Choosing  a Nursing Home  in both  1993 and  1994. 
TABLE  2 
AWARENESS  OF  NURSING  HOME  GUIDE 
PUBLICATION  1993  1994 
f 1 
Guide  to Choosing  a Nursing  Home  99Z0  8% 
FEW  BENEFICIARIES  WERE  AWARE  OF  OTHER  HCFA  PUBLICATIONS 
Table  3 illustrates  that  the  percent  of beneficiaries  aware  of five HCFA  publications 
other  than  the  Medigap  and  nursing  home  guides  ranged  from  4 to  14 percent  of the 
1002 beneficiaries  responding  to our  survey. 
TABLE  3 
AWARENESS  OF  HCFA  PUBLICATIONS 
PUBLICATION  BENEFICIARIES 
AWARE 
Medicare  and  Other  Health  Benefits  1470 
Medicare  Coverage  for Second  Surgical  Opinions  9% 
Medicare  Hospice  Benefits  9V0 
I  II 
IIMedicare  and  Coordinated  Care  Plans  6% 
Medicare  Savings for Qualified  Beneficiaries  4% 
We  realize  that  awareness  of these  publications  may depend  on a beneficiarys  needs. 
For  example,  it is understandable  that  a beneficial  who has not  needed  surge~  may 
not  be  aware  of the  publication  on second  surgical  opinions. 
6
 RECOMMENDATIONS

HCFA  publications  provide  information  that  Medicare  beneficiaries  and  their  families 
may use  to make  informed  health  care  decisions.  However,  they  cannot  benefit  from 
the  guidance  if they  do not  know the  information  is available. 
Publications  such  as the Medicare  Handbook  and  the  Guide  to Health  Insurance for 
People  with Medicare  have  broader  applicability  to beneficiaries.  We  noted  that  the 
rate  of awareness  for these  publications  is higher  than  for other  publications.  We  also 
realize  that  awareness  of some  of the  other  publications,  such as the  pamphlet  on 
hospice  benefits,  may depend  on a beneficiarys  needs.  Further,  those  publications 
that  beneficiaries  are  less aware  of are  referenced  in HCFAS Medicare  Handbook 
which  most  beneficiaries  do know about. 
As our  1993 report  on the  nursing  home  and  Medigap  guides  acknowledged,  HCFA  is 
working  with  the  Social  Security  Administration  and  the  Assistant  Secretary  for Public 
Affairs  to make  HCFA  information  more  accessible  to beneficiaries.  That  effort 
seems  to be working  for the  Medigap  booklet  we studied  in 1993.  HCFAS current 
work with  the  National  Association  of Insurance  Commissioners  (NAIC)  should  also 
increase  awareness  of the  Medigap  guide.  HCFA  and  NAIC  are  developing  disclosure 
statements  which  are  provided  to beneficiaries  who  purchase  Medigap  insurance.  The 
statements  refer  potential  Medigap  buyers  to the  Guide  to Health  Insurance for People 
with Medicare. 
We  recommend  that  HCFA  continue  their  current  efforts,  as well as experiment  with 
new methods,  to develop  a more  effective  strategy  to increase  beneficiary  awareness  of 
their  publications. 
Some  new methods  that  HCFA  might  consider  for experimentation  are  listed  below. 
HCFA  could  distribute  publications,  or a listing of publications  through  offices 
	
of physicians  and  other  health  care  providers. 
HCFA  carriers  could  include  a listing of HCFA  publications  with  the 
	
Explanation  of Medicare  Benefits  sent  to beneficiaries  after  claims  for Part  B 
services  have  been  processed. 
Post  Offices  could  display  a listing of HCFA  publications. 
 
7
 AGENCY  COMMENTS

The  HCFA  Administrator  commented  on our  draft  report,  and  concurred  with  our 
findings.  He  reported  that  HCFA  has several  initiatives  underway  designed  to educate 
Medicare  beneficiaries  andproviders  about  Medicare's  home  health  coverage.  For 
example,  HCFA  is developing  a new pamphlet  to be  distributed  to organizations  and 
health  care  providers  who  serve  beneficiaries.  The  Administrator  reported  HCFA  is 
also working  to improve  the  readability  and  distribution  of existing  publications. 
Appendix  C shows the  full text  of comments  provided  by HCFA. 
8
 APPENDIX  A 
RESPONSES  TO  THE  1993  SURVEY 
OF  MEDICARE  BENEFICIARIES 
A-1  RESPONSES  TO  1993 SURVEY  OF  MEDICARE  BENEFICIAR~ 
(1053 Respondents) 
Question  Responses  Percentage 
1.	 The  following  are  some  places  people  might  go to get  answers  if they  have 
questions  about  what  Medicare  pays for.  Wherewouldyougo to get 
information  about  what  Medicare  pays for? 
(Check  all that  apply) 
(N  =  1025- Number  Responding  to Question) 
Your  doctors  office  495  48 
Friend  or relative  103  10 
AARP  or other 
membership  organization  200  20 
Insurance  company  that 
process  your  Medicare  claims  324  32 
Social  Security  office  465  45 
Local  senior  citizens group  83  8 
Insurance  salesperson  17  2 
Medicare  Handbook  552  54 
Other  40  4 
Not  Answering:  28 
2.  How  many  times  in the  past  year  have  you used your Medicare  Handbook? 
(Check  ~  answer.) 
1 to3  times  368  36 
More  than  3 times  57  6 
I have  never  used  the 
Medicare  Handbook  345  34 
I do not  know what  the 
Medicare  Handbook  is  27  3 
I do not  recall  receiving  a 
Medicare  Handbook  213  21 
Not  Answering:  79 
A-2
 Question  Responses  Percentage 
3.	 Do you think  the Medicare  Handbook  is: 
(Check  ~  answer.) 
(N  =  425- Number  Who  Had  Used  Handbook) 
Very  Helpful  113  27 
Generally  Helpful  272  66 
Generally  Not  Helpful  19  5 
Not  Helpful  7  2 
Not  Answering:  14 
4.	 Thinking  about  the  Medieare  Handbook  you have  reeeived,  would  you say 
that... 
(N  =  425- Number  Who  Had  Used  Handbook) 
a.  The  wording  is easy to understand? 
Yes  314  80 
No  78 20 
Not  Answering:  33 
b.  The  lettering  is large  enough  to read? 
Yes  345  94 
No  23 6 
Not  Answering:  57 
c.  It covers  enough  information? 
Yes  284  85 
No  51 15 
Not  Answering:  90 
A-3
 Question  Responses  Percentage 
5.	 Medicare  publishes  a booklet  entitled  Guide to Health  Lwurance  for  People 
with  Medicare.  It discusses  things you should  look  for in choosing  Medigap 
insurance  to supplement  your  Medieare  coverage.  It is available  at yOUIStia.1 
Security  office. 
Before  today,  were  you aware  Medieare  had  a booklet  to help  you 
choose  other  health  insurance? 
Yes  139  14 
No  875  86 
Not  Answering:  39 
6.	 Medicare  also has  a booklet  entitled  Guide  to  Choosing  a Niming 
Home.  It discusses  things  to look  for in selecting  a nursing  home,  and  is 
available  from  several  offices, including  your  Social  Security  office. 
Before  today,  were  you aware  Medicare  had  information  on choosing  a 
nursing  home? 
Yes  93  9 
No  917  91 
Not  Answering:  43 
A-4
 APPENDIX  B 
RESPONSES  TO  THE  1994  SURVEY 
OF  MEDICARE  BENEFICIARIES 
B-1  RESPONSES  TO  1994 SURVEY  OF  MEDICARE  BENEFIC~ 
(1002 Respondents) 
Question  Responses  Percentage 
1.	 The  following  are  some  places  people  might  go to get  answers  if they  have 
questions  about  what  Medicare  pays for.  Where  would  you go to get 
information  about  what  Medicare  pays for? 
(Check  all that  apply.) 
(N  =  973- Number  Responding  to Question) 
Your  doctors  office  486  50 
Friend  or relative  67  7 
AARP  or other 
membership  organization  135  14 
Insurance  company  that 
processes  your  Medicare  claims  411  42 
Social  Security  office  337  35 
Local  senior  citizens group  58  6 
Insurance  salesperson  24  2 
Medicare  Handbook  518  53 
Medicare  Peer  Review 
Organization  (PRO)  107  11 
Other  26  3 
Not  Answering:  29 
2.  How  many  times  in the  past  year  have  you used  your  Medicare  Handbook? 
(Check  ~  answer.) 
1 to 3 times  331  36 
More  than  3 times  77  8 
I have  never  used  the 
Medicare  Handbook  297  32 
I do not  know what  the 
Medicare  Handbook  is  27  3 
I do not  recall  receiving  a 
Medicare  Handbook  191  21 
Not  Answering:  79 
B-2
 Question  Responses  Percentage 
3.	 Do you think  the Medicare  Handbook  is: 
(Check  ~  answer.) 
(N=  408- Number  Who  Had  Used  Handbook) 
Very  Helpful
 123  31 
Generally  Helpful
 249  64 
Generally  Not  Helpful
 14  4 
Not  Helpful
 5 1 
Not  Answering:  17

4.	 Thinking  about  the Medicare  Handbook  you have  received,  would  you say that... 
(N  = 408- Number  Who  Had  Used  Handbook) 
a.  The  wording  is easy to understand? 
Yes  312  84 
No  58  16 
Not  Answering:  38 
b.  The  lettering  is large  enough  to read? 
Yes  326  93 
No  25  7 
Not  Answering:  57 
c.  It covers  enough  information? 
Yes  290  87 
No  42  13 
Not  Answering:  76 
B-3
 Question  Responses  Percentage 
5.  Listed  below  are  Medicare  booldets  that  you can  obtain  free.  Before 
@&,  were  you aware  that  you could  obtain  the  following  free 
publications  from  Medicare? 
(Please  check  the  booklets  you were  aware  of before  todav.) 
Guide  to Health  Insurance 
for People  with Medicare  237  24 
Guide  10 Choosing a 
Nursing Home  78  8 
Medicare:  Coverage for 
Second  Surgical Opinion  94  9 
Medicare:  Hospice Benefits  90  9 
Medicare  and  Coordinated 
Care Plans  59  6 
Medicare  and  Other 
Health  Benefits  141  14 
Medicare:  Savings for  Qualified 
Beneficiaries  42  4 
Number  Who  Checked  One  or More  Publications:  405 
Number  Who  Did  Not  Check  Any Publications:  597 
B-4
 APPENDIX  C 
HCFA  COMMENTS 
c-1  <
,  ,,$ 
,,..l  .1, Health  Care 
.+   A DEPARTMENT  01-HEALTH & HUMAN SERVICES  Financing  Administration
* 
:< 
Memorandum 
. 
DATE  APR28  K195 
FROM	 Bruce  C. Wade 
Administrator  %-
SUBJECT	 Office  of Inspector  General  Draft  Report:  Beneficiary  Awareness  of 
HCFA  Publications,  (OEI-04-93-O0141) 
TO	 June  Gibbs  Brown 
Inspector  General 
booklets 
We reviewed  the  subject  draft  report  which  examined  beneficia~  awareness  of 
health 
the  Health  Care  Financing  Administration  publishes  to assist beneficiaries  with 
care  decisions.  Our  comments  are  attached  for your  consideration. 
Thank  you  for the  opportunity  to review  and  comment  on this report.  Please  advise  us if 
you would  like  to discuss  our  position  on the  reports  recommendation. 
Attachment 
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 Comments  of the  Health  Care  Financing  Administration  (HCFA]

on  Office  of Inspector  General  [OIG)  Draft  Report:

Beneficiary  Awareness  of HCFA  Publications,

(OEI-04-93-00141)

OIG  Recommendation

HCFA  should  continue  their  current  efforts,  as well as experiment  with  new methods,  to

develop  a more  effective  strategy  to increase  beneficiary  awareness  of their  publications.

Some  new methods  that  HCFA  might  consider  for experimentation  are  listed  below.

o	 HCFA  could  distribute  publications,  or a listing of publications,  through 
offices  of physicians  and  other  health  care  providers. 
o	 HCFA  carriers  could  include  a listing of HCFA  publications  with  the 
Explanation  of Medicare  Benefits  sent  to beneficiaries  after  claims  for 
Part  B services  have  been  processed. 
o  Post  offices  could  display  a listing of HCFA  publications. 
HCFA  Response

We  concur.  As mentioned  in the  report,  HCFA  is engaged  with internal  and  external

partners  to  increase  the  awareness  and  distribution  of its publications.  We  have  several

initiatives  under  way for  fiscal year  1995 designed  to educate  Medicare  beneficiaries  and

providers  about  what  Medicares  home  health  benefit  covers  and  pays  for.  These

initiatives  employ  multimedia  and  multiuser  approaches  to guarantee  maximum  use  and

benefit.

First,  a pamphlet  has  been  developed  which explains  Medicare  home  health  coverage,

eligibility,  fraud,  and  quality  concerns.  It is currently  being  reviewed  by HCFA

component  staff,  several  beneficiary  and  home  health  organizations,  and  Medicare

beneficiaries.  We  anticipate  having  a final revised  version  of the  pamphlet  complete  by

July/August  1995.  The  pamphlet  will be  distributed  to groups  and  organizations  that

provide  counseling  and  assistance  services  to beneficiaries  such as the  Information

Counseling  and  Assistance  (ICA)  Program  State  grantees,  the  Retired  Seniors  Volunteer

Program,  and  others.  It will also be  distributed  to hospitals  to be  shared  with  the  staff

(hospital  discharge  planners  and  social workers)  who assist beneficiaries  with  their

posthospital  health  care  needs.  We  also intend  to distribute  copies  of the  pamphlet  to

professional  provider  organizations  such as the  American  Medical  Association  and

American  Nurses  Association.  We  recognize  that  doctors  need  to understand  this  benefit

because  many  beneficiaries  consult  with their  doctors  about  Medicare  coverage.  Hence,

we will encourage  these  organizations  to put  the  pamphlet  in their  newsletters-and  other

correspondence  that  goes  to their  members.