Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                         66,736        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                         66,736                    2020  2020                                    
 
VERSION  VERSFMT                       Version Number                           
                         66,736                       1  Version 1                               
 
PLANNUM  RNDFKFMT                      Unique Plan Number                       
                         55,939                       .  Inapplicable                            
                         10,797        Range of values   Unique Plan Id                          
 
PLANTYPE PLAN3FMT                      Plan Type                                
                         15,401                       1  Medicare A                              
                         14,929                       2  Medicare B                              
                          7,520                       3  Medicare C/Medicare Advantage           
                         12,908                       4  Medicare D/Part D/MAPD                  
                          4,467                       5  Medicaid                                
                            763                       6  Other Public Plan                       
                          2,900                      20  Employer-sponsored insurance (ESI)      
                          1,900                      21  Employer-sponsored (ESI) Specialty Plan 
                          3,381                      30  Self-purchased Private Plan             
                          1,107                      31  Self-purchased Specialty Plan           
                             61                      40  Veteran’s Affairs Plan                  
                            787                      50  Tricare plan                            
                            397                      60  Retiree Drug Subsidy Plan               
                            215                      70  Other Insurance Plan Type Unknown       
 
BEGDATE  MMDDYYn8                      Coverage Begin Date for Year(MMDDYYYY)   
                         66,736        MMDDYYYY          Date as MMDDYYYY                        
 
ENDDATE  MMDDYYn8                      Coverage End Date for Year(MMDDYYYY)     
                             82                       .  Inapplicable                            
                         66,654        MMDDYYYY          Date as MMDDYYYY                        
 
SRCCOV01 COV2FMT                       Coverage Source Jan                      
                          1,952                       0  No Entitlement                          
                         12,211                       1  Survey Data Only                        
                         38,810                       2  CMS Administrative Data Only            
                         13,763                       3  Both Survey and Admin Data              
 
SRCCOV02 COV2FMT                       Coverage Source Feb                      
                          1,958                       0  No Entitlement                          
                         12,249                       1  Survey Data Only                        
                         38,622                       2  CMS Administrative Data Only            
                         13,907                       3  Both Survey and Admin Data              
 
SRCCOV03 COV2FMT                       Coverage Source Mar                      
                          1,950                       0  No Entitlement                          
                         12,253                       1  Survey Data Only                        
                         38,555                       2  CMS Administrative Data Only            
                         13,978                       3  Both Survey and Admin Data              
 
SRCCOV04 COV2FMT                       Coverage Source Apr                      
                          1,958                       0  No Entitlement                          
                         12,268                       1  Survey Data Only                        
                         38,486                       2  CMS Administrative Data Only            
                         14,024                       3  Both Survey and Admin Data              
 
SRCCOV05 COV2FMT                       Coverage Source May                      
                          2,071                       0  No Entitlement                          
                         12,234                       1  Survey Data Only                        
                         38,407                       2  CMS Administrative Data Only            
                         14,024                       3  Both Survey and Admin Data              
 
SRCCOV06 COV2FMT                       Coverage Source June                     
                          2,123                       0  No Entitlement                          
                         12,193                       1  Survey Data Only                        
                         38,499                       2  CMS Administrative Data Only            
                         13,921                       3  Both Survey and Admin Data              
 
SRCCOV07 COV2FMT                       Coverage Source July                     
                          2,130                       0  No Entitlement                          
                         12,209                       1  Survey Data Only                        
                         38,482                       2  CMS Administrative Data Only            
                         13,915                       3  Both Survey and Admin Data              
 
SRCCOV08 COV2FMT                       Coverage Source Aug                      
                          2,107                       0  No Entitlement                          
                         12,242                       1  Survey Data Only                        
                         38,485                       2  CMS Administrative Data Only            
                         13,902                       3  Both Survey and Admin Data              
 
SRCCOV09 COV2FMT                       Coverage Source Sep                      
                          2,117                       0  No Entitlement                          
                         12,271                       1  Survey Data Only                        
                         38,795                       2  CMS Administrative Data Only            
                         13,553                       3  Both Survey and Admin Data              
 
SRCCOV10 COV2FMT                       Coverage Source Oct                      
                          2,105                       0  No Entitlement                          
                         12,287                       1  Survey Data Only                        
                         39,107                       2  CMS Administrative Data Only            
                         13,237                       3  Both Survey and Admin Data              
 
SRCCOV11 COV2FMT                       Coverage Source Nov                      
                          2,186                       0  No Entitlement                          
                         12,276                       1  Survey Data Only                        
                         39,386                       2  CMS Administrative Data Only            
                         12,888                       3  Both Survey and Admin Data              
 
SRCCOV12 COV2FMT                       Coverage Source Dec                      
                          2,321                       0  No Entitlement                          
                         12,258                       1  Survey Data Only                        
                         39,674                       2  CMS Administrative Data Only            
                         12,483                       3  Both Survey and Admin Data              
 
COV01    ELIGCOVF                      Monthly Eligibility Jan                  
                          3,427                       0  Ineligible / Not covered                
                         63,309                       1  Eligible / Covered                      
 
COV02    ELIGCOVF                      Monthly Eligibility Feb                  
                          3,322                       0  Ineligible / Not covered                
                         63,414                       1  Eligible / Covered                      
 
COV03    ELIGCOVF                      Monthly Eligibility Mar                  
                          3,265                       0  Ineligible / Not covered                
                         63,471                       1  Eligible / Covered                      
 
COV04    ELIGCOVF                      Monthly Eligibility Apr                  
                          3,225                       0  Ineligible / Not covered                
                         63,511                       1  Eligible / Covered                      
 
COV05    ELIGCOVF                      Monthly Eligibility May                  
                          3,348                       0  Ineligible / Not covered                
                         63,388                       1  Eligible / Covered                      
 
COV06    ELIGCOVF                      Monthly Eligibility June                 
                          3,386                       0  Ineligible / Not covered                
                         63,350                       1  Eligible / Covered                      
 
COV07    ELIGCOVF                      Monthly Eligibility July                 
                          3,337                       0  Ineligible / Not covered                
                         63,399                       1  Eligible / Covered                      
 
COV08    ELIGCOVF                      Monthly Eligibility Aug                  
                          3,316                       0  Ineligible / Not covered                
                         63,420                       1  Eligible / Covered                      
 
COV09    ELIGCOVF                      Monthly Eligibility Sep                  
                          3,545                       0  Ineligible / Not covered                
                         63,191                       1  Eligible / Covered                      
 
COV10    ELIGCOVF                      Monthly Eligibility Oct                  
                          3,703                       0  Ineligible / Not covered                
                         63,033                       1  Eligible / Covered                      
 
COV11    ELIGCOVF                      Monthly Eligibility Nov                  
                          4,032                       0  Ineligible / Not covered                
                         62,704                       1  Eligible / Covered                      
 
COV12    ELIGCOVF                      Monthly Eligibility Dec                  
                          4,480                       0  Ineligible / Not covered                
                         62,256                       1  Eligible / Covered                      
 
S_DVH    DVHFMT                        Dental Vision or Hearing Plan            
                         64,253                       .  Inapplicable                            
                          1,779                       1  Dental only plan                        
                            631                       2  Vision only plan                        
                             54                       3  Dental and vision plan                  
                             19                       4  Other dental vision or hearing          
 
S_OTHPLN OTPLNFMT                      Other plan type                          
                         65,888                       .  Inapplicable                            
                            138                       1  Long term care plan                     
                            584                       2  Prescription drug only plan             
                             30                       3  Life insurance plan                     
                             96                       4  Cancer / dread disease plan             
 
S_HMOPPO YESNO_HI                      Is Plan an HMO/PPO                       
                          1,215                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            246                       N  Not ascertained                         
                              4                       R  Refused                                 
                          2,314                       1  Yes                                     
                          5,724                       2  No                                      
 
S_PHREL  REL2FMT                       Policyholder relationship                
                         57,233                       .  Inapplicable                            
                            278                       N  Not ascertained                         
                          7,630                       1  Sample person                           
                          1,529                       2  Spouse                                  
                             26                      30  Father                                  
                             36                      40  Mother                                  
                              4                      56  Partner                                 
 
S_COVNM  PEOPLE                        Total number of people covered by Plan   
                              1                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            465                       N  Not ascertained                         
                          5,524                       1  One person                              
                          3,212                       2  Two people                              
                            180                       3  Three people                            
                             84                       4  Four people                             
                             23                       5  Five people                             
                              6                       6  Six people                              
                              4                       7  Seven people                            
                              4                      8+  Eight or more people                    
 
S_OBTNP  MIPFMT                        How did MIP obtain Plan                  
                         57,233                       .  Inapplicable                            
                            423                       N  Not ascertained                         
                          3,791                       1  Directly                                
                          1,138                       2  Main insured person's current employer  
                          3,132                       3  Main insured person's prior employer    
                            277                       4  Union                                   
                             37                       5  Family business                         
                            356                       6  AARP                                    
                            272                       7  Deceased spouse's employer              
                             33                       8  Deceased spouse's union                 
                             44                       9  Fraternal/professional organization     
 
S_MSCOV  YESNO_HI                      Does Plan cover doctor visits / lab work 
                            264                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            360                       N  Not ascertained                         
                              6                       R  Refused                                 
                          6,010                       1  Yes                                     
                          2,863                       2  No                                      
 
S_IP     YESNO_HI                      Does Plan cover inpatient stay           
                            427                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            474                       N  Not ascertained                         
                              7                       R  Refused                                 
                          5,388                       1  Yes                                     
                          3,207                       2  No                                      
 
S_DNTAL  YESNO_HI                      Does Plan cover dental services          
                            202                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            417                       N  Not ascertained                         
                              5                       R  Refused                                 
                          3,218                       1  Yes                                     
                          5,661                       2  No                                      
 
S_VISN   YESNO_HI                      Does Plan cover vision services          
                            308                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            689                       N  Not ascertained                         
                              4                       R  Refused                                 
                          2,620                       1  Yes                                     
                          5,882                       2  No                                      
                 First available in 2020
 
S_COVNH  YESNO_HI                      Does Plan cover stay in nursing home     
                          1,965                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            415                       N  Not ascertained                         
                              6                       R  Refused                                 
                          1,268                       1  Yes                                     
                          5,849                       2  No                                      
 
D_COVRX  RXPLFMT                       Drug coverage for Plan                   
                         55,898                       .  Inapplicable                            
                            669                       N  Not ascertained                         
                          4,462                       1  Plan covers prescription drugs          
                          5,707                       2  Plan does not cover prescription drugs  
 
S_TRIRX  TRIRXFMT                      Where Tricare Member obtains medicine    
                              6                       D  Don't know                              
                         65,949                       .  Inapplicable                            
                            136                       N  Not ascertained                         
                            328                       1  Tricare mail order pharmacy             
                             64                       2  Tricare retail network pharmacy         
                            167                       3  Military Treatment Facility             
                             69                       4  Non-network retail pharmacy             
                             17                      91  Other                                   
 
S_PAYSP  YESNO_HI                      MIP pay any premium for Plan             
                            244                       D  Don't know                              
                         57,233                       .  Inapplicable                            
                            481                       N  Not ascertained                         
                              5                       R  Refused                                 
                          7,435                       1  Yes                                     
                          1,338                       2  No                                      
 
S_PREM   PREMAFMT                      Premium MIP pays for Plan                
                          1,872                       D  Don't know                              
                         59,301                       .  Inapplicable                            
                              4                       N  Not ascertained                         
                             40                       R  Refused                                 
                          1,866        Range of values   Premium Amount                          
                          3,061        Range of values   Premium Amount                          
                            351        Range of values   Premium Amount                          
                             67        Range of values   Premium Amount                          
                             43        Range of values   Premium Amount                          
                             20        Range of values   Premium Amount                          
                             27        Range of values   Premium Amount                          
                              9        Range of values   Premium Amount                          
                             17        Range of values   Premium Amount                          
                             11        Range of values   Premium Amount                          
                             15        Range of values   Premium Amount                          
                             32        Range of values   Premium Amount                          
 
D_ANNPRM PREMAFMT                      Annualized premium MIP pays for Plan     
                          1,872                       D  Don't know                              
                         59,301                       .  Inapplicable                            
                             32                       N  Not ascertained                         
                             40                       R  Refused                                 
                            326        Range of values   Premium Amount                          
                          1,073        Range of values   Premium Amount                          
                            693        Range of values   Premium Amount                          
                            542        Range of values   Premium Amount                          
                            540        Range of values   Premium Amount                          
                            541        Range of values   Premium Amount                          
                            537        Range of values   Premium Amount                          
                            333        Range of values   Premium Amount                          
                            245        Range of values   Premium Amount                          
                            140        Range of values   Premium Amount                          
                            132        Range of values   Premium Amount                          
                            389        Range of values   Premium Amount                          
 
S_PAYUNT PAYUNITF                      Unit of premium MIP pays for Plan        
                            256                       D  Don't know                              
                         59,301                       .  Inapplicable                            
                              2                       N  Not ascertained                         
                              7                       R  Refused                                 
                            677                       1  Per year                                
                            210                       2  Quarterly / Every 3 months              
                             44                       3  Every 2 months                          
                          5,892                       4  Per month                               
                            126                       5  Per week                                
                             36                       6  Every 6 months                          
                             57                       7  Every 2 weeks                           
                            128                      91  Other                                   
 
S_PAYOTH YESNO_HI                      Anyone else pays a portion of Plan cost  
                            291                       D  Don't know                              
                         55,623                       .  Inapplicable                            
                          2,035                       1  Yes                                     
                          8,787                       2  No                                      
 
S_PAYWHO PAYWHOF                       Who pays a portion of Plan cost          
                              6                       D  Don't know                              
                         64,701                       .  Inapplicable                            
                            591                       N  Not ascertained                         
                            398                       1  Sample person's current employer        
                            847                       2  Sample person's prior employer          
                             71                       3  Sample person's union                   
                              9                       4  Spouse's current employer               
                             86                       5  Spouse's former employer                
                              6                       6  Fraternal / professional organization   
                              2                       7  Medicaid / Medical assistance           
                             19                      91  Other                                   
 
D_FCLTYF FACILTYF                      Plan information obtained from Facility  
                         55,622                       .  Inapplicable                            
                         10,797                       0  Plan not reported by a facility         
                            317                       1  Plan reported by a facility             
 
