Section 14, Part C - Hospitalization and Health Insurance - Medicare, Medicaid, and Other Health Insurance Plans Not Directly Paid For By The Consumer Unit

Section 14, Part C covers participation in health insurance plans for which the consumer unit does not pay directly, such as Medicare, Medicaid, and military health care plans.

For definitions Information Booklet »

Choose one of the following

1. Enter 1 if CU has provided data for this section from prior interview - Interviews 2 through 5
2. Enter 2 if CU has not provided data for this section from prior interview - Interview 1 [and replacement CUs]

Last time you said that a CU member was/CU members were enrolled in Medicare. Has the number of CU members enrolled in Medicare changed?

1. Yes
2. No

How many members of your CU are covered by Medicare? [enter value] ______________

Are you or any members of your CU presently enrolled in a Medicare Prescription Drug plan?
The Medicare Prescription Drug plan is also known as Medicare Part D, which is the plan that began enrollment in November 2005.

1. Yes
2. No

Who is enrolled in a Medicare Prescription Drug plan? [enter text] ______________

In what month and year did you or CU member(s) enroll in the prescription drug plan?

* Enter month of enrollment [enter value] ______________

* Enter year of enrollment [enter value] ______________

What is the monthly premium for you or CU member(s) Medicare Prescription Drug plan?

* Do not include any monthly co-payments paid by the CU. [enter value] ______________

Is the monthly premium deducted from a Social Security payment?

1. Yes
2. No

Last time you said that a CU member was/CU members were enrolled in Medicaid. Has the number of members enrolled in Medicaid changed?

1. Yes
2. No

How many members of your CU are covered by Medicaid? [enter value] ______________

Are any members of your CU still covered by a plan other than Medicare or Medicaid such as TRICARE, CHAMPUS, or military health care?

1. Yes
2. No

Are you or any members of your CU presently enrolled in Medicare?
Medicare is the Federal Health Insurance Plan.

1. Yes
2. No

How many members of your CU are covered by Medicare? [enter value] ______________

Are you or any members of your CU presently enrolled in a Medicare Prescription Drug plan?
The Medicare Prescription Drug plan is also known as Medicare Part D, which is the plan that began enrollment in November 2005.

1. Yes
2. No

Who is enrolled in a Medicare Prescription Drug plan? [enter text] ______________

In what month and year did you or CU member(s) enroll in the prescription drug plan?

* Enter month of enrollment [enter value] ______________

* Enter year of enrollment [enter value] ______________

What is the monthly premium for you or CU member(s) Medicare Prescription Drug plan?

* Do not include any monthly co-payments paid by the CU. [enter value] ______________

Is the monthly premium deducted from a Social Security payment?

1. Yes
2. No

Are you or any members of your CU enrolled in Medicaid?

1. Yes
2. No

How many members of your CU are covered by Medicaid? [enter value] ______________

Are you or any member of your CU covered by any plan other than Medicare or Medicaid which provides free health care such as TRICARE, CHAMPUS or military health care?

1. Yes
2. No

End of Section 14C

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Last Modified Date: November 8, 2007