Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Beneficiary Awareness of HCFA Publications 
in 1997 
JUNE GIBBS BROWN 
Inspector General 
SEPTEMBER 1998 
OEI-04-97-00033  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them.  This statutory mission is carried out through a 
nationwide program of audits, investigations, inspections, sanctions, and fraud alerts.  The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General.  It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public.  The 
inspection reports provide findings and recommendations on the efficiency, vulnerability, and 
effectiveness of departmental programs. 
OEI's 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: 
REGION  HEADQUARTERS 
Betty Apt,  Project Leader
 Wynethea Walker, Program Specialist 
Jason Stanfield, Contractor
 Linda Moscoe, Technical Support 
Joe Townsel, Program Analyst
 Barbara Tedesco, Statistician 
Paula Bowker, Program Analyst

Greg Jones, Program Analyst

Janet Miller, Program Analyst

To obtain copies of this report, please call the Atlanta Regional Office at (404) 562-7743. 
Reports are also available on the World Wide Web at our home page address: 
http://www.dhhs.gov/progorg/oei  E X E C U T I V E  S U M M A R Y

PURPOSE 
To determine Medicare beneficiary awareness of Health Care Financing Administration 
publications in 1997. 
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 1997 survey to determine beneficiary satisfaction with Medicare, we asked 
beneficiaries about their awareness of the Medicare handbook and seven other HCFA 
publications.  We reported on the handbook and six of the seven booklets in a 1995 report. 
FINDINGS 
Most beneficiaries were aware of the Medicare handbook 
Eighty-seven percent of beneficiaries surveyed in 1997 said they knew about the Medicare 
handbook.  This was a statistically significant increase from 1995 when 75 percent said were 
familiar with the handbook. 
Beneficiary use of the Medicare handbook remains low, but users found it helpful 
In 1997, 38 percent of the beneficiaries who were aware of the handbook said they had used it in 
the past year.  This is about the same as 1995.  Of beneficiaries who had used the handbook, 95 
percent thought the handbook was helpful. 
Few beneficiaries were aware of HCFA's other publications 
!	 Twenty-four percent of the Medicare beneficiaries who responded to our survey were 
aware of HCFA's Guide to Health Insurance for People with Medicare Coverage. 
!	 Fifteen percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet on Medicare and Other Health Benefits. 
!	 Nine percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet on How to Help Medicare from Being Ripped Off. 
!	 Nine percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet on Medicare Hospice Benefits. 
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i  !	 Seven percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet Guide to Choosing a Nursing Home. 
!	 Six percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet on Medicare Managed Care Plans. 
!	 Six percent of the Medicare beneficiaries who responded to our survey were aware of 
HCFA's booklet on Medicare Coverage for Second Surgical Opinions. 
Most beneficiaries did not know how to obtain HCFA publications 
Seventy percent of the beneficiaries said they did not know how to obtain HCFAs free 
publications. 
CONCLUSION 
HCFA publications provide important information that Medicare beneficiaries and their families 
may use to make informed health care decisions.  However, beneficiaries can benefit from HCFA's 
guidance only if they know the information is available.  Since awareness of publications other 
than the handbook have not increased, it is obvious that methods previously used are not working. 
We are aware that as a result of the Balanced Budget Act of 1997,  HCFA will likely update 
several of their publications, such as the handbook and managed care booklet.  This presents 
HCFA a good opportunity to intensify efforts to make beneficiaries aware of the availability of all 
its publications. 
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ii  T A B L E  O F  C O N T E N T S

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

FINDINGS 
Most Beneficiaries Aware of Handbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Use of Handbook Remains Low, But Users Found It Useful  . . . . . . . . . . . . . . . . . . . . . 4

Few Aware of Other Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Most Did Not Know How to Obtain Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

APPENDICES

Responses to 1997 Medicare Beneficiary Survey  . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Confidence Intervals  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
 I N T R O D U C T I O N

PURPOSE 
To determine Medicare beneficiary awareness of Health Care Financing Administration 
publications in 1997. 
BACKGROUND 
Medicare Program 
Medicare is a Federal health insurance program for individuals age 65 and older and for certain 
categories of disabled people.  Authorized in 1965 by title XVIII of the Social Security Act, 
Medicare paid benefits in 1997 totaling over $211 billion to approximately 38 million 
beneficiaries.1  The Health Care Financing Administration (HCFA) within the Department of 
Health and Human Services has responsibility for the Medicare program. 
HCFA Publications 
HCFA publishes a Medicare handbook for beneficiaries that explains how the Medicare program 
works and what the benefits are.  HCFA publishes a new handbook every year, but generally only 
mails it to new enrollees.  In 1996, the year preceding our survey, HCFA mailed a new handbook 
to all beneficiaries.  HCFA officials now are considering the feasibility of mailing another new 
handbook to all beneficiaries. 
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, (2) advice on criteria beneficiaries should consider in 
selecting services, such as nursing home care and supplemental health insurance, and (3) tips that 
should alert beneficiaries to fraudulent activities. 
The handbook and other 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 handbook and booklets are available. 
__________________ 
1Health Care Financing Administration, United States Department of Health and Human Services, HCFA Statistics, 
October 1997. 
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1  Previous Surveys 
In 1993, the Office of Inspector General conducted a survey of Medicare beneficiaries to 
determine their awareness of the Medicare handbook and two booklets published by HCFA.2  In 
1994 and 1995, we conducted a similar survey of Medicare beneficiaries, and asked about their 
awareness of the handbook and seven booklets.3 
In all three surveys, we found that while most beneficiaries were aware of the handbook, few 
knew about the booklets. 
METHODS 
In July 1997, we mailed a questionnaire to 1269 randomly selected Medicare beneficiaries for 
whom Part B claims had been filed in Calendar Year 1996.  We used standard equations for 
estimating sample size with a binary response variable. 
Beneficiary participation in the survey was voluntary.  A total of 977 beneficiaries returned 
completed questionnaires, for a response rate of 77 percent.  Percentages in the report are based 
on the number of people answering each question.  Based on our response rate, estimates are 
within 3.5 percent of the true value at the 95 percent confidence level.  Some individual findings 
may be less precise, depending on the number of beneficiaries who responded to specific 
questions.  Appendix A shows beneficiary responses to the questionnaire.  Appendix B shows 
confidence intervals for the findings. 
As part of our 1997 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, and seven other HCFA publications.  The eight publications are 
described below. 
!  HCFA's Medicare Handbook explains the Medicare program and benefits. 
!	 HCFA's Guide to Health Insurance for People with Medicare Coverage booklet provides 
information on (1) Medicare coverage, (2) types of Medigap policies, and (3) tips for 
purchasing Medigap insurance. 
__________________ 
2Office of Inspector General, United States Department of Health and Human Services. Use of Nursing Home and 
Medigap Guides. OEI-04-92-00481, May 1994. 
3Office of Inspector General, United States Department of Health and Human Services. Beneficiary Awareness of 
HCFA Publications. OEI-04-94-00141, June 1995. 
4Office of Inspector General, United States Department of Health and Human Services. Medicare Beneficiary 
Satisfaction: 1997. OEI-04-97-00030. 
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2  !	 HCFA's Medicare and Other Health Benefits booklet explains how Medicare coordinates 
with other insurance that beneficiaries may have, such as Medigap, employer health plans, 
and Workman's Compensation. 
!	 HCFA's How to Help Stop Medicare from Being Ripped Off booklet describes what 
beneficiaries can do to prevent Medicare fraud. 
!	 HCFA's Medicare Hospice Benefits booklet explains (1) hospice services, (2) eligibility 
requirements, and (3) Medicare payments for hospice services. 
!	 HCFA's Medicare Coverage for Second Surgical Opinions booklet provides information 
on (1) when beneficiaries should get second surgical opinions, (2) how to find physicians 
to give second surgical opinions, and (3) Medicare payments for second surgical opinions. 
!	 HCFA's Guide to Choosing a Nursing Home booklet contains information on (1) factors 
to consider in selecting a nursing home, and (2) Medicare and Medicaid coverage of 
nursing home care. 
!	 HCFA's Medicare Managed Care Plans booklet 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. 
Comparison to Previous Surveys 
During our 1993, 1994, 1995, and 1997 surveys, we asked Medicare beneficiaries similar 
questions about the Medicare Handbook.  We compare their responses in this report. 
We asked Medicare beneficiaries similar questions about two of HCFA's publications in our 1993, 
1994, 1995, and 1997 surveys.  In 1994, 1995, and 1997 we asked similar questions about six 
publications.  For those publications on which we asked similar questions in more than one survey 
year, we calculated the percentage of responses so that they were comparable from year to year. 
We determined significant differences in responses to the two most recent surveys through use of 
a t-test.  If there was a statistical difference between the responses to the surveys, we stated the 
percent increased or decreased in the report.  If there was not a statistical difference, we stated 
that the percent stayed the same. 
---------------
We conducted this inspection in accordance with the Quality Standards for Inspections issued by 
the President's Council on Integrity and Efficiency. 
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3  F I N D I N G S

MOST BENEFICIARIES WERE AWARE OF THE MEDICARE HANDBOOK 
Eight-seven percent of the beneficiaries surveyed said they knew about the Medicare Handbook. 
Figure 1 illustrates that the percent of beneficiaries who knew of the handbook increased 
significantly from 1995 to 1997.  This increase may be due to HCFA having mailed a new 
handbook to each beneficiary in 1996. 
FIGURE 1

BENEFICIARY AWARENESS OF THE MEDICARE HANDBOOK

1997  87 
1995  75 
R 
A
E
Y
1994  76 
1993  76 
0  10  20  30  40  50  60  70  80  90  100 
PERCENT 
BENEFICIARY USE OF THE MEDICARE HANDBOOK REMAINS LOW, BUT USERS 
FOUND IT HELPFUL 
Figure 2 shows that slightly over a third of beneficiaries said they had used the handbook in the 
last year.  This number is about the same as in 1995. 
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4  FIGURE 2

BENEFICIARY USE OF THE MEDICARE HANDBOOK

1997  37 
1995  38 
R 
A
E
Y
1994  58 
1993  55 
10  20  30  40  50  60  70  80  90  100 
PERCENT 
At the same time, in 1993, 1994, 1995, and 1997, over half of the beneficiaries surveyed said they 
would refer to the Medicare handbook to get information concerning what Medicare pays for.  Of 
the beneficiaries who had used the handbook, 95 percent thought it was helpful.  Figure 3 shows 
that beneficiaries responded virtually the same in our 1993, 1994, and 1995 surveys. 
FIGURE 3

BENEFICIARIES WHO, HAVING USED THE HANDBOOK, FOUND IT USEFUL

1997  95 
1995  94 
R 
A
E
Y
1994  93 
1993  93 
0  10  20  30  40  50  60  70  80  90  100 
PERCENT 
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5  FEW BENEFICIARIES WERE AWARE OF HCFA'S OTHER PUBLICATIONS 
Table 1 illustrates that only 6 to 24 percent of the 977 beneficiaries responding to our survey in 
1997 were aware of HCFA's other publications. 
TABLE 1

AWARENESS OF HCFA PUBLICATIONS

BENEFICIARIES 
PUBLICATION  AWARE 
1993  1994  1995  1997 
Guide to Health Insurance for People with Medicare  13%  24%  26%  24% 
Coverage 
Medicare and Other Health Benefits  *  14%  18%  15% 
How to Help Medicare from Being Ripped Off  *  *  9%  9% 
Medicare Hospice Benefits  *  9%  8%  9% 
Guide to Choosing a Nursing Home  9%  8%  7%  7% 
Medicare Managed Care Plans  *  *  *  6% 
Medicare Coverage for Second Surgical Opinions  *  9%  7%  6% 
* If no percentages are shown, we did not ask about that publication in that 
particular year. 
As in previous years, the most familiar publication to beneficiaries relates to insurance policies 
that supplement Medicare.  It is important to realize that awareness of other publications may be 
dependent on a beneficiarys need.  For example, a beneficiary who has never had to choose a 
nursing home may not be aware of the publication concerning such a matter. 
MOST BENEFICIARIES DID NOT KNOW HOW TO OBTAIN HCFA PUBLICATIONS 
Seventy percent of the beneficiaries surveyed said they did not know how to obtain HCFA's free 
publications. 
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6  C O N C L U S I O N

HCFA publications provide important information that Medicare beneficiaries and their families 
may use to make informed health care decisions.  However, beneficiaries can benefit from HCFA's 
guidance only if they know the information is available.  Since awareness of publications other 
than the handbook have not increased, it is obvious that methods previously used are not working. 
We are aware that as a result of the Balanced Budget Act of 1997,  HCFA will likely update 
several of their publications, such as the handbook and managed care booklet.  This presents 
HCFA a good opportunity to intensify efforts to make beneficiaries aware of the availability of all 
its publications. 
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7  A P P E N D I X  A

RESPONSES TO 1997 SURVEY OF MEDICARE BENEFICIARIES 
(977 Respondents) 
___________________________________________________________________________ 
Question  Responses 
___________________________________________________________________________ 
1.  Where would you go to get information about what Medicare pays for? 
The following are some places people might go to get answers if they have questions 
about what Medicare pays for.  Check all the places you would go to find out what 
Medicare pays for. 
(N = 952 - Number Responding to Question) 
Your doctor's office  644 
Friend or relative  95 
AARP or other 
membership organization  133 
Insurance company that 
processes your Medicare claims  364 
Medigap insurance company  221 
Social Security office  268 
Local senior citizen's group  73 
The Health Care Financing 
Administration (HCFA)  22 
Insurance salesperson  18 
Medicare Handbook  523 
Medicare Peer Review 
Organization  25 
State's Information, Counseling, 
and Assistance office  30 
Other  27 
Not Answering: 25 
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A - 1  Question  Responses 
___________________________________________________________________________ 
2.	 Listed below are Medicare booklets that you can obtain free of charge.  Please 
check the booklets you were aware of before today. 
(N = 750 - Number Who Checked One or More Publications) 
Guide to Health Insurance 
for People with Medicare  182 
Guide to Choosing a 
Nursing Home  54 
Medicare Coverage for 
Second Surgical Opinion  46 
Medicare Hospice Benefits  68 
Medicare Managed Care 
Plans  43 
Medicare and Other Health 
Benefits  114 
How to Help Medicare from 
Being Ripped Off  64 
Medicare Handbook  650 
Not Checking Any of the Above: 227 
___________________________________________________________________________ 
3.  Do you know how to obtain these free publications from Medicare? 
Yes  278 
No  660 
Not Answering: 39 
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A - 2  Question  Responses 
___________________________________________________________________________ 
4.  How many times in the past year have you used your Medicare Handbook? 
(Check one answer.) 
1 to 3 times  281 
More than 3 times  51 
I have not used the 
Medicare Handbook in 
the past year  403 
I do not know what the 
Medicare Handbook is  51 
I do not recall receiving a 
Medicare Handbook  118 
Not Answering: 73 
___________________________________________________________________________ 
5.	 Do you think the Medicare Handbook is: 
(Check one answer.) 
(N = 332 - Number Who Had Used Handbook) 
Very Helpful  137 
Generally Helpful  171 
Generally Not Helpful  13 
Not Helpful  3 
Not Answering: 8 
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A - 3  A P P E N D I X  B

CONFIDENCE INTERVALS 
Estimate  Boundaries for the 95% 
Description 
Confidence Intervals 
Beneficiaries who knew about 
Medicare handbook  87%  +/- 2.4% 
Beneficiaries who had used 
Medicare handbook  37%  +/- 3.1% 
Beneficiaries who would refer to 
handbook for information  55%  +/- 3.2 % 
Beneficiaries who had used Medicare 
handbook and found it useful  95%  +/- 2.4% 
Beneficiaries who did not know how to 
obtain free publications  70%  +/- 2.9% 
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B - 1
 Estimate  Boundaries for the 95% 
Description 
Confidence Intervals 
Beneficiaries aware of other publications: 
Guide to Health Insurance for 
People with Medicare  24%  +/- 3.1% 
Medicare and Other Health 
Benefits  15%  +/- 2.6% 
How to Help Medicare From 
Being Ripped Off  9%  +/- 2.0% 
Medicare Hospice Benefits  9%  +/- 2. 0% 
Guide to Choosing a Nursing 
Home  7%  +/- 1.8% 
Medicare Managed Care Plans  6%  +/- 1.7% 
Medicare Coverage for Second 
Surgical Opinions  6%  +/- 1.7% 
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B - 2