Department of Health and Human Services 

OFFICE OF


INSPECTOR GENERAL


Beneficiary Satisfaction with 

1996 Medicare Handbook 

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JUNE GIBBS BROWN ~v 

z Inspector General
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++ FEBRUARY 1997 

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OFFICE OF INSPECI’OR 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. 

The 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, Team Leader Stuart Wright, I+ogram Specialkt


Jason Stanfield, Contractor Linda Moscoe, Technical Suppoti


Jackie Watkins, Program Analyst Barbara Tedesco, Statistician


Joe Townsel, I?rogramAnalyst


Peggy Daniel, Program Analyst


Tammy Hipple, Statistician


To obtain a copy of this report, call the Atlanta Regional Office at 404-331-4108. 
> 

Department of Health and Human Services 

OFFICE OF


INSPECTOR GENERAL


Beneficiary Satisfaction with 

1996 Medicare Handbook 

@ SERVICE$ 

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# JUNE GIBBS BROWN 

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@-- FEBRUARY 1997 ‘*dza OEI-04—%00280 
EXECUTIVE SUMMARY 

PURPOSE 

To determine beneficiary satisfaction with the format and content of the 1996 

Medicare Handbook. 

BACKGROUND 

Prior to 1996, the Health Care Financing Administration (HCFA) mailed a Medicare 

handbook to new enrollees, but did not mail it to all beneficiaries unless major 

changes occurred in the Medicare program. In 1996, HCFA mailed a new handbook 

to all beneficiaries. However, to contain the cost of printing and mailing, HCFA cut 

the number of pages of the 1996 Medicare Handbook by revising the format and 

including fewer details. HCFA officials are now considering the feasibility of mailing a 

new handbook to all beneficiaries every year. 

To help them plan future handbooks, HCFA requested that we conduct a survey of 

beneficiaries to get their opinions on the new fo;mat and content. Some 538 

beneficiaries responded to our survey. 

FINDINGS 

About a fourth of the respondents had not received the 19% Me&are Handbook 

Most beneficiaries who did receive it were satisfied with the format and content of the 

1996 handbook 

Ninety-one percent said the new handbook was clearly written. 

Ninety-three percent said it provided enough information to understand Medicare 

benefits. 

Ninety-five percent thought it would be helpful to them. 

Eighty-one percent of beneficiaries who remembered receiving previous handbooks 

preferred the 1996 shorter edition over the previous longer editions. 

i 
Opinions were mixed on frequency of distribution for handbooks 

Forty-eight percent said they would like to receive a new handbook every year. 

Forty-five percent said they would like to receive a new handbook only when there 

were major changes in the Medicare program. 

AGENCY @MMENTS 

The HCFA Administrator commented on our report. Since a fourth of the 

beneficiaries said they did not receive the handbook, HCFA plans to examine their 

distribution strategies to determine ways to improve dissemination of the handbook. 

ii 
TABLE OF CONTENTS 

PAGE 

ExmuTM3 SUMMARY 

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..1


FINDINGS


� AFourth of Beneficiaries Had not Received Handbook . . . . . . . . . . . . . . . . . 2


� Most Were Satisfied with in....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2


c About Three-fourths Typically Use Handbook . . . . . . . . . . . . . . . . . . . . . . ...2


c Opinions Were Mixed About Frequency of Handbook Distribution . . . . . . . . . 2


AGENCY COMM13NTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3


APPENDIX 

Beneficiary Responses to Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..A-l 

HCFAComments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..B-l 
INTRODUCTION 

PURPOSE 

To determine beneficiary satisfaction with the format and content of the 1996 

Medicare Handbook. 

BACKGROUND 

Every year, the Health Care Financing Administration (HCFA) publishes a Medicare 

handbook for beneficiaries that explains how the Medicare program works and what 

the benefits are. Prior to 1996, HCFA mailed the handbook to new enrollees, but did 

not mail it to all beneficiaries unless major changes occurred in the Medicare program. 

Handbooks were available upon request from several sources, such as Social Security 

offices, HCFA regional offices, and senior citizen organizations. 

In 1996, HCFA mailed a new handbook to all beneficiaries. However, to contain the 

cost of printing and mailing, HCFA cut the number of pages of the 1996 Medicare 

Handbook by revising the format and including fewer details. HCFA officials are now 

considering the feasibility of mailing a new handbook to all beneficiaries every year. 

To help them plan future handbooks, HCFA requested that we conduct a survey of 

beneficiaries to get their opinions on the format and content. 

METHODS 

In July 1996, we mailed questionnaires to 749 Medicare beneficiaries. Beneficiary 

participation in the sumey was voluntary. A total of 538 beneficiaries returned 

completed questionnaires, for a response rate of 72 percent. 

Percentages in this report are based on the number of beneficiaries answering each 

question. Estimates are within 5.0 percent of the true value at the 95 percent 

confidence level for most questions. Appendix A shows beneficiary responses to the 

questionnaire, 

A consideration in surveys of this type is that the results may be biased if nonrespondents 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 542 respondents and the 232 non-respondents. 

The analyses revealed no significant difference, which suggests that our survey results 

were not biased with respect to these factors. 

—— .— — 

We conducted this inspection in accordance with the Quality Standards for Iiwpections 

issued by the President’s Council on Integrity and Efficiency. 

1 
FINDINGS


A FOURTH OF THE BENEFICIARIES RESPONDING TO OUR SURVEY HAD 

NOT RECEIVED THE 19% M!?DIC4RE M4NDBOOK 

�	 Twenty-seven percent of the respondents surveyed said they had not received 

the 1996 Medicare Handbook. 

MOST BENEFICIARIES WHO DID RECEIVE lT WERE SATISFIED WITH THE 

FORMAT AND CONTENT OF THE HANDBOOK 

� Ninety-seven percent said the wording was easy to understand. 

� Ninety-eight percent said the lettering was large enough to read. 

�	 Ninety-three percent said the new handbook provided enough information to 

understand Medicare benefits. 

� Ninety-five percent thought it would be helpful to them. 

� Ninety-one percent said it was clearly written. 

�	 Eighty-one percent of beneficiaries who remembered receiving previous 

handbooks preferred the 1996 shorter edition over the previous longer editions. 

ABOUT THRE13FOURTHS OF BENEFICIARIES TYPICALLY USE THE 

HANDBOOK 

�	 Seventy-three percent of beneficiaries who remembered receiving previous 

handbooks said they generally use their handbook at least once a year. 

�	 Thirty-seven percent of the beneficiaries who had received the 1996 handbook 

said they had used it. (As the 1996 handbook was mailed only a few months 

prior to our survey, we are unable to determine a year’s use for it.) 

BENEFICIARY OPINIONS WERE MIXED ABOUT HOW OIVEN THEY 

WANTED TO RECEIVE A NEW HANDBOOK 

� Forty-eight percent said they would like to receive a new handbook every year. 

�	 Forty-five percent said they would like to receive a new handbook only when 

there were major changes in the Medicare program. 

�	 Six percent of the beneficiaries said they would like to receive a new handbook 

every 3 years. 

2 
AGENCY COMMENTS 

The HCFA Administrator commented on our draft report. Since a fourth of the 

beneficiaries said they did not receive the handbook, HCFA plans to examine their 

distribution strategies to determine ways to improve dissemination of the handbook. 

Appendix B shows the full text of the comments provided by HCFA. 

3

----------------------------- ----------------------------- ---------------------------- ------------------------ --

APPENDIX A 

RESPONSES TO 19% MEDICARE HANDBOOK SURVEY 

Question Response Percentage 

1.	 Medicare recently mailed the 19% Medicare Handbook to each beneficiary. It 

is a 3@age booklet with a two-page introduction. It h= a picture of a portion 

of the American flag on the cover. 

Did you receive your 1996 Medicare Handbook? 

Yes 392 73% 

No 146 27% 

2. Have you used your new 1996 Medicare Handbook yet? 

Yes 146 37% 

No 246 63% 

3.	 Thinking about the 1996 Medicare Handbook you have receiv@ would you say 

that... 

a. The wording is easy to understand? 

Yes 369 97% 

No 13 3% 

b. The lettering is large enough to read? 

Yes 380 98% 

No 7 2% 

A-1

Question Responses Percentage 

4.� Does the 1996 Medicare Handbook pruvide enough information for you to 

understand your Medicare benefits? 

Yes 354 93% 

No 27 7% 

If No, please explaiw 11 Responded 

Tests Which Are Not Covered I 2 

Coverage for Mental and Emotional Disabilities I 1 

Medigap Insurance 1 I 

Limits to Medicare Benefits I 1 

Coverage for Dental Care 1 

HMOS I 1 

Coverage for Drugs I 1 

Emergency Room Coverage 1 I 

IIMaximums for Lifetime Benefits I 1 II 

Coverage for Glasses Following Cataract Surgery 1 

5. Do you think the 1996 Medicare Handbook will be: 

(Check one.) 

Very Helpful 166 42% 

Generally Helpful 206 53% 

Generally Not Helpful 11 370 

Not Helpful at All 7 270 

A-2

Question Responses Percentage 

6. was any part of the new 1996 Medicare Handbook confusing to you? 

Yes 30 8% 

No 337 92?40 

If you answered Y- which part was confusing 16 Responded 

Definition of Home Care I 1


Reserve Days I 1


How Much Doctors Can Charge I 1


Skilled Nursing Home Coverage I 1


Hospice Care


Unlimited Benefit Period (Page 7) 1


Difference between Part A and Part B 1


Coverage for Tests I 1


Coverage for Outpatient Treatment I 1


Home Health I 1


Medigap Insurance 1
 I


Exceptions to the General Rules 1


A-3

----------------------------------------------------------------------------------------------------------------

Question Responses Percentage 

7.� Medicare Handbooks are given to beneficiaries when they enroll in the 

Medicare progranq and were mailed to all beneficiaries in 1990. 

The 1996 Medicare Handbook is less detailed than previous editions of the 

handbook. Therefore, it has half the number of pages than previous editions. 

Please compare the 1996 Medieare Handbook to the longer, more detailed 

Medicare Handbook we issued in the past. Tell us which one you like best. 

(please check ONLY ONE.) 

I prefer the shorter edition, 

even though it has fewer details 

(like the 1996 Medicare Handbook). 

I prefer the longer edition with 

more details (like previous 

Medicare Handbooks). 

I don’t remember the previous 

editions, so I cannot compare 

178 469Z0 

42 11% 

them to the 1996 Medica;e Handbook. 168 43% 

8. How many times a year do you generally use your Medicare Handbook? 

(Check ~.) 

1 to 3 times 

More than 3 times 

I have not ever used 

the Medicare Handbook. 

I do not recall receiving 

a Medicare Handbook before 

new one was sent to me. 

188 49% 

46 12% 

84 22% 

63 17% 

A-4

Question Responses Percentage 

9.� A new Medicare Handbook is printed every year, even if there are few changes 

to the Medicare program. How often would you like to receive a new copy of 

the handbook? 

(please check ONLY ONE.) 

Every year, regardless of how 

minor the changes are in the 

Medicare program. 180 48% 

Every 3 years. 24 6% 

Only when there are major 

changes in the 

Medicare program. 168 45% 

Other: 3 19?0 

Every 5 Years 1 

Every 4 Years, Plus When Major Changes 1 

Often Enough to Keep Abreast of Changes 1 

A-5

10. Do you have suggestions for improving the handbook to make it more useful to 

beaiciarieslike-jcmrself? -

Send only the changes in a page or two 3 I 

Make the wording simpler--more elementary 3 I 

Eliminate hard glossy cover--too expensive 3 

I 

Keep instructions on a topic together--do not split 2


it up (e.g., managed care starts on page 4, and is


continued on pages 19 and 20.)


Give more details as to what is covered and what is 2 

not covered 

Just say what ~ covered, and omit what is @ 1 

covered 

Show an example of an EOMB with explanation of 1 

what the figures mean 

Make it smaller 1 

Cut all the ifs, ands, and buts 1 

Make the handbook a 3-ring binder. Then send 1 

only pages that changed 

Send to persons when they are age 64 so they will 1 

know they can apply early 

Avoid using shaded boxes 1 

A-6

APPENDIX B 

HCFA COMMENTS 

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Washington c),c, 292871 

OEC 24 JW


T(’) :	 June Gibbs Brown 

Inspector General 

SUBJECT: Drafl Repofl on the 1996 Medicure M-wibook 

Thank you for sharing the recent working drafl report concerning the /996 Mwkarw Hcmibwk 

We requested thk survey to gauge customer satisfaction with our new Hmibook design. The 

findings cmthe content, h-mat and distribution of this publication were helpful. It was gratifying 

to learn thatthe vast majority of our beneficiaries were satisfied with the infommtion and i~s 

presentation and that most beneficiaries use the I-iundbuok regularly, 

We were interested in the finding th~t 28 percent of those surveyed stated that they had not 

received the /996 Handbook. This is surprising considering the attention generated by last year’s 

mailing. We believe fbrther evaluation of that segment of the beneficiary population will be 

helptid in our efforts to continuously improve the quality of bot h content and distribution of our 

informationalmaterials. We plan to carefilly examine our distribution strategies in order to define 

the group reportingnmreceipt and to enhance the effectiveness of the distribution. We hope 

members of your staff that are familiar with these issueswill be able to work with us on this 

initiative, 
n ,* ,lmcr# ~ 

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$ DEPARTMENT OF HEALTH& HUMAN SERVICES Office of Inspector General ~ 

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%%4-d,a Memorandum 

Date ~ 5 ~ 

~ro~	 June Gibbs Brown 

Inspector Gener 86 (@ 

OIG Final Repor : ‘Beneficiary Satisfaction with 1996 Medicare %@C~Handb~ok,,, OEI-O P -96-00280 

Bruce C. Vladeck


“To Administrator


Health Care Financing Administration


Attached is our final inspection report on beneficiary satisfaction


with the 1996 Medicare Handbook. More than 500 randomly selected


beneficiaries nationwide responded to our survey about their


satisfaction with the content and format of the new handbook.


Most Medicare beneficiaries who received the new handbook thought it


provided them with enough information to understand Medicare


benefits. Actually, most preferred the condensed 1996 version to


the more detailed earlier versions of the handbook. However, 27


percent said they had not received the 1996 handbook. Beneficiary


opinions were mixed on how often they would like to receive the


handbook. The Health Care Financing Administration (HCFA) plans to


examine their distribution strategies to determine ways to improve


dissemination of handbooks.


We appreciate your comments on our draft report. We are pleased to


hear that HCFA is examining distribution strategies to determine


ways to improve dissemination of the handbook.


If you have any questions or comments, please call me or George 

Grob, Deputy Inspector General for Evaluation and Inspections, or 

have your staff contact Mary Beth Clarke at (202) 619-2481. 

Attachment


cc : Melissa Skolfield


Assistant	 Secretary for


Public Affairs


David Garrison


Principal Deputy Assistant


Secretary for Planning


and Evaluation


Richard J. Tarplin


Assistant Secretary


for Legislation-Designate


John J. Callahan


Assistant Secretary for


Management and Budget
 . 
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f-! ,**WC* ‘ 

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# DEPARTMENT OF HEALTH& HUMAN SERVICES offiCe Of Inspector General s

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-4+%,na Memorandum 

Date FEB 5 ~ 

From June Gibbs Brown 

@& &

Inspector Gener 

OIG Final Repor : ‘Beneficiary Satisfaction with 1996 Medicare


S@@Handbook,,l OEI-() P -96-00280


Bruce C. Vladeck 

“To Administrator 

Health Care Financing Administration 

Attached is our final inspection report on beneficiary satisfaction


with the 1996 Medicare Handbook. More than 500 randomly selected


beneficiaries nationwide responded to our survey about their


satisfaction with the content and format of the new handbook.


Most Medicare beneficiaries who received the new handbook thought it


provided them with enough information to understand Medicare


benefits. Actually, most preferred the condensed 1996 version to


the more detailed earlier versions of the handbook. However, 27


percent said they had not received the 1996 handbook. Beneficiary


opinions were mixed on how often they would like to receive the


handbook. The Health Care Financing Administration (HCFA) plans to


examine their distribution strategies to determine ways to improve


dissemination of handbooks.


We appreciate your comments on our draft report. We are pleased to


hear that HCFA is examining distribution strategies to determine


ways to improve dissemination of the handbook.


If you have any questions or comments, please call me or George


Grob, Deputy Inspector General for Evaluation and Inspections, or


have your staff contact Mary Beth Clarke at (202) 619-2481.


Attachment


cc : Melissa Skolfield


Assistant	 Secretary for


Public Affairs


. David Garrison


Principal Deputy Assistant


Secretary for Planning


and Evaluation


Richard J. Tarplin


Assistant Secretary


for Legislation-Designate


John J. Callahan


AssisCant Secretary for


Management and Budget
 . 
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# DEPARTMENT OF HEALTH& HUMAN SERVICES OffIceof Inspector General 

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Memorandum 

D.!e ~ s ~


~[om June Gibbs Brown d


Inspector Gener &!?j&


S@eCtHandbook,,, 

OIG Final Repor 

OEI-Ov

:
 ‘Beneficiary Satisfaction with 1996 Medicare

-96-00280


Bruce C. Vladeck 

“To Administrator 

Health Care Financing Administration 

Attached is our final inspection report on beneficiary satisfaction


with the 1996 Medicare Handbook. More than 500 randomly selected


beneficiaries nationwide responded to our survey about their


satisfaction with the content and format of the new handbook.


Most Medicare beneficiaries who received the new handbook thought it


provided them with enough information to understand Medicare


benefits. Actually, most preferred the condensed 1996 version to


the more detailed earlier versions of the handbook. However, 27


percent said they had not received the 1996 handbook. Beneficiary


opinions were mixed on how often they would like to receive the


handbook. The Health Care Financing Administration (HCFA) plans to


examine their distribution strategies to determine ways to improve


dissemination of handbooks.


We appreciate your comments on our draft report. We are pleased to


hear that HCFA is examining distribution strategies to determine


ways to improve dissemination of the handbook.


If you have any questions or comments, please call me or George


Grob, Deputy Inspector General for Evaluation and Inspections, or


have your staff contact Mary Beth Clarke at (202) 619-2481.


Attachment


cc : Melissa Skolfield


Assistant	 Secretary for


Public Affairs


David Garrison


Principal Deputy Assistant


Secretary for Planning


and Evaluation


Richard J. Tarplin


Assistant Secretary


for Legislation-Designate


John J. Callahan


Assistant Secretary for


Management and Budget
 . 
� 

/ ,* SSWC8* ~ 

*4+ + 

2 

** DEPARTMENT OF HEALTH& HUMAN SERVICES OffIce of Inspector General 

~ 

5 

%’%~bv,,a 4c 

Memorandum 

Date ~ 5 ~ 

~~0~	 June Gibbs Brown 

Inspector Gener 86 & 

OIG Final Repor : ‘Beneficiary Satisfaction with 1996 Medicare 

S@eCtHandbook,,, OEI-OP -96-00280 

Bruce C. Vladeck


“To Administrator


Health Care Financing Administration


Attached is our final inspection report on beneficiary satisfaction


with the 1996 Medicare Handbook. More than 500 randomly selected


beneficiaries nationwide responded to our survey about their


satisfaction with the content and format of the new handbook.


Most Medicare beneficiaries who received the new handbook thought it


provided them with enough information to understand Medicare


benefits. Actually, most preferred the condensed 1996 version to


the more detailed earlier versions of the handbook. However, 27


percent said they had not received the 1996 handbook. Beneficiary


opinions were mixed on how often they would like to receive the


handbook. The Health Care Financing Administration (HCFA) plans to


examine their distribution strategies to determine ways to improve


dissemination of handbooks.


We appreciate your comments on our draft report. We are pleased to


hear that HCFA is examining distribution strategies to determine


ways to improve dissemination of the handbook.


If you have any questions or comments, please call me or George


Grob, Deputy Inspector General for Evaluation and Inspections, or


have your staff contact Mary Beth Clarke at (202) 619-2481.


Attachment


cc : Melissa Skolfield


Assistant	 Secretary for


Public Affairs


David Garrison


Principal Deputy Assistant


Secretary for Plaming


and Evaluation


Richard J. Tarplin


Assistant Secretary


for Legislation-Designate


John J. Callahan


Assistant Secretary for


Management and Budget

,*,Sn’let, ~ 

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% < DEPARTMENT OF HEALTH & HUMAN SERVICES OffIce of Inspector General 

++%,m Memorandum 

FEB 5 W? 

Date “/s/ June G. Brown 

~rom	 June Gibbs Brown 

Inspector General 

OIG Final Report : It
Beneficiary Satisfaction with 1996 Medicare


S@eCtHandbook,,, c)EI-04-96-00280


Bruce C. Vladeck


To Administrator


Health Care Financing Administration


Attached is our final inspection report on beneficiary satisfaction


with the 1996 Medicare Handbook. More than 500 randomly selected


beneficiaries nationwide responded to our survey about their


satisfaction with the content and format of the new handbook.


Most Medicare beneficiaries who received the new handbook thought it


provided them with enough information to understand Medicare


benefits. Actually, most preferred the condensed 1996 version to


the more detailed earlier versions of the handbook. However, 27


percent said they had not received the 1996 handbook. Beneficiary


opinions were mixed on how often they would like to receive the


handbook. The Health Care Financing Administration (HCFA) plans to


examine their distribution strategies to determine ways to improve


dissemination of handbooks.


We appreciate your comments on our draft report. We are pleased to


hear that HCFA is examining distribution strategies to determine


ways to improve dissemination of the handbook.


If you have any questions or comments, please call me or George


Grob, Deputy Inspector General for Evaluation and Inspections, or


have your staff contact Mary Beth Clarke at (202) 619-2481.


Attachment


cc : Melissa Skolfield 

Assistant	 Secretary for


Public Affairs


David Garrison


Principal Deputy Assistant


Secretary for Planning


and Evaluation


Richard J. Tarplin


Assistant Secretary


for Legislation-Designate


John J. Callahan


Assistant Secretary for


Management and Budget