"'...
Dewartment of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
MEDICARE BENEFICIARY SATISFACTION: 
1994 
" S'ERVIC'E.. 
JU 
GIBBS BROWN 
Inspector General 
JU 
1995 
b'''d'  OEI-0493-00140  OFFICE OF INSPECfOR GENERA 
The mission of the Offce 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 Service' (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 Offce of Audit Servce, the 
Offce of Investigations, and the Offce 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 SERVICE 
The OIG's Offce of Audit Services (OAS) provides all auditing services 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 
carryng out their respective responsibilties 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 effciency throughout the Department. 
OFFICE OF INTIGATIONS 
The OIG's Offce 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. 
AN 
OFFCE OF EVALUATION  INSPECfONS 
The OIG's Offce 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 effciency, vulnerabilty, 
and effectiveness of departmental programs. 
OEl's Atlanta Regional Offce 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 Rel!on  Headauarters

Betty Apt  Team Leader  Tom Noplock Program Specialist

James Green  Contractor  Brian Ritchie Technical Support

Peggy Daniel Program Analyst  Jennifer Antico  Program Specialist

Jackie Andrews  Program Analyst  Barbara Tedesco  Statitician 
Joe Townsel  Program Analyst 
Tammy Bonney,  Program Analyst 
To obtain a copy of this report, call the Atlanta Regional Offce at (404) 331-5022.  Department of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
MEDICARE BENEFICIARY SATISFACTION: 
1994 
\' SERVICe.. 
JU 
GIBBS BROWN 
Inspector General 
ff 
'0  JU 
1995 
0'''d3a 
OEI-0493-00140  EXECUTIVE 
SUMMAR Y

PUROSE 
To determne Medicare beneficiary experience and satisfaction with Medicare servces. 
BACKGROUN 
This is the fourth survey the Office of Inspector General (OIG), Department of 
Health and Human Servces (HHS), has conducted to determine beneficiary 
experience and satisfaction with Medicare servces. In July 1994, we mailed a 
questionnaire to 1279 randomly selected beneficiaries for whom Medicare Part B 
claims were submitted in Calendar Year 1993. Participation in the survey 
was 
voluntary and yielded a response rate of 78 percent--
1002 beneficiaries. 
FIINGS 
Overal, beneficiares reported positive experience with several key aspect of the 
Medicae program. 
Seventy-nine percent of the beneficiaries responding to our survey said the 
Medicare program was understandable. 
Seventy-five percent of the beneficiaries said they could get information about 
Medicare when they needed it. Most beneficiaries said they would consult the
Medicare Handbook and their physicians to get specific information. 
Eighty-two percent of the beneficiaries said they were aware of the 
participating physician provision of Medicare. Seventy-one percent 
reported 
using participating physicians.

Eighty-five percent of the beneficiaries said they were satisfied with the way 
Medicare carriers processed their claims. 
Eighty-two percent of the beneficiaries who had called their carriers were 
satisfied with the servce they received the last time they called. 
Compared to prior year, we see positie changes in several areas of the Medicae 
program. 
In 1991, 67 percent of beneficiaries said they experienced at least one problem 
with their last Medicare claim. In the last three years, the percent of
beneficiaries who experienced a problem decreased by 50 percent.  Beneficiaries who had appealed decisions about their Medicare claims were 
more positive about their experiences in 1994 than in 1993. 
 In  1994, 76 percent
understood the final decision, compared to 67 percent in 1993. Likewise, in 
1994, 62 percent thought their appeals were handled fairly, compared to 59 
percent in 1993.

1994, more beneficiaries were seeking Medicare information from an 
In 
1994, 42 percent of the beneficiaries surveyed said they 
appropriate source.  In 
would contact their carrier for Medicare information, compared to 32 percent 
in 1993. Conversely, fewer beneficiaries said they would contact Social Security 
for Medicare information--35 percent in 1994 compared to 45 percent in 
1993. 
Ou surey alo 
indicated some trouble spots. 
Telephone Servce--Twenty-six percent of the beneficiaries who had tried to call 
their carriers had to call three or more times to get through. Four percent 
never reached the carrier. Seventy-three percent of the beneficiaries who 
encountered an automated voice system when calling the 
carrer experienced 
problems with the system. 
Home Health  and  Hospital Charges--Thirty-two percent of the beneficiaries 
who had received home health services did not understand what home health 
servces Medicare paid for. Twenty-three percent of the beneficiaries who had 
been hospitaJized did not understand what hospital charges Medicare had paid 
for. 
Physician Fees--Twenty-six percent of the beneficiaries surveyed did not know 
Medicare Jimits physicians' fees for specific services. 
Appeal Rights--Thirty-one percent of the beneficiaries surveyed did not know 
they could appeal or request a review of decisions Medicare carrers made 
about their claims. 
Six-
Second Surgica Opinons-- four percent of the beneficiaries surveyed did 
not know Medicare pays for a second opinion on the need for surgery. 
RECOMMNDATION 
We recommend that the Health Care Financing Administration develop a plan for 
improving beneficiary satisfaction and understanding in the trouble areas mentioned 
above.  COMM 
AGENCY 
The HCF A Administrator commented on our report, and concurred with our 
recommendation. He reported that HCFA will soon be conducting a number of 
demonstrations designed to improve carrier telephone servce. Further, HCFA has 
planned an initiative to increase beneficiary awareness of Medicare coverage for 
second surgical opinions and is revising the Explanation of Medicare Benefits.  . . . . . . . . . . . . . . . . . . . . . ..  ..  ...  . . . .  ......   
. . . ..  ..  ...   ...   ...   ...   ...   ....    ....    ....    ....    .....     ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ..... .    . .... .    . ....  .   .. ...  .   .. ...  .   .. ..  .  .. ..  .  .. ..  .  ... .   . ... .   . ...    ....    ....   . .. .  . .. .  . . . . . . . .  ...   ..  ....  
 . . . . . .  ..  ..  .. .  ..  ..  ..  ..  . ..  ..  ..  ..  ..  . ..  ..  ..  ..  .. .  ..  ..  ..  ..  .. .  ..  ..  ..  ..  . ..  ..
TABLE OF CONTENTS

PAGE 
EXCU SUMY

INODUCTON. . 
. . . . . . . . . . . . 1 
FIINGS. . 
. . . . . . . . . . . . . . . . . 3 
Beneficiaries Understand the Medicare Program. . . . . . . . . . . . . . . . . . . . . . . . 3 
General Understanding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
. . 3

Understanding Specific Servces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 
Beneficiaries Get Information When Needed. . . . . . . . . . . . . . . . . . . . . . . . . . 4 
Getting General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . 4 
Getting Specific Information
Sources of Information 
. . . 5

Beneficiaries Are Satisfied With Claims Processing. . . . . . . . . . . . . . . . . . . . . . 
Claims Processing Problems. 
. . . . . . . . . . . . 8 
Appeal Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
Beneficiaries Satisfied With Carriers' Telephone Servces. . . . . . . . . . . . . . . . . 
Problems With Telephone Services 
Problems With Automated Voice System. . . . . . . . . . . . . . . . . . . . . . 
.. 12 
Beneficiaries Unaware of Payments for Second Surgical Opinions 
'"'''''' 13 
Beneficiaries Aware of "Participating Physician" Program. . . . . . . . . . . . 
RECOMMNDATION. . . . . . . . 
AGENCY COMMNT. . 
ENDNOTE. . . . 
APPENICE 
Responses to 1994 Survey of Medicare Beneficiary Satisfaction. . . 
. . . . . . . . A-
Analysis of Respondents vs. Non-Respondents. . . . . . . . . . . . . . . . . . . . . .. B
HCFA Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . .. C- INTRODUCTION
PUROSE
To determine Medicare beneficiary experience and satisfaction with Medicare servces.
BACKGROUN
Medicare is a Federal health insurance program for individuals age 65 and older, and
for certain categories of disabled people. Medicare was authorized in 
1965 by title
XVII of the Social Security Act. In Fiscal Year 1993, Medicare served approximately 
36 milion people, known as beneficiaries, and paid benefits totallng approximately 
$143 bilion. 1 
The Medicare program has two parts. Part A (hospital insurance) helps pay for
inpatient hospital care, some inpatient care in a skilled nursing faciJity, skil!ed home 
health care, and hospice care. A person entitled to Medicare automatically receives 
Part A coverage. Part B (medical insurance) covers physician servces, outpatient 
hospital servces, and other medical servces and supplies. Part B is optional. 
Beneficiaries desiring Part B coverage pay a monthly premium. Both Part A and Part 
B have deductible and coinsurance requirements. Beneficiaries must pay deductibles 
and coinsurance either out of pocket or through supplemental insurance coverage.

The Health Care Financing Administration (HCFA), Department of Health and 
Human Services (HHS), has responsibility for the Medicare program. However
, other
organizations share program administration. The Social Security Administration 
establishes eligibilty, enrolls beneficiaries in the program
, and collects premiums for 
Part B coverage. Private health insurance companies contract with the Federal 
Government to servce claims for Medicare payment. Insurance companies that 
handle Part A claims are called intermediaries. Those handling Part B claims are 
called carriers. 
METHODS
In July 1994, we mailed a survey instrument to 1299 randomly selected Medicare
beneficiaries. We selected beneficiaries for whom Medicare Part B claims had been
fied in Calendar Year 1993. Appendix A 
contains the questionnaire and beneficiaries 
responses to the questions. 
Based upon previous experience with similar client and beneficiary surveys
, 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 variabJe.  -------------
We dropped 20 beneficiaries from our sample because 15 questionnaires were 
undeJiverable and 5 beneficiaries were deceased. This reduced the sample size from 
1299 to 1279.

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 projectable to the universe 
of 35 milion Medicare beneficiaries. Percentages in the report are based on the 
number of beneficiaries answering each question. Appendix B presents an analysis of 
respondents and non-respondents. 
Comparion to Previous Sureys 
3 and 1993 4 we conducted national surveys of Medicare beneficiaries to 
In 1989,2 1991 
assess their awareness of and satisfaction with various aspects of the Medicare 
program. 
The majority of questions used in the 1994 survey were used in our 1993 survey.

Therefore, Medicare beneficiary responses in 1993 and 1994 are comparable. The 
1993 and 1994 surveys were also similar to the 1989 and 1991 
surveys. However, some
questions were worded and sequenced slightly different. Additionally, we provided
more response options to questions in the 1993 and 1994 surveys than we did in the 
1989 and 1991 surveys. Therefore, we cannot compare beneficiary responses in each 
of the four survey years for all questions. However, we did make comparisons
whenever possible, and determined "significant" differences in responses through use
of at-test. 
We conducted this inspection in accordance with the 
 Quality Standards for Inspections
issued by the President s Council on Integrity and Efficiency.  .................... .................................................................................................................."....".'...................".."....."........."..".'..."."...."."..'.''.....''...'.''.'.''.'.''.'.''.'.'..'.'.''..............
FINDINGS
MOST BENEFICIA UNERSTAN TH MEDICAR PROGRA 
Genral Undrstanding

Over three-fourths (79 percent) of the beneficiaries said that the Medicare program is
understandable. This is a significant increase over 1993 when 75 percent said the 
program was understandable. Figure 1 shows the 
levels of understanding over the 
four survey years. 
FIGUR 1
BENEFICIAIE UNERSTAN 
TH MEDICAR PROGRA 
79
PERCENT
100
90 ......................... 
80 ".".""..............  70.
70 
60 
60 
40 ... 
30 ... 
20 
10 
1989  1991  1993  1994
YEAR
Undrstanding Specifc Services
Most beneficiaries understand specific payments for servces such as home health 
payments, physician fees, and hospital payments.
Home Health Payments: Of the beneficiaries who had received home health servces 
53 percent said they understood what services Medicare had paid for. This is a 
decrease from 1993, when 68 percent said they understood what home health servces
Medicare funds had paid for. Fifteen percent in 1994 and 
19 percent in 1993 said
 they either did not remember if Medicare home health payments were clear, or the
claims had not yet been paid.
Physician Fees: We asked the beneficiaries if they knew Medicare limits fees that 
physicians can charge for specific services. About three-
fourths (74 percent) of the 
beneficiaries knew about the limits. This percent is significantly higher than the 64 
percent who knew in 1993.
Hospita Payments: Six-two percent of the beneficiaries who had been hospitalized 
since covered by Medicare said they understood what hospital servces Medicare had 
paid for. Twenty-three percent said it had not been clear to them. The remainig 15 
percent either did not remember or Medicare had not yet paid their claims. Such 
beneficiary responses were about the same as we found in our 1993 survey. 
BENEFICIAIE GET INORMTION WHN NEEDED
Gettg General Information 
Seventy-five percent of the beneficiaries said they thought they could get general
information about Medicare when they needed it. This is about the same percent of
beneficiaries who believed they could do so in 1993. Table 1 ilustrates that the
percent of beneficiaries who said they can get general information in 1993 and 1994 is
less than the percent who believed so in 1989 and 1991. However, the 1993 and 1994 
surveys had a "Don t Know" response option that was not offered in 1989 and 1991. 
TABLE 1 
BENEFICIA CAN GET GENERA INORMTION 
. 1991. 
;1989 
Yes  85%  90%  72%  75%
15%  10%
Dont Know  21%  20%
Gettg Specic Informtion 
Sixty-seven percent of the beneficiaries who have needed specific information about
their Medicare coverage said they have been able to obtain it most of the time. Table
2 shows that the percent of beneficiaries who could get specific Medicare information
varied from year to year. ... 
:"(\.'':.,. "'.  '".' "-".:::.".'.-::, . :-.. :: .:../,'(. :- ... '   . -.:.... ..  ,;  ... .,..:. . . .,...."". : :.: ,. )-. :" .:.  . ,' ':  :.:  :.
TABLE 2 
BENEFICIA CAN GET SPECIFC INORMTION
......n.. ' n. ..n. ... .. .

::e
Most of the Time  58%  67%  60%  67%
Some of the Time  29%  23%  28%  23%
Seldom or Never  13%  10%  12%  10%
Soures of Informtion
From a list of possible places people might go to get answers if they have questions
about what Medicare pays for, beneficiaries were asked to indicate which places they 
would go. They could check more than one likely source. 
and their
Most beneficiaries get Medicare information from the  Medicare Handbook 
doctors' offices. Fifty-three percent of all beneficiaries said they would refer to the 
Fifty percent said they would go to their doctor s office. These 
Medicare Handbook. 
responses are about the same as we obtained from beneficiaries on this same question 
in our 1993 survey.

Beneficiary use of Social Security offices as a source of information decreased between
1993 and 1994. In 1993, 45 percent of the beneficiaries said they would go to a Social 
Security Office for information. In 1994, only 35 percent said they would use a Social 
Security office. 
Conversely, the number of beneficiaries who said they would contact their Medicare
carrier for information increased between 1993 and 1994. About 32 percent said they
would use a Medicare carrier in 1993, as compared to 42 percent in 1994.
Medicae Handbook Considered Helpful 
Source of Inormation: In both 1994 and 
1993, slightly over 40 percent (44 percent and 42 percent, respectively) of the 
beneficiaries surveyed said they had used their Medicare Handbook in the past year. 
In 1994 and 1993, 95 percent and 94 percent of the beneficiaries, respectively, who 
had used the handbook said it was either "very helpful" or "generally helpful." Most 
said the handbook is easy to understand, contains adequate information, and the prit
is easy to read. 
WI 
BENEFICIAIE AR SATISFID  PROCEING OF MEDICAR
CLS
Eighty-five percent of the beneficiaries said they are at least "generally" satisfied with 
the way Medicare carriers processed their claims. As Figure 2 ilustrates
, few 
beneficiaries said they were dissatisfied.  ."'..............""'..."'.
FIGUR 2

CL 
WI 
SATISFACTON  PROCEING

Very Satisfied (44%)
Claim Not Paid Yet (3%)
Very Dissatisfied (1%)
Generally Dlssallsfled (2%)
Neither (9\\) 
Generally Sallsfled (41%)
Figure 3 shows the number of beneficiaries expressing satisfaction in 1994 is about the 
same as that in 1993. The 
1993 and 1994 surveys had a response option that was not 
offered in 1989 and 1991. Also, in 1989, we asked only those beneficiaries who 
submitted their own claims about their satisfaction. Therefore, we were unable to 
determine if differences from year to year were significant. 
FIGUR 3

TRS 
WI CLS 
IN BENEFICIAY SATISFACTON  PROCEING

PERCENT 
100 
85"'..."............... 
6:3"."."..".".".."'...."."' 
70 .... 
60 ... 
50 .... 
40 .. 
80. 
20.... 
10 .... 
1989  1991  1998  1994 
YEAR 
_SATISFIED  IZ DISSATISFIED EH NEITHER/UNPAID CLAIM ........................................................................."....".."...""'.''".....'.'"'''''.....''.'.'................................................................................
Seventy-three percent of the beneficiaries said Medicare carriers pay claims quickly 
enough. This is about the same percentage who, in 1993 , said claims were paid 
quickly enough. 
Claim Processig Problem
Although 85 percent of the beneficiaries said they were generally satisfied or better 
with the way Medicare processed their claims, some had encountered diffculties. 
When given a list of possible reasons beneficiaries might be dissatisfied, 30 percent of
the beneficiaries surveyed identified one or more problems with their last Medicare 
claim. This is less than the 35 percent who cited one or more problems in 1993
, and
much less than the 67 percent who cited problems in 
1991. 
Figure 4 shows claim processing problems beneficiaries experienced prior to their 
claims being paid. Numbers in the figure represent the percent of all beneficiaries
surveyed. 
FIGUR 4

CLS

BENEFICIAY PROBLEMS PRIOR TO PAYMNT OF 
PERCENT 
40 ......."..""."...."'."".."..".."'...............................".
30 .."."................
20 ......................................  ""'''........mm...n............mmn'''''''''hmnn''''''''hnmn. 
10..".".  ...n...............umn..........m.mm''''..........mnn 
Problem Getllng Claim Status  Claim Payment Taking Too Long 
-1991 
1993  m; 1994 
Figure 5 shows claims processing problems beneficiaries experienced after their claims
had been paid. Although carriers send beneficiaries an Explanation of Medicare 
Benefits (EOMB) that explains what a carrier has paid on a Part B claim 
beneficiaries continue to have problems understanding the payments. Numbers in
Figure 5 represent the percent of all beneficiaries surveyed.  ...... ....../ ..  ..................................... . .....................:..'.:.-"...".."......."..'...."....."......""".........................,...... .....................................
FIGAURF 5 

CLS

BENEFICIAY PROBLEMS  PAYMNT OF 
PERCENT 
40 "'''..G8....................................................... 
30  -m...................mn.....................nmm'''''''''''''''''''''''''h................"'h..m.,--.... 
20 
16........... 
10 .. 
Undll."..dlfll 011111P1IYII.nt  Uadlntlndlnl CIIIIII Dlnl.1  Uld.'ll8adlnll EOW. 
.1991 
1993  mm 1994 
Benefciry Awareness of Appeal Rights 
Medicare beneficiaries have a right to appeal or request a review of any decision 
made on their Medicare claims. 
Six-nine percent of the beneficiaries we surveyed knew they could appeal or request 
a review of decisions Medicare carriers made about their claims. Table 3 shows that 
the number of beneficiaries who knew they could appeal or request a review of their 
Medicare claims significantly declined in 1994. 
TABLE 3

AWARNE OF APPEA RIGHT

BENEFfQ 
YEAR OF 
SuRVEY 
t\V? 
1989  76% 
1991  78% 
1993  75% 
1994  69% 
In 1994, only five percent of the beneficiaries said they had ever appealed a Medicare 
decision on their claims. This response was about the same in 
1993 and 1991 when six 
percent said they had appealed a decision.  In 1993 and 1994, we asked beneficiaries who had appealed about their understanding 
of final decisions, and their opinion about the fairness of the decision. Table 4 
shows 
that more than three-fourths of the beneficiaries who had appealed understood the 
appeal decision. Six-two percent of them thought their appeals were handled faily. 
TABLE 4
OPINONS ABOUT APPEA
Understood Final Decision  67%  76% 
Thought Appeal Handled Fairly  59%  62% 
BENEFICIA AR SATISFID WI CARR TELEPHONE SERVICE 
Only 26 percent of the beneficiaries we surveyed said they had tried to call their 
carrers. Figure 6 shows that 82 percent of the beneficiaries who had called their 
carriers said they were generally or very satisfied with the servce they received the last 
time they called.
FIGUR 6
WI 
SATISFACTON  PHONE SERVICE

Very Satisfied (37%) 
Very Dissatisfied (3%) 
Generally Dissatisfied (6%) 
Neither (9%) 
Generally Satisfied (45%)  ....... ."......... .................."........."'.....".........."...".....................".... ...........................-..-.-.-.-.....
Figure 7 shows the percent of beneficiaries who were satisfied with carrier telephone 
servce increased from 1993. The 1993 and 1994 surveys offered a "Neither Satisfied 
nor Dissatisfied" option that was not offered in the previous two surveys. Therefore 
we were unable to determine if differences in survey results were statistically 
significant for each of the four survey years. 
FIGUR 7

TRS 
IN BENEFICIAY SATISFACTON WH CALG CARRS

PERCENT 
100 
9 0 
 BO..  1I4.................  ii2.........."........ 
80 .... 

74...."'...."'.......".""... 
70.. 
60 .... 
50.". 
40... 
30 .... 
20 .... 
1989  1991  1993  1994 
YEAR 
12 
SATISFIED  DISSATISFIED  mJ NEITHER 
Prble Wih Carrr Telephone Servce 
Less than half of the beneficiaries who called their carriers were able to get through 
on the first try. However, 70 percent said they were able to get through within two 
tries. Table 5 shows this is a significant improvement over 1993 when 60 percent said 
they were able to get through within two tries.  . ...... 
.)..,.. ... ... ....... ,-. .  .. ... ....... ........:.. ....... -.. ..;..\ ..:.......... ............."...;...(.. ..: .:.".:  .,'. ......... .....:. ..-... .... .....:...:..................."............"......"..'.'.'.................'.'..'.'.......'.'.''.........................................................
TABLE 5 
CARRS 
CALING 
First Try  35%  46% 
Second Try  25%  24% 
Three or More Tries  32%  26% 
Never Got Through
The 26 percent of surveyed beneficiaries who had called their carriers were given a list 
of possible reasons why they might have been dissatisfied the last time they called. 
They could cite as many problems as they experienced. Fifty-two percent cited one or 
more problems in 1994, which is a slight increase over 1993 when 50 percent cited 
problems. 
Figure 8 ilustrates that some beneficiaries stil have problems 
getting through to the 
carriers to get questions answered. Numbers shown in the chart represent the percent 
of the 247 beneficiaries who had called their carriers. 
FIGUR 8
CAR
BENEFICIAY PROBLEMS GETTG THOUGH TO 
PERCENT 
100 
90 .......................... 
80 ................. 
...........nmn'."'....... ...nh"'.................mmm......................."''''''_n........... 
60 .  '''''''''''..nn....................-,..... 
50 
40 .. 
30 ... 
20 ... 
10 .... 
LINE BUSY  PUT ON HOLD 
.1989 
!21991 
1993  1994  ... ... . '
. ""
................ ........................................................................................".."...".'.'.'......'.'....'.'.........''.....'.'........'.''.'........''.'.'................ ...............
Figure 9 shows problems beneficiaries experienced after they got a telephone 
connection with their carriers. 
FIGUR 9
CAR 
BENCIAY  AFR GETTG THOUGH 
PROBLEMS  TO 
PERCENT 
40 "'''.....''.''................ 
30 "'.""'....".".""'''''''''....''.''.''..............  moo'''''''''''_n.... 
20 
.1!i..................................  ""''''''''__mn'''''''''__m..............--..........
14 13
10 
DIFFERENT  DISCOURTEOUS  ANSWERS NOl  QUESTION
ANSWER8  UNDERSTOOD  UNANSWERED 
.1989 
!;1994 
1991  wm 1993 
Problem wih Automated Voice 
Systems 
Some Medicare carriers use automated voice systems to handle telephone calls. 
Seventy-nine of the 247 beneficiaries who had cal1ed their carriers had experienced 
automated systems. Table 6 shows that more beneficiaries encountered automated 
voice systems in 1994 than in 1993 and 1991.
TABLE 6

AUTOMATED VOICE SYSTEM

fiTT;  LEPBY: 
AUTOMATED VOICE  23%
 31%  36%
MEDICARE EMPLOYEE
 77%
 69%
 64%

Seventy-three percent (58 of 79) of the beneficiaries using automated 
voice systems in
1994 said they encountered problems using the systems. This is higher than in 1993 
when only 60 percent experienced problems.  We asked those beneficiaries who had encountered automated voice systems to check 
possible problems they may have had. They could check one or more problems. 
Twenty-one of the 58 beneficiaries citing problems said they did not have a 
touch-tone telephone to respond to an automated voice system. 
Twenty-six of the 58 beneficiaries said they could not understand the directions 
given by automated systems. 
Seventeen of the 58 beneficiaries cited other problems, such as the system 
going too fast and diffculty getting to talk to a person when they needed. 
MOST BENEFICIA WERE NOT AWAR MEDICAR PAYS FOR SECOND 
SURGICAL OPINONS 
In 1994, slightly more than a third (36 percent) of all beneficiaries surveyed were 
aware that Medicare pays for a second opinion on the need for 
surgery. Table 6
shows that the number of beneficiaries who were aware that Medicare paid for second 
opinions has decreased each of the four survey years. 
TABLE 6
SECOND SURGICAL OPINONS
19$9 
AWARE OF SECOND OPINIONS  43%  41% 
MOST BENEFICIA KNW ABOUT PARTICIPATIG PHYSICIAS 
Medicare has "participating physicians" who agree to charge no more than the 
Medicare approved amount. Medicare pays 80 percent of the approved amount. A 
beneficiary is responsible for paying a deductible and a 20 percent coinsurance. 
Figure 10 shows that the number of beneficiaries who were aware of participating 
physicians in 1994 is about the same as in 1993 , but greater than the percent in 
1989 
and 1991.  ......................................."."..'............."..........'.'............'..'......'...'......'..'........................"......"....".....'..........".........."..'....................."'..."""."".'....".."................................................
FIGUR 
BENEFICIAY AWARNE OF PARTICIPATIG PHYSICIAS 
PERCENT 
100 
90 ............................  m''''''''''''''''''''''..mmm'''''''''''''''nmm... 
70 ... 
60 ... 
60 . 
40 ... 
so 
20 ... 
10 ... 
1988  1891  1995  1994 
YEAR 
Figure 11 shows that beneficiaries' use of "participating physicians" in 1994 has 
increased slightly. 
FIGUR 
BENEFICIAY USE OF PARTICIPATIG PHYSICIAS 
PERCENT 
100 
--,-....m....................................... 
80 
80 ........."""'''...''''''....''. 
70 ""........
66.........  66. 
60 
60 ... 
40 
so 
20 
10 .. 
1968  1991  1995  1994 
YEAR 
Twenty-two percent of beneficiaries we surveyed said they did not know their carriers 
provided information on participating physicians.  RECOMMENDATION
The number of beneficiaries who say, overall, they understand the Medicare program 
has increased since 1993. More beneficiaries are able to get specific information 
about their coverage, and this is possibly due to their going to more appropriate
sources for information. It seems that HCFA and SSA education efforts have been
successful in getting beneficiaries to call their carriers with Medicare questions rather
than their Social Security offices. However, some particular problems identified by 
beneficiaries need attention by HCFA.
Telephone Servce 
Most beneficiaries who had called their carriers for assistance were satisfied with the
servces they had received. However, the number of beneficiaries experiencing 
problems callng their carriers increased slightly from our 1993 survey. Further, 26 
percent of the beneficiaries had to call three or more times to reach their carriers, and 
4 percent were unable to reach their carriers at all. Most beneficiaries who 
encountered automated voice systems experienced problems with the systems. 
Home Health and Hospital Charges
Of the beneficiaries who have had home health services, fewer understood what 
servces Medicare paid for than did in our 1993 survey. Thirty-two percent of the 
beneficiaries who had received home health services did not understand what home 
health services Medicare had paid for. This is an increase from 1993 when only 13 
percent said they did not understand what home health servces Medicare paid for. 
Twenty-three percent of beneficiaries who had been hospitalized did not understand 
what hospital charges Medicare paid for. 
Physician Fees 
One-fourth of the beneficiaries surveyed did not know Medicare limits physicians' fees
for specific services.

Appeal Rights
Beneficiary understanding of appeal rights is decreasing. In 1994, only 69 percent 
knew about their appeal rights, compare to 75 percent in 1993. 
Second Surgical Opinions
Almost two-thirds (64 percent) of the beneficiaries surveyed did not know that 
Medicare wil pay for a second opinion on the need for surgery. We reco=end that HCFA develop a plan for improvig 
beneficiar satifacton and 
understading in the trouble areas mentioned above. 
We recognize that this beneficiary survey alone does not validate that major problems 
exist. It does, however, target important areas that are worthy of more attention. As 
HCFA develops a plan of action to deal with the trouble spots, we will be glad to
assist by sharing with HCFA results of recently completed and on-going studies.
Among those are studies on EOMBs and home health servces.  AGENCY COMMENTS 
AGENCY COMMNT 
The HCFA Administrator commented on our report, and concurred with our 
recommendation. He reported that HCFA wil soon be conducting a number of
demonstrations designed to improve carrier telephone service. Further, HCFA has
planned an initiative to increase beneficiary awareness of Medicare coverage for 
second surgical opinions and is revising the Explanation of Medicare Benefits. 
Appendix C shows the full text of the comments provided by HCFA.  ENDNOTES 
Health Care Financing Administration, United States Department of Health 
and Human Servces  HCFA Statistics. 
July 1994. 
Office of Inspector General, United States Department of Health and Human 
Servces.  A Survey of Medicare Beneficiary Satisfaction.  OAI-04-89-89040. 
Office of Inspector General, United States Department of Health and Human 
Services.  Medicare Beneficiary Satisfaction: 1991.  OEI-04-90-89030. 
Office of Inspector General, United States Department of Health and Human 
Servces.  Medicare Beneficiary Satisfaction: 1993 . OEI-04-92-00480. APPENDIX A
REPONSES TO 1994 SURVEY OF MEDICAR BENEFICIAY 
SATISFACTON 
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 rounding.

For Questions 5 , 6, 14, 18, and 20, respondents could check more than one 
choice. The sum of the percentages wil total more than 
100. 
Question  Responses  Percentage 
PART 1: MEDICAR COVERAGE 
thi.. 
In general, do you 
The Medicare program is understandable? 
Yes	 745 
198 
Not Answering: 59 
You can get information about Medicare when you need it? 
Yes  713

Don t Know 194

Not Answering: 44
Medicare pays your claims quickly enough? 
Yes  698

130

Don t Know 129

Not Answering: 45 ---------------------------------------------------------------------------------------------------------
Question  Responses  Percentage 
Thinkin in a hospita for at 
g about the most recent time you were a patient 
least one night, was it clear to you what Medicae paid for? 
one answer. 
(Check 
I have not been in the 
hospital for at least 
one night since I have 
had Medicare.  323
Yes, it was clear what 
Medicare paid for.  383
not clear what 
, it was 
Medicare paid for.  140
I do not remember if it 
was clear what Medicare 
paid for. 
Medicare has not yet paid 
the hospital. 
Not Answering: 61 
Did you know  before today that Medicae lits how much doctors ca charge 
you for specifc servces? 
Yes(cid:1) 716 
250 
Not Answering: 36 
A - 2 ---------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentage 
Thg 
about the most recent tie you received  in your
medica servces 
home  home health agem;y, was it clear to you what Medicae paid for? 
from a 
aner. 
one 
(Check 
I have not received medical 
services from a home health 
agency since I have had Medicare.  709
Yes, it was clear what Medicare 
paid for.  105
not clear what 
, it was 
Medicare paid for. 
I do not remember if it was 
clear what Medicare paid for.
Medicare has not yet paid for 
the home health services. 
I don t know what Medicare 
paid for.
Not Answering:

What tyes of medical insurance do you or your spouse have in addition to 
Medicae? 
(Check al that apply)
(N = 918 - Number Responding to Question) 
Do not have additional 
insurance coverage 
192 
Medicaid 
Health insurance through your

or your spouse  current 
former employer  329 
Private Medicare supplement  248 
Other 
135 
Not Answering: 84

A - 3 ----------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentage 
PART 2: GETTING INORMTION ABOUT MEDICAR 
The followig are some places people might go to get aners if they have
questions about what Medicae pays for. Where would you go to get
inormation about what Medicae pays for? 
(Check al that apply. 
(N = 973 - Number Respondig to Question) 
Your doctor s office  486 
Friend or relative 
AAP or other 
membership organization  135 
Insurance company that 
processes your Medicare claims
 411 
Social Security office  337 
Local senior citizens' group 
Insurance salesperson

Medicare Handbook  518 
Medicare Peer Review 
Organization (PRO) 
107 
Other 
Not Answering: 29 
When you have needed specifc inormation about what Medicae pays for 
how often were you able to get the inormation you needed? 
one answer. 
(Check 
Most of the time 
403 
Some of the time 
141 
Seldom or never 
I have never needed information  360 
Not Answering: 39

A - 4 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentages
lited below are ways the Governent could use to tell people about changes 
in the Medicae program. Whch way is best for notig you of Medcae 
changes?
ONLY ONE
(please check 
Announcements on television 
and radio 
Pamphlets describing 
the changes 376
Notices included with my 
Social Security check 164
Medicare Handbook 366
New 
Announcements in the newspaper
Speeches or presentations by
Medicare representatives
Other
Not Answering: 27
How many ties  Medicare Handbook
in the past year have you used your 
one answer.)
(Check 
1 to 3 times 331
More than 3 times
I have never used the
12)
Medicare Handbook (Skip to Q- 297
I do not know what the 
Medicare Handbook is (Skip to Q-12) 27 
I do not recall receiving a 
12) 
Medicare Handbook (Skip to Q- 191 
Not Answering: 79 
thi 
10.(cid:1) Do you  Medicare Handbook is:
the 
one anwer.
(Check 
(N = 408 - Number Who Had Used Handbook)
Very Helpful  123 
Generally Helpful  249 
Generally Not Helpful 
Not Helpful 
Not Answering: 17
A - 5 -------------------------------------------------------------------------------------------------------------
Question  Responses  Percentages 
Thg 
11.(cid:1) Medicae Handbook you have received, would you say
about the 
that. 
Yes 
(N = 408 - Number Who Had Used Handbook)
No
The wording is easy to understand?
312 
Yes 
Not Answering: 38 
No 
The lettering is large enough to read?
326 
Not Answering: 57 
It covers enough information?
Yes  290
Not Answering: 76 
ClS 
PART 3: MEDICAR 
12.(cid:1) Did you know  before today that your doctors are supposed to fie your 
Medicare clais for you? 
Yes  891 
Not Answering: 28 
13.(cid:1) Overal!, how satified are you with the way Medicare has processed your
clais? 
Very Satisfied  422
Generally Satisfied  390
Neither Satisfied nor Dissatisfied 
Generally Dissatisfied 
Very Dissatisfied 
Medicare has not yet paid claim 
Not Answering: 45 
A - 6 -------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentages 
14.	 Did you have any of the followig problems the last tie you had a Medicae 
clai for a doctor s viit? 
as manv as apply 
(Check 
(N = 920 - Number Respondig to Question) 
I had difficulty getting information
on the status of my claim.
I did not understand what part of 
my claim Medicare paid and why. 107 
I did not understand why Medicare 
denied the claim.
Medicare took too long to pay. 
I did not understand the notice 
Medicare sent (EOMB). 111 
I did not have a problem with my
Medicare claim. 670 
Other 
Not Answering: 82

PART 4: CALLING MEDICAR 
15.	 Have you ever tred to call the insurance company that processes your 
Medicae claims? 
Yes  247 
No (Skip to Q-21)  692 
Not Answering: 63 
Thg 
16.	 about the last tie you tred to ca, how many tres did it tae you to 
reach them? 
one answer. 
(Check 
Caer) 
(N = 247 - Number Who Had Called 
First Try  108 
Second Try 
Three or More Tries
Never Got Through

Not Answering: 10

A -
 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentage 
17.  How satisfied were you with the servce you received the last tie you caed? 
(Check Q! aner. 
(N = 247 - Number Who Had Caed Caer) 
Very Satisfied
Generally Satisfied  109
Neither Satisfied nor Dissatisfied 
Generally Dissatisfied 
Very Dissatisfied 
Not Answering: 3

cag 
18.  Listed below are possible problems someone might have when  the 
Medicae insurance company. Did you have any problems the last 
tie you
caed? 
as manv as apply 
(Check 
(N = 246 - Number Responding to Question) 
Was not able to get question answered 
Line was busy

Got different answers from 
different people 
Put on "hold" too long 
Could not understand the answer 
they gave me 
Person answering the call 
was not very courteous 
I did not have a problem with 
the service I received 
141 
Other 
Not Answering: 1

19.  Some Medicae inTsuhrangce  companes use an automated voice sytem to handle 
telephone cas.  about the last tie you caed the Medicae 
inurance company that processes your clai, how was your ca anered? 
Caer) 
(N = 247 - Number Who Had Caed 
By an Automated Voice 
By a Medicare Employee 
(Skip to Q-21)  143 
Not Answering: 25

A- 8
 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentages 
20.  Lited below are possible reasons that someone would be ditified with 
cag 
the Medicae inurance company and gettg an automated voice. Did 
you have any of these problems the last tie you caed? 
as many as applv 
(Check 
(N = 58 - Number Responding to Question) 
I did not have a touch-
tone telephone 
I could not understand the directions 
Other 
Not Answering: 21

CLS 
PART 5: APPEALING 
21.	 Someties people disagree with the decisions made on their Medicae clai. 
When this happens, you may appeal or request a revew of those deciions. 
Did you know  before today that you could appeal or request a review? 
Yes	 657 
289 
Not Answering: 56

22.	 Have you ever appealed a decision made by Medicae on a clai you 
submitted? 
Yes

No 
(Skip to Q-25)  890

Not Answering: 65

23.	 Did you understand the fial decision made on your clai? 
(N = 47 - Number Who Had Appealed) 
Yes 
Not Answering: 10

24.	 Do you thi your appeal was handled fairly? 
(N = 47 - Number Who Had Appealed) 
Yes 
Not Answering: 10

A- 9
 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Question  Responses  Percentage 
PART 6: GETTG SECOND OPINONS 
25.(cid:1) If your doctor reco=ends that you have surgery, Medicae wi help you pay 
to get the opinon of another doctor to make sure the surgery is real 
necessary. Were you aware  before today that Medicae would help to pay for 
you to get a second opinon before havig surgery? 
Yes(cid:1) 349 
610 
Not Answering: 43

Thg 
26.(cid:1) about the last tie you had non-emergency surgery, did you get a 
second doctor s opinon before havig the surgery? 
Yes(cid:1) 138 
412 
I have never had non-emergency 
surgery  391 
Not Answering: 61

PART 7: "PARTICIPATIG DOCTORS" PROGRA 
27.(cid:1) Medicae has "partcipating doctors" who agree to charge no more than 
Medicare s approved amount. Medicae pays 80% of the approved amount. 
You are onJy responsible for payig the deductible and the 20% coinurance. 
Before today. had you ever heard about Medicae "parcipatig docors?" 
Yes(cid:1) 786 
176 
Not Answering: 40

28.  Are any of your doctors "participatig doctors?" 
Yes  680 
Don t Know  215 
Not Answering: 37 
A - 10 Question  Responses  Percentage 
30.	 Have you ever contacted the insurance company that processes your Medicae 
clai to get tbe names of doctors who are "parcipatig doctors?" 
Yes 
701 
I did not know I could get this 
information from the insurance 
company that processes my claims  197 
Not Answering: 43 
Thg 
31.	 about the future, how likely are you to select a "partcipatig docor
for health cae servces? 
one answer. 
(Check 
Likely to select 
participating doctor  643 
Not likely to select 
participating doctor 
Wil not matter if doctor 
is "participating  210 
Not Answering: 75 
A - 11
 . .
....... 
.....
APPENDIX B
ANALYSIS OF REPONDENT VS. NON-REPONDEN 
A consideration in surveys of this type is that the results may be biased if non-
respondents are significantly different from respondents. To determine whether 
significant differences exist in this survey, we performed various analyses, including a 
comparison of age and gender for the 1002 respondents and the 277 non-respondents. 
The analyses revealed no significant difference, which suggests that our survey results 
were not biased. 
ANALYSIS BY AGE 
The average age for respondents was 74, compared to age 77 for non-respondents. A 
means test revealed that the difference in average ages for the two groups was 
statistically significant. Therefore, to analyze for potential bias related to age, we 
divided respondents into two groups, those younger than 73 1/2 and those older than 
that age. We then performed a t-test on each group s responses to three key 
questions on the questionnaire (Questions la, Ib
, and lc). Those three questions 
posed to all respondents, relate to program understandability, availabilty of 
information, and claims processing quickness. That is, the frequency of positive and 
negative responses for the two age groups was not significantly different. Therefore 
no statistical evidence of age bias was shown. 
ANALYSIS BY GENDER 
The analysis by gender showed that the distribution of male and female respondents 
was not comparable to the distribution of non-respondents. 
. SAMLE  REPONDENT  N().!HrE$POM? 
43%
 41%
 47%

FEMA

57%
 59%
 53%

Due to the significant percentage differences between male and female respondents 
versus non-respondents, additional analysis was necessary. 
We performed a t-test on each gender s responses to three key questions on the 
questionnaire (Questions la, Ib, and lc). The t-tests revealed no statistically 
significant differences between responses to those questions by males and responses to 
those questions by females.  ANALYSIS BY TIM OF REPONSE 
As an additional guard against obtaining biased results, some surveys similar to this 
one are reviewed for differences which may exist between early and late responses. 
The rationale is that late respondents and non-respondents may share certain 
tendencies. For example, when compared to early respondents, late respondents could 
hold more negative (or, at least, less enthusiastic) opinions. 
To test for possible late response bias in this survey, the first 748 responses (75 
percent) were compared to the last 244 responses. 
Again, three key questions were used for analysis. The early responses to the key 
questions were, cumulatively, 75. 3 percent positive. The later responses were 75. 
percent positive. Although this difference is not statistically significant, we ran the t-
test, and found no statistical difference in responses of the early and late responses.  APPENDIX C 
HCFA COMMENTS 
C - 1  -. 
(" 
Health Care 
DEPARTMENT OF HEALTH &. HUMAN SERVICES 
Financing Administration 
l."l.g  Memorandum 
DATE  APR 28 
1995 
FROM  Bruce C. Vladec 
Administrator V 
SUBJECT  Offce of Inspector General Draft Report: "Medicare Beneficiary 
Satisfaction: 1994 " (OEI-04-93-00l40) 
June Gibbs Brown 
Inspector General 
We reviewed the subject draft report which examined Medicare beneficiaries' experience 
and satisfaction with Medicare servces. 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 recommendation. 
Attachment 
SAtG 
PDlG 
DIG-
DlG-
DIG- 1C)' 0rT  ;':J
AIG-CFAA  z-;
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OGC/IG  ;T1 
EXSEC  (c"  L-V 
DATE SENT (cid:1) X' ro  Comments of the Health Care Financing: Administration (HCFA) 
on Offce of Inspector General (OIG) Report: 
Medicare Beneficiarv Satisfaction: 1994" 
OEI-04-93-00140 
Recommendation
OIG 
HCFA should develop a plan for improving beneficiar satisfaction and understanding in

the trouble areas mentioned in the report; i.e, telephone servce, home health and
hospital charges, physician fees, appeal rights, and second surgical opinions.

HCFA Response 
We concur. Very soon we will be conducting a number of demonstrations designed to 
improve telephone servce. Our consumer intiative will address second surgical opinions. 
The remaining recommendations will be addressed in the 
Exlanation of Medicare 
Benefits revision. 
If a 1995 survey is planned, we would like to suggest including questions pertaining to 
managed care or a separate survey devoted to managed care issues: