Health Insurance Questionnaire

Health Insurance Core User Note 1
--------------------------------------------------------------------------------------------------

HLTHINT

Now I'm going to ask you about health insurance.

PRESS "ENTER" TO CONTINUE

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

MCARE

(SHOW FLASHCARD H)

At any time between [MONTH1] 1st and today

was [FIRST NAME] [LAST NAME] covered by Medicare?

(1) Yes

(2) No

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

CARETHEN

In which months was [FIRST NAME] [LAST NAME]

covered by Medicare?

(1) Yes

(2) No

@ In this month?

@ In [MONTH4]?

@ In [MONTH3]?

@ In [MONTH2]?

@ In [MONTH1]?

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

MCNUMB

May I see his/her Medicare card to record the

claim number and type of coverage?

FLASHCARD H PROVIDES AN EXAMPLE OF A MEDICARE CARD

WHICH SHOULD BE SHOWN TO THE RESPONDENT.

(N) Card Not Available

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

MCBACK

If I were to call later would you be able to provide me

with his/her Medicare number?

(1) Yes

(2) No

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

CAIDNOW

At any time between [MONTH1] 1st and the end of [MONTH4]

was [FIRST NAME] [LAST NAME] covered by

MEDICAID?

(1) Yes

(2) No

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

CAIDOTH

At any time between [MONTH1] 1st and the end of [MONTH4]

was [FIRST NAME] [LAST NAME] covered by any other

public assistance program that pays for medical care?

(1) Yes

(2) No

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

CAIDNM

May I see his/her MEDICAID card

to verify the name of the medical program?

NAMES OF THE CHILDREN COVERED ARE LISTED

ON THE CARD OF THE PRIMARY RECIPIENT.

(N) Card Not Available

(1) Verified to be a MEDICAID card

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

KIDCOV How about his/her child(ren)?

Was/were ***READ NAME(S) LISTED BELOW***

covered by Medicaid or some other public assistance medical

program at any time between [MONTH1] 1st and today?

(1) Yes

(2) No

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

CAIDKIDS PARENT IS [PARENTS NAME]

Which of his/her children was covered

by MEDICAID?

ENTER (N) FOR NO MORE

@ @ @ @ @ @ @ @

@ @ @ @ @ @ @

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

CDMNTH

In which months was [FIRST NAME] [LAST NAME] and/or

his/her child(ren) covered

READ EACH ANSWER CATEGORY

(1) Yes

(2) No

@ In [MONTH5]?

@ In [MONTH4]?

@ In [MONTH3]?

@ In [MONTH2]?

@ In [MONTH1]?

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

CAIDBEGYR

The Medicaid coverage

that [FIRST NAME] [LAST NAME] had

when did that coverage start?

YEAR: @

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

CAIDBEGMTH

In what month did that coverage start?

MONTH: @

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

CAIDBEGPB

I recorded that the last time [FIRST NAME] [LAST NAME]

received Medicaid was in [YEAR REPORTED IN CAIDBEGYR].

Is that correct?

(1) Yes

(2) No

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

HIVER

Earlier I recorded that for some, or all, of the time

from [MONTH1] 1st through today [FIRST NAME] [LAST NAME]

was covered by a health insurance plan

held in the name of [NAME OF HEALTH INSURANCE "OWNER"].

Is that correct?

(1) Yes

(2) No

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

H4MNTH

(Other than the Medicare or MEDICAID we just talked about)

Is [FIRST NAME] [LAST NAME] covered by (any other)

health insurance

(1) Yes

(2) No

(N) NONE OF THESE MONTHS

@ in this month?

Was he/she covered

READ EACH ANSWER CATEGORY

@ in [MONTH4]?

@ in [MONTH3]?

@ in [MONTH2]?

@ in [MONTH1]?

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

CBHINS

If I were to call back later would it be possible

for me to get this information?

(1) Yes

(2) No

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

HIOWN

During any time from [MONTH1] 1st through today,

did [FIRST NAME] [LAST NAME] also have health insurance in

his/her own name?

(1) Yes

(2) No

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

HIOWNER

Was his/her health insurance coverage in his/her

own name or was he/she covered as a family

member on someone else's plan?

(1) Plan in own name

(2) Covered by someone else's plan

(3) Both

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

HIHOLDR

Who had the health insurance plan that covered [FIRST NAME] [LAST NAME]?

ENTER THE LINE NUMBER OF THE PERSON

(N) No one currently living here

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

HEMPLY

Let's talk about the plan in [FIRST NAME] [LAST NAME]'s own name.

Was the health insurance obtained through

READ ANSWER CATEGORIES

(1) His/her current employer or work

(2) His/her former employer

(3) His/her Union

(4) CHAMPUS

(5) CHAMPVA

(6) Or the Military/VA health care

(7) Privately purchased

(8) Or in some other way

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

HEMPLYSPEC

READ IF NECESSARY

How was that health insurance obtained?

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

HICOST

Did his/her current employer (former employer or union) pay

all, part, or none of the premium of the plan?

(1) All

(2) Part

(3) None

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

HIPERS Other than [FIRST NAME] [LAST NAME], who else was covered

by this plan?

ENTER LINE NUMBERS OF PERSONS COVERED

(A) All household members

(N) None/No more

@ @ @ @ @ @ @ @

@ @ @ @ @ @ @

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

HIOTHR

During the period from [MONTH1] 1st through

the end of [MONTH4], did this plan also cover

anyone who did NOT live in this household?

(1) Yes

(2) No

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

HIWHO

Who, OUTSIDE this household, did the plan cover?

ENTER (1) FOR EACH YES THAT APPLIES

ENTER (2) FOR EACH NO THAT APPLIES

@ Spouse/Partner

@ Children 18 years of age or older

@ Children under 18 years old

@ Others

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

H1KDCOV

Was [FIRST NAME] [LAST NAME] covered by

a health insurance plan (other than Medicaid) at any time

between [MONTH1] 1st and today?

(1) Yes

(2) No

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

H2KDCOV Which children if any were covered by a health insurance plan

(other than Medicaid) at anytime between

[MONTH1] 1st and today?

READ LIST OF CHILDREN'S NAMES DISPLAYED

ENTER APPROPRIATE LINE NUMBER OF EACH CHILD COVERED

ENTER (N) FOR NONE OF THESE CHILDREN/NO MORE

@ @ @ @ @ @ @ @

@ @ @ @ @ @ @

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

HI1OUT

Was [FIRST NAME] [LAST NAME] covered by the health insurance plan

of someone who does NOT currently live in the household?

(1) Yes

(2) No

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

HI2OUT Which children if any were covered by the health insurance plan of

someone who does NOT currently live in the household?

READ LIST OF CHILDREN'S NAMES DISPLAYED

ENTER LINE NUMBER OF EACH CHILD COVERED BY SOMEONE OUTSIDE

ENTER (N) FOR NONE OF THESE CHILDREN/NO MORE

@ @ @ @ @ @ @ @

@ @ @ @ @ @ @

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

HINONE I recorded that [FIRST NAME] [LAST NAME] was NOT covered

by any health insurance plan during the months of

[MONTH(S) NOT COVERED - SEE SCREEN H4MNTH]

Which ONE OR MORE of these reasons describe why [FIRST NAME] [LAST NAME]

was not covered?

(SHOW FLASHCARD I) ENTER (N) AFTER LAST ENTRY

(1) Too expensive, can't afford health insurance

(2) No health insurance offered by (employer of self, spouse, or parent)

(3) Not working at a job long enough to qualify

(4) Job layoff, job loss, or any reason related to unemployment

(5) Not eligible because working part time or temporary job

(6) Can't obtain insurance because of poor health, illness, age,

or a preexisting condition

(7) Dissatisfied with previous insurance OR don't believe in insurance

(8) Have been healthy, not much sickness in the family,

haven't needed health insurance

(9) Able to go to VA or military hospital for medical care

(10) Covered by some other health plan, such as Medicaid

(11) No longer covered by parents policy

(12) Other @ @ @ @ @ @

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

HISPEC

Specify the exact "OTHER" reason not covered by health insurance

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

HIHOWLNGYR

I recorded that [FIRST NAME] [LAST NAME] was

covered by health insurance in [MONTH1].

Before [MONTH1], when was the last time

[FIRST NAME] [LAST NAME] was WITHOUT

health insurance coverage?

In what year was that?

(A) Always covered by health insurance

YEAR: @

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

HIHOWLNGMTH

In what month was that?

MONTH: @

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

HIHOWLNGPB

I recorded the last time [FIRST NAME] [LAST NAME]

was covered by health insurance was in [YEAR REPORTED IN HIHOWLNGYR]

Is that correct?

(1) Yes

(2) No

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

HINOLNGYR

I recorded that [FIRST NAME] [LAST NAME] was

not covered by health insurance

(other than Medicare and/or Medicaid)

in [MONTH1].

Before then, when was the last time [FIRST NAME] [LAST NAME]

was covered? In what year was that?

(N) Never covered by health insurance

YEAR: @

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

HINOLNGMTH

In what month in [YEAR REPORTED IN HINOLNGYR] was that?

MONTH: @

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

HINOLNGPB

I recorded the last time [FIRST NAME] [LAST NAME]

was covered by health insurance was in [YEAR REPORTED IN HINOLNGYR].

Is that correct?

(1) Yes

(2) No

-------------------------------------------------------------------------------------------------- end of content rule

Page Last Modified: May 12, 2006

Census Bureau Links: Home · Search · Subjects A-Z · FAQs · Data Tools · Catalog · Census 2000 · Quality · Privacy Policy · Contact Us