Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                         61,738        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                         61,738                    2021  2021                                    
 
VERSION  VERSFMT                       Version Number                           
                         61,738                       1  Version 1                               
 
PLANNUM  RNDFKFMT                      Unique Plan Number                       
                         51,157                       .  Inapplicable                            
                         10,581        Range of values   Unique Plan Id                          
 
PLANTYPE PLAN3FMT                      Plan Type                                
                         14,172                       1  Medicare A                              
                         13,735                       2  Medicare B                              
                          6,776                       3  Medicare C/Medicare Advantage           
                         11,992                       4  Medicare D/Part D/MAPD                  
                          4,162                       5  Medicaid                                
                            651                       6  Other Public Plan                       
                          2,585                      20  Employer-sponsored insurance (ESI)      
                          1,850                      21  Employer-sponsored (ESI) Specialty Plan 
                          3,449                      30  Self-purchased Private Plan             
                          1,095                      31  Self-purchased Specialty Plan           
                             44                      40  Veteran’s Affairs Plan                  
                            726                      50  Tricare plan                            
                            320                      60  Retiree Drug Subsidy Plan               
                            181                      70  Other Insurance Plan Type Unknown       
 
BEGDATE  MMDDYYn8                      Coverage Begin Date for Year(MMDDYYYY)   
                         61,738        MMDDYYYY          Date as MMDDYYYY                        
 
ENDDATE  MMDDYYn8                      Coverage End Date for Year(MMDDYYYY)     
                             69                       .  Inapplicable                            
                         61,669        MMDDYYYY          Date as MMDDYYYY                        
 
SRCCOV01 COV2FMT                       Coverage Source Jan                      
                          1,686                       0  No Entitlement                          
                         11,001                       1  Survey Data Only                        
                         36,264                       2  CMS Administrative Data Only            
                         12,787                       3  Both Survey and Admin Data              
 
SRCCOV02 COV2FMT                       Coverage Source Feb                      
                          1,704                       0  No Entitlement                          
                         10,998                       1  Survey Data Only                        
                         36,074                       2  CMS Administrative Data Only            
                         12,962                       3  Both Survey and Admin Data              
 
SRCCOV03 COV2FMT                       Coverage Source Mar                      
                          1,698                       0  No Entitlement                          
                         10,996                       1  Survey Data Only                        
                         36,008                       2  CMS Administrative Data Only            
                         13,036                       3  Both Survey and Admin Data              
 
SRCCOV04 COV2FMT                       Coverage Source Apr                      
                          1,740                       0  No Entitlement                          
                         10,983                       1  Survey Data Only                        
                         35,930                       2  CMS Administrative Data Only            
                         13,085                       3  Both Survey and Admin Data              
 
SRCCOV05 COV2FMT                       Coverage Source May                      
                          1,713                       0  No Entitlement                          
                         11,000                       1  Survey Data Only                        
                         35,830                       2  CMS Administrative Data Only            
                         13,195                       3  Both Survey and Admin Data              
 
SRCCOV06 COV2FMT                       Coverage Source June                     
                          1,747                       0  No Entitlement                          
                         11,011                       1  Survey Data Only                        
                         35,774                       2  CMS Administrative Data Only            
                         13,206                       3  Both Survey and Admin Data              
 
SRCCOV07 COV2FMT                       Coverage Source July                     
                          1,707                       0  No Entitlement                          
                         11,025                       1  Survey Data Only                        
                         35,793                       2  CMS Administrative Data Only            
                         13,213                       3  Both Survey and Admin Data              
 
SRCCOV08 COV2FMT                       Coverage Source Aug                      
                          1,693                       0  No Entitlement                          
                         11,014                       1  Survey Data Only                        
                         35,870                       2  CMS Administrative Data Only            
                         13,161                       3  Both Survey and Admin Data              
 
SRCCOV09 COV2FMT                       Coverage Source Sep                      
                          1,663                       0  No Entitlement                          
                         11,006                       1  Survey Data Only                        
                         36,186                       2  CMS Administrative Data Only            
                         12,883                       3  Both Survey and Admin Data              
 
SRCCOV10 COV2FMT                       Coverage Source Oct                      
                          1,737                       0  No Entitlement                          
                         10,996                       1  Survey Data Only                        
                         36,419                       2  CMS Administrative Data Only            
                         12,586                       3  Both Survey and Admin Data              
 
SRCCOV11 COV2FMT                       Coverage Source Nov                      
                          1,812                       0  No Entitlement                          
                         10,983                       1  Survey Data Only                        
                         36,703                       2  CMS Administrative Data Only            
                         12,240                       3  Both Survey and Admin Data              
 
SRCCOV12 COV2FMT                       Coverage Source Dec                      
                          1,934                       0  No Entitlement                          
                         10,977                       1  Survey Data Only                        
                         36,951                       2  CMS Administrative Data Only            
                         11,876                       3  Both Survey and Admin Data              
 
COV01    ELIGCOVF                      Monthly Eligibility Jan                  
                          3,233                       0  Ineligible / Not covered                
                         58,505                       1  Eligible / Covered                      
 
COV02    ELIGCOVF                      Monthly Eligibility Feb                  
                          3,161                       0  Ineligible / Not covered                
                         58,577                       1  Eligible / Covered                      
 
COV03    ELIGCOVF                      Monthly Eligibility Mar                  
                          3,142                       0  Ineligible / Not covered                
                         58,596                       1  Eligible / Covered                      
 
COV04    ELIGCOVF                      Monthly Eligibility Apr                  
                          3,209                       0  Ineligible / Not covered                
                         58,529                       1  Eligible / Covered                      
 
COV05    ELIGCOVF                      Monthly Eligibility May                  
                          3,022                       0  Ineligible / Not covered                
                         58,716                       1  Eligible / Covered                      
 
COV06    ELIGCOVF                      Monthly Eligibility June                 
                          2,921                       0  Ineligible / Not covered                
                         58,817                       1  Eligible / Covered                      
 
COV07    ELIGCOVF                      Monthly Eligibility July                 
                          2,804                       0  Ineligible / Not covered                
                         58,934                       1  Eligible / Covered                      
 
COV08    ELIGCOVF                      Monthly Eligibility Aug                  
                          2,859                       0  Ineligible / Not covered                
                         58,879                       1  Eligible / Covered                      
 
COV09    ELIGCOVF                      Monthly Eligibility Sep                  
                          3,056                       0  Ineligible / Not covered                
                         58,682                       1  Eligible / Covered                      
 
COV10    ELIGCOVF                      Monthly Eligibility Oct                  
                          3,337                       0  Ineligible / Not covered                
                         58,401                       1  Eligible / Covered                      
 
COV11    ELIGCOVF                      Monthly Eligibility Nov                  
                          3,712                       0  Ineligible / Not covered                
                         58,026                       1  Eligible / Covered                      
 
COV12    ELIGCOVF                      Monthly Eligibility Dec                  
                          4,165                       0  Ineligible / Not covered                
                         57,573                       1  Eligible / Covered                      
 
S_PHREL  REL2FMT                       Policyholder relationship                
                         52,578                       .  Inapplicable                            
                            248                       N  Not ascertained                         
                          7,524                       1  Sample person                           
                          1,334                       2  Spouse                                  
                              1                      56  Partner                                 
                              4                      58  Child                                   
                             49                      60  Parent                                  
 
S_COVNM  PEOPLE                        Total number of people covered by Plan   
                         52,578                       .  Inapplicable                            
                            417                       N  Not ascertained                         
                          5,422                       1  One person                              
                          3,056                       2  Two people                              
                            161                       3  Three people                            
                             72                       4  Four people                             
                             23                       5  Five people                             
                              4                       6  Six people                              
                              2                       7  Seven people                            
                              3                      8+  Eight or more people                    
 
S_OBTNP  MIPFMT                        How did MIP obtain Plan                  
                         52,578                       .  Inapplicable                            
                            367                       N  Not ascertained                         
                          3,883                       1  Directly                                
                          1,038                       2  Main insured person's current employer  
                          2,928                       3  Main insured person's prior employer    
                            249                       4  Union                                   
                             32                       5  Family business                         
                            354                       6  AARP                                    
                            250                       7  Deceased spouse's employer              
                             27                       8  Deceased spouse's union                 
                             32                       9  Fraternal/professional organization     
 
S_HMOPPO YESNO_HI                      Is Plan an HMO/PPO                       
                          1,280                       D  Don't know                              
                         52,578                       .  Inapplicable                            
                            240                       N  Not ascertained                         
                              5                       R  Refused                                 
                          2,592                       1  Yes                                     
                          5,043                       2  No                                      
 
S_DVH    DVHFMT                        Dental Vision or Hearing Plan            
                         59,252                       .  Inapplicable                            
                          1,785                       1  Dental only plan                        
                            626                       2  Vision only plan                        
                             60                       3  Dental and vision plan                  
                             15                       4  Other dental vision or hearing          
 
S_OTHPLN OTPLNFMT                      Other plan type                          
                         60,945                       .  Inapplicable                            
                            136                       1  Long term care plan                     
                            518                       2  Prescription drug only plan             
                             18                       3  Life insurance plan                     
                            121                       4  Cancer / dread disease plan             
 
S_MSCOV  YESNO_HI                      Does Plan cover doctor visits / lab work 
                            162                       D  Don't know                              
                         52,578                       .  Inapplicable                            
                            756                       N  Not ascertained                         
                              1                       R  Refused                                 
                          5,353                       1  Yes                                     
                          2,888                       2  No                                      
 
S_IP     YESNO_HI                      Does Plan cover inpatient stay           
                            361                       D  Don't know                              
                         52,578                       .  Inapplicable                            
                            867                       N  Not ascertained                         
                              4                       R  Refused                                 
                          4,785                       1  Yes                                     
                          3,143                       2  No                                      
 
S_DNTAL  YESNO_HI                      Does Plan cover dental services          
                            189                       D  Don't know                              
                         52,588                       .  Inapplicable                            
                            371                       N  Not ascertained                         
                              3                       R  Refused                                 
                          3,298                       1  Yes                                     
                          5,289                       2  No                                      
 
S_VISN   YESNO_HI                      Does Plan cover vision services          
                            285                       D  Don't know                              
                         52,588                       .  Inapplicable                            
                            374                       N  Not ascertained                         
                              1                       R  Refused                                 
                          2,777                       1  Yes                                     
                          5,713                       2  No                                      
                 First available in 2020
 
S_COVNH  YESNO_HI                      Does Plan cover stay in nursing home     
                          1,840                       D  Don't know                              
                         52,588                       .  Inapplicable                            
                            373                       N  Not ascertained                         
                              9                       R  Refused                                 
                          1,259                       1  Yes                                     
                          5,669                       2  No                                      
 
S_PAYSP  YESNO_HI                      MIP pay any premium for Plan             
                            209                       D  Don't know                              
                         52,578                       .  Inapplicable                            
                            861                       N  Not ascertained                         
                              3                       R  Refused                                 
                          6,898                       1  Yes                                     
                          1,189                       2  No                                      
 
S_PAYUNT PAYUNITF                      Unit of premium MIP pays for Plan        
                            246                       D  Don't know                              
                         54,840                       .  Inapplicable                            
                              4                       N  Not ascertained                         
                             10                       R  Refused                                 
                            596                       1  Per year                                
                            179                       2  Quarterly / Every 3 months              
                             28                       3  Every 2 months                          
                          5,571                       4  Per month                               
                             89                       5  Per week                                
                             38                       6  Every 6 months                          
                             48                       7  Every 2 weeks                           
                             89                      91  Other                                   
 
S_PREM   PREMAFMT                      Premium MIP pays for Plan                
                          1,633                       D  Don't know                              
                         54,840                       .  Inapplicable                            
                              4                       N  Not ascertained                         
                             46                       R  Refused                                 
                          1,803                       1  $100 or less                            
                          2,843                     101  $101-$500                               
                            354                     501  $501-$1000                              
                             44                    1021  $1001-$1500                             
                             49                    1501  $1501-$2000                             
                             22                    2016  $2001-$2500                             
                             21                    2600  $2501-$3000                             
                             15                    3100  $3001-$3500                             
                             19                    3575  $3501-$4000                             
                              8                    4060  $4001-$4500                             
                             11                    4600  $4501-$5000                             
                             26                    5316  Over $5000                              
 
D_ANNPRM PREMAFMT                      Annualized premium MIP pays for Plan     
                          1,633                       D  Don't know                              
                         54,840                       .  Inapplicable                            
                             23                       N  Not ascertained                         
                             46                       R  Refused                                 
                            277                       0  $100 or less                            
                          1,130                     101  $101-$500                               
                            659                     501  $501-$1000                              
                            497                    1003  $1001-$1500                             
                            497                    1501  $1501-$2000                             
                            482                    2002  $2001-$2500                             
                            442                    2502  $2501-$3000                             
                            318                    3005  $3001-$3500                             
                            246                    3501  $3501-$4000                             
                            129                    4008  $4001-$4500                             
                            138                    4501  $4501-$5000                             
                            381                    5001  Over $5000                              
 
S_PAYOTH YESNO_HI                      Anyone else pays a portion of Plan cost  
                            411                       D  Don't know                              
                         52,578                       .  Inapplicable                            
                            711                       N  Not ascertained                         
                              4                       R  Refused                                 
                          2,631                       1  Yes                                     
                          5,403                       2  No                                      
 
S_PAYWHO PAYWHOF                       Who pays a portion of Plan cost          
                              8                       D  Don't know                              
                         59,107                       .  Inapplicable                            
                            662                       1  Sample person's current employer        
                          1,556                       2  Sample person's prior employer          
                            150                       3  Sample person's union                   
                             21                       4  Spouse's current employer               
                            186                       5  Spouse's former employer                
                              3                       6  Fraternal / professional organization   
                              6                       7  Medicaid / Medical assistance           
                             39                      91  Other                                   
 
D_COVRX  RXPLFMT                       Drug coverage for Plan                   
                             14                       D  Don't know                              
                         51,393                       .  Inapplicable                            
                            584                       N  Not ascertained                         
                          4,223                       1  Plan covers prescription drugs          
                          5,524                       2  Plan does not cover prescription drugs  
 
S_TRIRX  TRIRXFMT                      Where Tricare Member obtains medicine    
                              7                       D  Don't know                              
                         61,012                       .  Inapplicable                            
                            141                       N  Not ascertained                         
                            260                       1  Tricare mail order pharmacy             
                             54                       2  Tricare retail network pharmacy         
                            161                       3  Military Treatment Facility             
                             87                       4  Non-network retail pharmacy             
                             16                      91  Other                                   
 
D_FCLTYF FACILTYF                      Plan information obtained from Facility  
                         51,157                       .  Inapplicable                            
                         10,318                       0  Plan not reported by a facility         
                            263                       1  Plan reported by a facility             
 
