Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

1993 MEDICARE BENEFICIARY 

SATISFACTION: MICHIGAN 

AUGUST 1993 OEI-05-92-00390 
EXECUTIVE SUMMARY


PURPOSE 

This inspection was conducted to compare Michigan beneficiary satisfaction with the 

Medicare program to beneficiary satisfaction nationwide. 

BACKGROUND 

Medicare is a Federal health insurance program for individuals age 65and older and 

for certain categories of disabled people. The Health Care Financing Administration 

(HCFA) within the Department of Health and Human Sezvices has responsibility for 

the Medicare program. Private health insurance companies called intermediaries and 

carriers contract with the Federal Government to sexvice claims for Medicare 

payment. In Michigan, Blue Cross and Blue Shield of Michigan serves as both 

intermediary and carrier. 

Due to reports of problems with the Michigan Medicare Part B Carrier, HCFA 

requested that the Inspector General conduct a satisfaction survey of Michigan 

beneficiaries in comparison to beneficiary satisfaction levels nationwide. 

FINDINGS 

Overa& the responses of Michigan benejiciarin are similar to those offered by 

benejkiaries nationally. 

Seventy-five percent of beneficiaries nationwide and 72 percent of Michigan 

beneficiaries think the Medicare program is understandable. Eighty-three percent of 

national and 82 percent of Michigan respondents said they were very or generally 

satisfied with the way Medicare processed their claims. 

Howeveq Michigan benejkiari.es are ik satirjkd with the service thq receive when they 

caU the& cani.er. 

Twenty-two percent of Michigan beneficiaries compared to 14 percent of national 

beneficiaries said they were dissatisfied with the service they received the last time 

they called their carrier. Michigan beneficiaries most frequently mentioned “The line 

was busy,” as a problem when calling the carrier. 

Alvo, more Michigan than national beneficiaries consider the camkr a soume of 

infoirnatibn about Medicare, bti freer actually contact the cam”e~ 

Forty percent of Michigan beneficiaries say they would go to the carrier for 

information about Medicare compared to 32 percent nationally. However, only 24 

1 
percent of Michigan beneficiaries say they have called the carrier in the past 

compared to 29 percent nationally. 

CONCLUSION 

Our survey and past Contractor Performance Evaluation Program scores indicate that 

beneficiary telephone service in Michigan could be improved. 

ii 
TABLE OF CONTENTS


PAGE 

Executive SUMMARY . . . . ..o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..o...i


INTRODUCI’ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1


FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


Overall, the responses of Michigan beneficiaries are similar to those offered by


national beneficiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4


Michigan beneficiaries are less satisfied With carrier telephone service . . . . . . . . . . 5


More Michigan beneficiaries consider the carrier asourceof


information about Medicare, but fewer actually contact the carrier . . . . . . . . . . . . 7


CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8


APPENDICES


k Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1


B: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1


C. Non-response analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c-1


D: Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1

INTRODUCTION


PURPOSE 

This inspection was conducted to compare Michigan beneficiary satisfaction with the 

Medicare program to beneficiary satisfaction nationwide. 

BACKGROUND 

Medicare l+ngram 

Medicare isa Federal health insurance 

certain categories of disabled people. 

million people known as beneficiaries. 

beneficiaries in the State of Michigan. 

The Medicare program has two parts. 

inpatient hospi~al care, some inpatient 

program forpeopleage65 andolder and for 

Nationally, Medicare serves approximately 33 

There are approximately 1.2 million Medicare 

Part A (hospital insurance) helps pay for 

care in a skijled nursing facility; sfilled home 

health care, and hospice care. A person entitled to Medicare automatically receives 

this coverage. Part B (medical insurance) covers physicians’ services, outpatient 

hospital services, and other medical services and supplies. Part B is optional. 

Beneficiaries desiring this coverage pay a monthly premium. Both Part A and Part B 

have deductible and coinsurance requirements. Beneficiaries must pay these either 

out of pocket or through supplemental insurance coverage. 

The Health Care Financing Administration (HCFA) within the Department of Health 

and Human Semites (HHS) has responsibility for the Medicare program. However, 

other organizations share in Medicare’s administration. Private health insurance 

companies contract with the Federal Government to setice claims for Medicare 

payment. Insurance companies that handle Part A claims are called intermediaries. 

Those handling Part B claims are called carriers. In Michigan, Blue Cross and Blue 

Shield of Michigan seines as both intermediary and carrier. 

Past studies 

In 1989 and 1991 the Inspector General conducted national surveys of Medicare 

beneficiaries to assess their awareness of and satisfaction with various aspects of the 

Medicare program. In addition, the Inspector General conducted similar surveys of 

beneficiaries in Georgia and New Jersey. The HCFA requested both of these State 

surveys due to reports of beneficiary dissatisfaction with the Part B carriers in those 

States. See Appendix A for a bibliography of related Inspector General reports. 

1

Michigan 

In 1990, HCFA received a petition of approximately 1,500 signatures from the 

Advocacy Organization for Patients of Providers located in East Lansing, Michigan. 

The organization asked HCFA to provide an alternative carrier to administer the 

Medicare program in Michigan due to the poor quality of service provided by the 

Michigan carrier. In response to this petition, HCFA undertook a survey of physicians 

in Michigan to gauge their satisfaction level with the Michigan carrier. 

Annually, HCFA measures carrier performance through the Contractor Performance 

and Evaluation Program (CPEP).l The overall performance rate for the Michigan 

carrier dropped from 96 percent in Fiscal Year (FY) 1990, to 90 percent in FY 1991. 

Also, the CPEP rate for the Michigan carrier in the specific function of claims 

processing dropped to 72 percent in FY 1991 from 90 percent in FY 1990. A carrier 

that attains a score of fewer than 70 percent on a functional criterion is considered to 

have failed that criterion. In 1992, the overall CPEP rate rose back up to 96 percent, 

and the rate for the specific function of claims processing rose to 100 percent. 

Due to the petition, the past CPEP rates and other reports of problems with the 

Michigan carrier, HCFA requested that the Inspector General conduct a satisfaction 

survey of Michigan beneficiaries in comparison with beneficiary satisfaction levels 

nationwide. The Office of Inspector General conducted its last national sumey in 

1991. Because 1992 was an election year and much media attention was focused on 

health care issues, Medicare beneficiaries attitudes about Medicare might have 

changed. Therefore, to more accurately compare the satisfaction of national and 

Michigan beneficiaries, we conducted the Michigan survey at the same time as the 

1993 national survey. See Medicare Z3enefkia~ Satisfaction: 1993, 0EI-04-92-O0480. 

METHODOLOGY 

Sunq 

We selected a random sample of 1,283 Michigan beneficiaries from Medicare Part B 

claims submitted in calendar year 1991. We mailed surveys to these beneficiaries in 

February 1993. After the initial mailing, we sent a reminder letter followed by a new 

survey to those who did not respond. 

We received and entered into a database 1,057 sumeys, a response rate of 82 percent. 

Forty-seven blank surveys were returned for various reasons and not entered into our 

lThe CPEP is a review and appraisal system which uses results and output 

oriented measures based on standards and criteria required by Section 1816(f) of the 

Social Security Act. The CPEP is intended by HCFA to enhance contractor 

performance and is reported in the Annual Contractor Evaluation Report. 

2 
database. See Appendix B for more about the methodology. Appendix C contains an 

analysis of respondents vs. non-respondents. 

Comprkon 

The same survey form was administered to both national and Michigan beneficiaries. 

A copy of the questionnaire with the Michigan vs. national responses is in Appendix 

D. We compared national and Michigan beneficiaries’ responses using a Chi-square 

test of independence along with a statistical test comparing the difference between 

binomial proportions to determine whether the geographic location of a beneficiary 

influences their satisfaction with Medicare as measured through the survey. The 

geographic location of a beneficia~ acts as a proxy for the carrier. 

SCOPE 

We did not design a survey to specifically measure Michigan Medicare beneficiaries’ 

satisfaction with the Michigan Part B carrier. Rather, the survey measures beneficiary 

satisfaction with Medicare semices overall, including both Parts A and B. Questions 

20-25 in the questionnaire most directly address Part B carrier functions. 

This inspection was conducted in accordance with the Quality Standards for 

Inspections as developed by the President’s Council on Integrity and Efficiency. 

3

FINDINGS


Ove@ the responses offered by Michigan beneficiaries are similar to those offered


by national beneficiaries.


Seventy-five percent of beneficiaries nationwide and 72 percent of Michigan


beneficiaries think the Medicare program is understandable. Also, of the proportion


of national and Michigan beneficiaries who have used hospital and/or home health


services in the past, approximately 60 percent of both understood what Medicare paid


for the last time they used the service. Sixty-four percent of national and 65 percent


of Michigan beneficiaries knew before taking the survey that Medicare limits how


much doctors can charge for specific services. Thirty-eight percent of national and 39


percent of Michigan respondents say that the best way to inform them of Medicare


changes is to mail them a new Medicare handbook. Thirty-four percent of


respondents in both groups say the best way to inform them of Medicare changes is to


mail them


pamphlets about the changes.


Both national and Michigan Figure 1


beneficiaries offered positive 

responses about Medicare 

claims processing. Eightythree percent of national and 

82 percent of Michigan 

respondents said they were 

very or generally satisfied 

with the way Medicare 

processed their claims. Nine 

percent of national and 11 

percent of Michigan 

beneficiaries were neither 

satisfied nor dissatisfied with 

the way Medicare processed 

their last claim, Only 4 

percent of national and 5 

percent of Michigan 

respondents were generally 

Beneficiaries Are Satisfied with Claims Processing 

110 

la Legend 

w 1 SSS2	 � Nathmal 

� Michigan 

9 11 

satisfii neither dissatisfiednotyetpaidclaim 

Sy Pe?cultalp 

or vexy dissatisfied with their last claims processing. 

4

Equal numbers of national and Michigan beneficiaries experienced the same problems . 

with their last Medicare claim for a doctor’s visit: 

Table 1 , 

Problem National Michigan 

I did not have a problem with my 65% 66% 

Medicare claim. 

I did not understand what part of my 15% 14% 

claim was paid and why. 

I did not understand the notice (EOMB) 13% 15% 

Medicare sent after processing my claim. 

Medicare took too long to pay the claim. 9% 8% 

I did not understand why Medicare 8% 6% 

denied the claim. 

I had difficulty getting information from 3% 2% 

Medicare on the status of my claim. 

There are some questions where the differences between Michigan and national 

respondents are statistically significant 2. The following differences in this report focus 

on the beneficiary’s contact with the carrier. See Appendix D for a COPYof the 

questionnaire with a breakout of all Michigan/national responses. 

Michigan beneficiaries are less satisfied with the service they receive when they call 

their carrier. 

Twenty-two percent of Michigan beneficiaries were dissatisfied with the sexvice they 

received the last time they called their carrier compared to 14 percent nationally (see 

Figure 2.) Furthermore, while 74 percent of national beneficiaries were satisfied 

with the service they received, only 60 percent of Michigan beneficiaries were satisfied. 

2Unless otherwise noted, all differences from this point on reported between 

Michigan and national beneficiaries are statistically significant. 

5 
Figure 2 

BENEFICIARY SATISFACTION 

00 WithSenke When Caillng the Carrier 

76 74 

m 

m %zl � Na;m~ 

00 

66 ; 

� Michigan 

60


46


40


Sa


w


2s 22


20


15 14


10


KI. Satisfii neither diss&isfied 

‘---mP 

When asked what specific problems they might have had when calling the carrier, 51 

percent of national compared to 39 percent of Michigan beneficiaries said, “I did not 

have a problem with the service I received.” Michigan beneficiaries most frequently 

mentioned ‘The line was busy,” as a problem when calling the carrier. Figure 3 shows 

the problems and percentages mentioned by national and Michigan beneficiaries. 

Figure 3 

~Beneficiaries’ Problems Wkh Calling the Carrier 

Natkmsl Michigan 

No Fmblenm 39 

I* 27 Puton HoldToo Lono 33 I 

I* 17 Canllkihg Aluwen 20 I 

I@10 cuuutiatundmtmd~ 11 I 

I@ 10 Fef80n&WOlkq NotOM1001M 9 P I 

I@9 Couldnt GotQudon Anawued 14 I 

6

Three times more Michigan beneficiaries (10 percent) than national beneficiaries (3 

percent) also said they had''other'' problems when calling the carrier. Among these 

“other” problems, the amount of time and phone calls it took to solve the problem was 

most often stated. This was most completely expressed by a beneficiary who wrote, “It 

took 10 phone calls and 2 visits to a local office over 5 months to finally find someone 

to explain and take action to get a check processed for a claim from November 1991.” 

There were no national beneficiaries who expressed this type of problem in the “other” 

category. 

More Michigan beneficiaries consider the carrier a place to go for information about 

Medicare, but fewer actually contact the carrier. 

Forty percent of Michigan compared to 32 percent of national respondents consider 

the carrier a source for information about Medicare. However, both Michigan and 

national beneficiaries (about 55 percent) most often listed The Medicare Handbook as 

their source for information about Medicare. 

Although more Michigan beneficiaries consider the carrier as a place to go for 

information, fewer Michigan beneficiaries actually contact their carrier. Twenty-four 

percent of Michigan beneficiaries have called their carrier in the past compared with 

29 percent of national beneficiaries. In addition, 33 percent fewer Michigan 

beneficiaries have contacted the carrier to obtain the name of a participating doctofi. 

3Medicare participating doctors agree to charge no more than Medicare’s 

approved amount. Medicare pays 80 percent of the approved amount. The 

beneficiary pays the 20 percent coinsurance after meeting the deductible. 

7 
CONCLUSION•

The results of this survey show that Michigan beneficiaries are less satisfied with the 

telephone service they receive from Blue Cross Blue Shield of Michigan. 

Furthermore, our review of the Michigan carrier’s CPEP scores revealed that in the 

last few years the Michigan carrier has consistently scored low in the criterion of 

beneficiary and provider services. The primary cause has been their inability to 

answer incoming beneficiary telephone calls timely. We hope that HCFA will use this 

information along with its CPEP review to improve the service that beneficiaries 

receive in Michigan from the carrier. 

8

APPENDIX A•

Bibliography 

Office of Inspector General, United States Department of Health and Human 

Services. A Survey of Medicare Beneficiary Satisfaction. 0EI-04-89-89040. October 

1989. 

Ibid. Benejcia~ Satkfaction with Geoy”a’s Medicare Cam”er. OEI-O4-9O-O1O5O. 

February 1990. 

Ibid. New Jersey Medicare Beneficia~ Satzkfachon. 0EI-02-90-02040. October 1990. 

Ibid. Medicare Benejcia~ Satisfaction: 1991. 0EI-04-90-89030. October 1991. 

Ibid. Medicare Beneficia~ Satisfaction: 1993. 0EI-04-92-O0480. Draft report. 

A-1

APPENDIX B•

Methodology 

The purpose of the survey was to assess beneficiary experience and satisfaction with


the Medicare program in Michigan. The sample universe was comprised of


beneficiaries who received Part B Medicare Benefits in Calendar Year 1991.


From approximately 1.1 million individuals who received such benefits, a non-stratified


simple random sample was selected.


The sample size was calculated to produce an estimate within 3.5 percent of the true


value at the 95 percent confidence inte~al. To arrive at the sample size, standard


equations were used for estimating sample size with a binary response variable.


We drew a sample of 1,450 Health Insurance Claim Numbers (HICNS) using


systematic random sampling. From this list of 1,450 HICNS we excluded all


beneficiaries who had a date of death on the file and those who were in an HMO as


of January 1993. This left a total of 1,283 individuals in Michigan who are receiving


semices under the Fee-for-service mechanism and were alive as of January 1993.


On February 4, 1993, questionnaires were mailed to 1,283 beneficiaries in the State of


Michigan. A follow-up letter was


sent on February 16, 1993 to 783


beneficiaries. Another survev and _ . . .
 ‘l”able 1 letter was mailed on Februa& 23, 

1993 to 580 beneficiaries who had 

not responded. 

A total of 1,057 beneficiaries 

responded, for a response rate of 

82 percent. Forty-seven 

incomplete surveys were returned 

for various reasons (see Table I.) 

Com~arison of National Survev 

Reasons for Return 

Returned because of death 15 

Returned as undeliverable 13 

Returned for other reasons 19 

(alzheimer, incapacity) 

Total 47 

At the same time the Michigan questionnaire was mailed, the same questionnaire was 

mailed to a national sample of beneficiaries. The national survey was used to 

compare the responses from the Michigan survey. Using a Chi-square test of 

independence along with a statistical test comparing binomial proportions, we 

determined whether the geographic location (carrier) of beneficiaries influences how 

beneficiaries would respond. 

B-1

APPENDIX C•

ANALYSIS OF RESPONDENTS VS. NON-RESPONDENTS 

An important consideration in surveys of this type is the bias that maybe introduced 

into the results if the non-respondents are different from those responding to the 

survey. To test for the presences of any bias, we obtained demographic information 

for all individuals to whom questionnaires were sent. For the 1,283 individuals, we 

determined their Medicare status, sex and race. These categorical data were tested 

using a Chi-square with the appropriate degrees of freedom. 

The results are presented in Table A, The Chi-square values given in the table 

provide a test of the difference in the distribution of the respondent versus the nonrespondents for the variable. The table also provides the response rates for the 

different values of the variables. 

Examination of the table show that two variables have a statistically significant 

difference between respondents and non-respondents; Medicare status and race. An 

analysis of the effect of non-responses by Medicare status and race follows Table A. 

However, the effect of the non-responses is inconsequential and within the bounds of 

our confidence level, plus or minus 3.5 percent. Given the results of these analyses, 

we believe that the results fairly represent the opinions of the sample of beneficiaries 

to whom questionnaires were sent. 

c-l 
MEDICARE STATUS 

Responders 

Aged 964 91.2% 

Disabled 93 8.8% 

Total 1057 

SEX 

Responders 

Male 421 39.8% 

Female 636 60.2% 

Total 1057 

RACE 

Responders 

White 939 88.8% 

Non-White 100 9.5% 

Unknown 18 1.7% 

Total I 1057 I 

Non 

Responders 

194 85.8% 

32 14.2% 

226 

Non 

Responders 

84 37.2% 

142 62.8% 

226 

Non 

Responders 

175 77.4% 

44 19.5% 

7 3,1% 

226 I 

Percent 

Total Responding 

1158 83.2% 

125 74.4% 

1283 82.4% 

CHI-SQ=6.061* 

Total 

505 

778 

1283 

* 

D.F.=1 

Percent 

Responding 

83.4% 

81.7% 

82.4% 

CHI-SQ=O.553 

D.F.=1 

144 I 69.4% 

25 I 72.0% 

1283 I 82.4% 

CHI-SQ=21.263+ 

D.F.=2 

* Significant at P <.05 

+ Significant at P <.05 

c-2 
For Medicare status, survey results show that 72 percent of the aged beneficiaries 

understood the Medicare program while only 65 percent of the disabled beneficiaries 

understood the Medicare program. To determine the effect of this difference, we 

undertook an analysis of non-responders. We assumed that a non-responder would 

answer the same as a responder with the same status would answer the question. (See 

Table B for a complete break down of questions la, lb and lc.) 

Table B - Medicare Status 

Percent Adjusted Percent 

Question Answering Yes Answering Yes 

Q-la. 72.4% 72.3% 

Q-lb. 67.8% 67.7% 

Q-1.c. 64.2% 64.19Z0 

Similarly, for race, sumey results show 73 percent of whites understood the Medicare 

program. The survey results for non-whites was 66 percent, while the results for 

unknown was 89 percent. A more important observation is that approximately 69 

percent of non-whites responded to the sumey, while over 84 percent of whites 

responded. (See Table C for a complete break down of questions la, lb and lc.) 

Table C - Race 

Percent Adjusted Percent 

Question Answering Yes Answering Yes 

Q-la. 72.4% 72.39Z0 

Q-lb. 67.8% 67.7% 

Q-1.c. 64.2T0 64.2% 

c-3 
APPENDIX D


COMPARISON OF NATIONAL SAMPIE WIT’H MICHIGAN SAMPLE 

The percentages are shown in bold, while the number of response are italicized and in 

pare~thesis. fiotall questions till addupto 100percent due to rounding. Questions with 

statistically significant (p < .05) differences are marked with an asterisk. 

Question 

PART 1: MEDICARE COVERAGE 

1. In gene~ do you think... 

a. 

*b. 

* 

c. 

The Medicare program is


understandable?


YEs


NO


You can get information about


Medicare when you need it?


YEs


NO


DON’T KNOW


Medicare pays your claims


quickly enough?


NO


DON’T KNOW


National Michigan 

Percentage Percentage 

(Responses) (Responses) 

75V0 72% 

(753) (721) 

25% 28% 

(256) (275) 

72$Z0 68% 

(730) (g) 

7% 

(76) (61) 

21% 26% 

(215) (268) 

71% 64% 

(727) (653) 

15% 14% 

(153) (145) 

14% 21% 

(144) (219) 

D-1

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

2 What types of medical insurance do you or your spouse have in addition to 

Medicare? 

(Check all that apply) 

DO NOT HAVE ADDITIONAL 

INSURANCE COVERAGE 20% 

(199) 

MEDICAID 11% 

(111) 

*HEALTH INSURANCE THROUGH YOUR 

OR YOUR SPOUSE’S CURRENT OR 

FORMER EMPLOYER 33V0 

(329) 

*PRIVATE MEDICARE SUPPLEMENT	 27% 

(273) 

CHAMPUS	 .5% 

(5) 

*OTHER	 24V0 

(238) 

3. Do you feel at this you are in good health? 

YEs 67% 

(664) 

NO 33% 

(331) 

D-2 

17% 

(170) 

9% 

(94) 

52% 

(537) 

18% 

(181) 

.5% 

(5) 

20% 

(200) 

64% 

(644) 

36% 

(370) 
National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

4. Thinking about the most recent time you were a patient in at hospital for a least one 

nigh~ was it clear to you what Medieare paid for? 

(Check w answer.) 

I HAVE NOT BEEN IN THE HOSPITAL 

FOR AT LEAST ONE NIGHT SINCE 

I HAVE HAD MEDICARE COVERAGE 34% 

(352) 

YES, IT WAS CLEAR WHAT MEDICARE 

PAID FOR 40% 

(416) 

NO, IT WAS NOT CLEAR WHAT MEDICARE 

PAID FOR 15% 

(151) 

I DO NOT REMEMBER IF IT WAS CLEAR 

WHAT MEDICARE PAID FOR 10% 

(100) 

MEDICARE HAS NOT YET PAID THE 

HOSPITAL 1% 

(13) 

34% 

(350) 

37% 

(384) 

16% 

(169) 

1270 

(122) 

170 

(14) 

D-3

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

5.	 Thinking about the last time you received medical services in vour home from a 

home health a~encv , was it clear to you what Medicare paid for? 

(Check w answer) 

I HAVE NOT RECEIVED MEDICAL SERVICES 

FROM A HOME HEALTH AGENCY SINCE I 

HAVE HAD MEDICARE 789Z0 74% 

(783) (765) 

YES, IT WAS CLEAR WHAT MEDICARE 

PAID FOR 15% 15% 

(154) (157) 

*NO, IT WAS NOT CLEAR WHAT MEDICARE 

PAID FOR 370 5% 

(30) (49) 

I DO NOT REMEMBER IF IT WAS CLEAR 

WHAT MEDICARE PAID FOR 3% 4% 

(30) (37) 

MEDICARE HAS NOT YET PAID FOR THE 

HOME HEALTH SERVICES 1% 270 

(12) (21) 

6.	 Thinking about the last time you went to the doctor, was it clear to you before vou 

went what Medicare would pay for? 

(Check ~ answer) 

*I HAVE NOT BEEN TO THE DOCTOR SINCE 

I HAVE HAD MEDICARE 4% 2940 

(36) (17) 

YES, IT WAS CLEAR WHAT MEDICARE WOULD 

PAY FOR 55% 57% 

(563) (586) 

NO, lT WAS NOT CLEAR WHAT MEDICARE 

WOULD PAY FOR 34% 36% 

(348) (367) 

I DO NOT RECALL	 7% 6% 

(74) (57) 

D-4

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

7.	 Did you know before today that Medicare limits how much doctors can charge you 

for specific seMces? 

64% 65% 

(653) (664) 

NO 36% 35% 

(373) (354) 

*8. If you should ever need nursing home care, do you have a way to cover the cost? 

YEs 37% 26% 

(362) (229) 

NO (skip to Q-10) 60% 70% 

(587) (622) 

I AM CURRENTLY IN A NURSING HOME 

(Skip to Q-n) 3% 3% 

(32) (39) 

9.	 Listed below are some ways people might pay for nursing home care. Which of these 

would you rely on if you ever needed nursing home care for more than 5 months? 

(Check all that apply.) 

PERSONAL SAVINGS 56% 

(160) 

RETIREMENT INCOME 44% 

(126) 

PRIVATE INSURANCE 3170 

(88) 

*MEDICAID 30% 

(87) 

EQUITY IN YOUR HOME 32% 

(91) 

OTHER 9% 

(25) 

63% 

(137) 

44$?0 

(96) 

28% 

(61) 

1970 

(42) 

26% 

(57) 

6% 

(14) 

D-5

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

* 

10.	 Many people think Medicare will pay for long-term nursing home care. It currently 

does not. Before today, did you think that Medicare WOULD PAY for long-term 

nursing home care for more than 5 months? 

YEs 24% 32% 

(222) (244) 

NO 76% 68% 

(702) (527) 

PART 2 GETTING INFORMATION ABOUT MEDICARE 

11.	 The following are some places people might go to get answers if they have question 

about what Medicare pays for. 

*YOUR DOCTOR’S OFFICE 4870 53% 

$322) (:s4) 

A FRIEND OR RELATIVE 

(103) (86) 

AARP OR OTHER MEMBERSHIP 

ORGANIZATION 20% 19% 

(200) (199) 

*INSURANCE COMPANY THAT PROCESSES 

YOUR MEDICARE CLAIMS 32% 40% 

(324) (415) 

THE SOCIAL SECURITY OFFICE 45% 47% 

(465) (489) 

*A LOCAL SENIOR CITIZENS’ GROUP 870 12% 

(83) (120) 

AN INSURANCE SALESPERSON 2% 1% 

(17) (13) 

THE MEDICARE HANDBOOK 54% 55% 

(552) (s4!;) 

OTHER 4% 

(40) (30) 

D-6

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

12.	 When you have needed speeific information about what Medicare pays for, how often 

were you able to get the information you needed? 

(Check ~.) 

MOST OF THE TIME 39% 36% 

(3!&) (368) 

SOME OF THE TIME 16% 

(182) (167) 

SELDOM OR NEVER 8% 7% 

(82) (73) 

I HAVE NEVER NEEDED 

INFORMATION 35’ZO 40% 

(360) (411) 

D-7

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

13.	 Listed below are ways the Government could use to tell people about changes in the 

Medieare program. 

Which way is best for notifying you of Medieare changes? 

(Please check ONLY ONE.) 

ANNOUNCEMENTS ON TELEVISION 

AND RADIO 7940 670 

(70) (60) 

PAMPHLETS DESCRIBING THE CHANGES 

MAILED TO ME 34% 34% 

(357) (357) 

NOTICES INCLUDED WITH MY SOCIAL 

SECURITY CHECK 17% 19% 

(179) (193) 

A NEW MEDICARE HANDBOOK 

MAILED TO ME THAT INCLUDES THE 

CHANGES 38$Z0 39% 

(394) (403) 

ANNOUNCEMENTS IN THE 

NEWSPAPER 1% 1% 

(12) (lo) 

SPEECHES OR PRESENTATIONS BY 

MEDICARE REPRESENTATIVES 1% .9% 

(11) (9) 

OTHER .8$Z0 .970 

(9) (9) 

D-8

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

14. How many times in the past year have you used your Medicare Handbook? 

(Check ~.) 

1 TO 3 TIMES 36% 

(368) 

MORE THAN 3 TIMES 6% 

(57) 

*I HAVE NEVER USED THE MEDICARE 

HANDBOOK (Skip to Q-17) 34% 

(345) 

I DO NOT KNOW WHAT THE MEDICARE 

HANDBOOK IS (Skip to Q-17) 3% 

(27) 

*I DO NOT RECALL RECEIVING A 

MEDICARE HANDBOOK (Skip to Q-17) 21% 

(213) 

15. Do you think the Medicare Handbook is: 

(Check ~.) 

VERY HELPFUL 27% 

(113) 

GENERALLY HELPFUL 66% 

(:2&) 

GENERALLY NOT HELPFUL 

(19) 

NOT HELPFUL AT ALL 2% 

(7) 

34% 

(338) 

5% 

(50) 

42% 

(419) 

470 

(39) 

16% 

(158) 

24% 

(91) 

69% 

(2SJ) 

(22) 

1% 

(2) 

D-9

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

16. Thinking about the Medicare Handbook you have receive~ would you say that... 

a.	 The wording is easy to understand? 

YEs 80% 84% 

(313) (294) 

NO 20% 16% 

(78) (.55) 

b. The lettering is large enough to read? 

YEs 

NO 

c.	 It covers enough information? 

YEs 

NO 

PART 3: MEDICARE CLAIMS 

17.	 Did you know before today that your 

claims for you? 

YEs 

NO 

94% 92% 

(344) (300) 

670 8% 

(23) (27) 

8s% 8s% 

(283) g;) 

15% 

(51) (45) 

doctors are supposed to file your Medicare 

90% 89% 

(92;) ~1) 

(loo) (111) 

D-10

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

18. Over~ how satisfied are you with the way Medicare has processed your claims? 

VERY SATISFIED 37% 

(378) 

GENERALLY SATISFIED 46% 

(472) 

NEITHER SATISFIED NOR 

DISSATISFIED 9% 

(91) 

GENERALLY DISSATISFIED 370 

(26) 

VERY DISSATISFIED l% 

(12) 

*MEDICARE HAS NOT YET PAID CLAIM 4% 

(39) 

33% 

(339) 

49% 

(494) 

11% 

(110) 

3% 

(35) 

270 

(16) 

2% 

(20) 

D-II

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

19. Did you have any of the following problems the last time you had a Medicare claim 

for a doctor’s visit? 

(Check as manv as apdy.) 

I HAD DIFFICULTY GETTING INFORMATION 

FROM MEDICARE ON THE STATUS OF 

MY CLAIM 3% 

(27) 

I DID NOT UNDERSTAND WHAT PART OF MY CLAIM 

MEDICARE PAID AND WHY 15% 

(144) 

I DID NOT UNDERSTAND WHY MEDICARE 

DENIED THE CLAIM 8% 

(79) 

MEDICARE TOOK TOO LONG TO PAY 

MY CLAIM 9% 

(85) 

I DID NOT UNDERSTAND THE NOTICE 

MEDICARE SENT AFTER PROCESSING 

MY CLAIM. (THE NOTICE IS CALLED 

“EXPLANATION OF MEDICARE 

BENEFITS.” ) 13% 

(128) 

I DID NOT HAVE A PROBLEM WITH MY 

MEDICARE CLAIM 65% 

(643) 

*OTHER 3% 

(34) 

PART 4. CALLING MEDICARE 

* 

2% 

(25) 

1470 

(136) 

6% 

(60) 

8% 

(76) 

15% 

(151) 

66% 

(668) 

5% 

(54) 

20.	 Have you ever tried to call the insurance company the processes your Medicare 

claims? 

YES - Month and Year of Last Call: 29% 24% 

(288) (228) 

NO (Skip to @26) 71% 769Z0 

(708) (725) 

D-12

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

21. Thinking about the last time you tried to cdl, how many tries did it take you to reach 

them? 

(Check ~.) 

FIRST TRY 

SECOND TRY 

*THREE OR MORE TRIES 

NEVER GOT THROUGH 

22.	 How satisfied were you with the semice 

(Check ~.) 

*VERY SATISFIED 

GENERALLY SATISFIED 

*NEITHER SATISFIED NOR 

DISSATISFIED 

GENERALLY DISSATISFIED 

VERY DISSATISFIED 

35% 3090 

(95) (65) 

25% 20% 

(71) (44) 

32% 41% 

(86) (89) 

890 9% 

(22) (19) 

you received the last time you called? 

31% 20% 

(87) (43) 

43% 40% 

(119) (85) 

12% 19% 

(32) (41) 

9% 13% 

(25) (27) 

5% 9% 

(13) (19) 

D-13

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

23.	 IJsted below are possible problems someone might have when calling the Medicare 

insurance campany. 

Did you have any problems the last time you called? 

(Check as manv as auuly.) 

I WAS NOT ABLE TO GET MY QUESTION 

ANSWERED 9% 14% 

(20) (31) 

THE LINE WAS BUSY 43% 43% 

(100) (95) 

I GOT DIFFERENT ANSWERS FROM 

DIFFERENT PEOPLE 17% 2070 

(39) (43) 

I WAS PUT ON “HOLD’ TOO LONG 27% 33% 

(63) (73) 

I COULD NOT UNDERSTAND THE 

ANSWER THEY GAVE ME 10% 11% 

(23) (24) 

THE PERSON ANSWERING THE CALL 

WAS NOT VERY COURTEOUS 109IO 970 

(23) (19) 

*I DID NOT HAVE A PROBLEM WITH THE 

SERVICE I RECEIVED 50% 39% 

(116) (85) 

*OTHER 3% 10% 

(7) (23) 

24.	 Some Medicare insurance companies use an automated voice system to handle 

telephone calls. 

Thinking about the last time you called the Medicare insurance company that 

processes your cl- how was your call answered? 

BY AN AUTOMATED VOICE 31% 33% 

(80) (62) 

BY A MEDICARE EMPLOYEE 69% 67% 

(Skip to Q-26) (177) (128) 

D-14

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

25.	 IAsted below are possible reasons that someone would be dissatisfied with calling the 

Medicare insurance company and getting an automated voice. 

Did you have any of these problems the last time you called? 

(Check as manv as am@.) 

*I DID NOT HAVE A TOUCH-TONE 

TELEPHONE TO RESPOND TO THE 

AUTOMATED VOICE SYSTEM 73% 35% 

(35) (22) 

I COULD NOT UNDERSTAND THE 

DIRECITONS GIVEN BY THE 

AUTOMATED VOICE SYSTEM 38% 29% 

(18) (18) 

OTHER 14% 2170 

(7) (13) 

PART 5: APPEALING CLAIMS 

* 

26.	 Sometimes people disagree with the decisions made on their Medicare claims. When 

this happens, you may appeal or request a review of those decisions. 

Did you know ~ that you could appeal or request a review? 

YEs 75% 71% 

(749) (712) 

NO 25% 29% 

(254) (296) 

27. Have you ever appealed a decision made by Medicare on a claim you submitted? 

YEs 6% 5% 

(60) (46) 

NO (Skip to @30) 94% 95% 

(904) (930) 

D-15

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

28. Did you understand the final decision made on your claim? 

YEs 65% 73?40 

(35) (24) 

NO 35% 27% 

(19) (9) 

29. Do you think your appeal was handled fairly? 

YEs 59% 62% 

(28) (18) 

NO 4170 389Z0 

(20) (11) 

PART 6 GETTING SECOND OPINIONS 

30.	 If your doctor recommends that you have surgexy, Medicare will help you pay to get 

the opinion of another doctor to make sure the surgery is really necessary. 

Were you aware before today that Medicare would help to pay for you to get a 

second opinion before having surge~? 

YEs 39% 38% 

(397) (392) 

NO 61% 62% 

(624) (630) 

31.	 Do you think people should be required to get a second opinion form another doctor 

to make sure non-emergeney surgery is really necessary? 

YEs 51% 55% 

(~;) (54J 

NO 

(49) (39) 

DEPENDS ON THE TYPE OF SURGERY 4470 4170 

(447) (409) 

D-16

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

32.	 Thinking about the last time you had non-emergency surgery, did you get a second 

doctor’s opinion before having the surgery? 

YEs 19% 18% 

(185) (184) 

NO 43% 45% 

(425) (446) 

I HAVE NEVER HAD 

NON-EMERGENCY SURGERY 39% 37% 

(382) (369) 

PART 7: “PARTICIPATING DO~ORS” PROGRAM 

33.	 Medicare has “participating doctors” who agree to charge no more than Medicare’s 

approved amount. Medicare pays 80% of the approved amount. You are only 

responsl%le for paying the deductible and the 2070 coinsurance. 

Before today, had you ever heard about Medicare “participating doctors?” 

YEs 83% 82% 

(853) (848) 

NO 17% 18% 

(172) (189) 

* 

34. Are any of your doctors “participating doctors?” 

YEs 65% 71% 

(677) (735) 

NO 970 7% 

(94) (68) 

DON’T KNOW 2s% 22% 

(262) (209) 

D-17

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

* 

35.	 Have you ever contacted the insurance company that processes you Medicare claims 

to get the names of doctors who are “participating doctors?” 

YEs 6% 4% 

(65) (43) 

NO 69% 74% 

(703) (734) 

I DID NOT KNOW I COULD GET THIS INFORMATION 

FORM THE INSURANCE COMPANY THAT PROCESSES MY 

CLAIMS 24% 21% 

(246) (209) 

36.	 Thinking about the future, how likely are you to select a “participating doctor” for 

health care semices? 

(Check ~.) 

*LIKELY TO SELECT “PARTICIPATING 

DOCTOR” 65% 70% 

(634) (698) 

NOT LIKELY TO SELECI’ 

“PARTICIPATING DOCTOR’ 8% 7% 

(78) (70) 

WILL NOT MATTER ID DOCTOR IS 

“PARTICIPATING” 27% 23% 

(262) (209) 

PART 8 HEALTH CARE FACILITIES 

37.	 For people who are interested the Medicare program has information by individual 

hospital on mortality (death) rates of Medicare patients. Were you aware before 

My that the Federal Government publishes ‘!Medicare Hospital Mortality 

Information?” 

YEs 9% 7% 

(87) (73) 

NO 91% 9370 

(916) (949) 

D-18

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

38.	 Have you ever used the “Medicare Hospital Mortality Information” to choose a 

hospital? 

.4% Ivo 

(4) (10) 

NO 44% 46fzo 

(449) (460) 

I DID NOT KNOW ABOUT THE 

MORTALITY INFORMATION 55% 53% 

(565) (520) 

39.	 If in the future you need to be hospitalize how likely are you to use the mortality 

(death rate) information to select a hospital? 

[Assume you have a choice of going to one of two hospitals and both are equally 

convenient and seemingly of equal quality. Would you use the mortality information 

to select which hospital to go to?] 

LIKELY TO USE THE INFORMATION 56% 

(525) 

NOT LIKELY TO USE THE 

INFORMATION 44% 

(413) 

40. Who selected your hospital the last time you were hospitalized? 

(Check ~.) 

*YOU 35% 

(363) 

*YOUR DOCTOR 48% 

(488) 

YOUR RELATIVES OR FRIENDS 5% 

(47) 

AMBULANCE DRIVER 270 

(20) 

OTHER 2% 

(22) 

I HAVE NEVER BEEN IN HOSPITAL 9% 

(88) 

59% 

(551) 

41% 

(385) 

31% 

(306) 

54% 

(:54) 

(37) 

2% 

(17) 

2940 

(19) 

7% 

(75) 

D-19

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

41.	 The Medicare Program also publishes information of the results on inspections done 

on nursing homes. Before todav, were you aware that the Federal Government had 

this type of information on nursing homes? 

YEs 22% 20% 

(218) (205) 

NO 78% 80% 

(794) (817) 

42. Have you ever used this information to choose a nursing home? 

YEs 2% 2% 

(16) (24) 

NO 6070 56% 

(592) (552) 

I DID NOT KNOW ABOUT THE NURSING 

HOME INFORMATION 38% 41% 

(375) (405) 

43.	 Now that you know about the nursing home informatio~ are you likely to use the 

information if you should need to select a nursing home? 

YES, LIKELY TO USE THE 

INFORMATION 85% 88% 

(843) (865) 

NO, NOT LIKELY TO USE THE 

INFORMATION 15% 12% 

(145) (120) 

44.	 Medicare also publishes a booklet entitled “Guide to Choosihg a Nuning Home.” It 

discusses things to look for in selecting a nursing home, and is available from several 

offitxx+ including your Social Security office. 

Before today, were you aware Medicare had information on choosing a nursing 

home? 

YEs 10% 9% 

(97) (94) 

NO 90?Z0 91940 

(909) (932) 

D-20

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

45. Have you ever used the booklet to help you select a nursing home? 

YEs 1% 1% 

(9) (11) 

NO 51% 50% 

(499) (490) 

I DID NOT KNOW MEDICARE HAD A 

BOOKLET ABOUT CHOOSING A 

NURSING HOME 48% 49% 

(476) (488) 

46. Was the booklet helpful? 

YEs 2% 4% 

(19) (36) 

NO 2% 2% 

(17) (20) 

I HAVE NOT USED THE BOOKLET %% 94% 

(786) (806) 

47.	 Now that you know about the bookle~ are you likely to use it if you should need to 

select a nursing home? 

YES, LIKELY TO USE BOOKLET 84% 87% 

(806) (850) 

NO, NOT LIKELY TO USE BOOKLET 16% 14% 

(150) (133) 

48.	 Medicare also has a booklet entitled “Gui& to Health Ihsurance for People with 

Me&we.” It discusses things you should look for in choosing Medigap insurance to 

supplement your Medicare coverage. Ig too, is available at your Social Security 

office. 

Before today, were you aware Medicare had a booklet to help you choose other 

health insurance? 

YEs 13% 12% 

(132) (118) 

NO 87% 88% 

(865) (902) 

D-21

National Michigan 

Percentage Percentage 

Question (Responses) (Responses) 

49.	 Have you ever used the booklet to help you seleet health insurance to supplement 

your Medicare? 

YEs 2% 2% 

(16) (23) 

NO 40% 39% 

(394) (393) 

I DID NOT KNOW MEDICARE HAD A 

BOOKLET ABOUT CHOOSING OTHER 

HEALTH INSURANCE 58% 58% 

(571) (585) 

50. Was the booklet helpful? 

YEs 7% 6% 

(61) (5s) 

NO 1% 2% 

(9) (17) 

I HAVE NOT USED THE BOOKLET 92% 92% 

(810) (832) 

51.	 Now that you know Medicare has a booklet to help you choose health insura.nee, are 

you likely to use it should you wish to purchase health insurance to supplement your 

Medicare or to change your current supplemental policy? 

YES, LIKELY TO USE BOOKLET 65% a% 

(619) (608) 

NO, NOT LIKELY TO USE BOOKLET 35% 36% 

(339) (342) 

Is there anything else you want to tell us about Medicare? 

POSITIVE 5% 20% 

(6) (64) 

NEGATIVE 60% 34% 

(70) (108) 

MIXED 4% 5% 

(5) (17) 

OTHER 30% 41% 

(35) (130) 

D-22