Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                         60,542        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                         60,542                    2015  2015                                    
 
VERSION  VERSFMT                       Version Number                           
                         60,542                       4  Version 4                               
 
PLANNUM  RNDFKFMT                      Unique Plan Number                       
                         50,036                       .  Inapplicable                            
                         10,506        Range of values   Unique Plan Id                          
                 First available in 2015
 
PLANTYPE PLAN3FMT                      Plan Type                                
                         14,008                       1  Medicare A                              
                         13,649                       2  Medicare B                              
                          5,619                       3  Medicare C/Medicare Advantage           
                         11,306                       4  Medicare D/Part D/MAPD                  
                          4,315                       5  Medicaid                                
                            847                       6  Other Public Plan                       
                          3,017                      20  Employer-sponsored insurance (ESI)      
                          1,524                      21  Employer-sponsored (ESI) Specialty Plan 
                          3,416                      30  Self-purchased Private Plan             
                          1,065                      31  Self-purchased Specialty Plan           
                             56                      40  Veteran’s Affairs Plan                  
                            699                      50  Tricare plan                            
                            651                      60  Retiree Drug Subsidy Plan               
                            370                      70  Other Insurance Plan Type Unknown       
 
S_INS    INSPLFMT                      Insurance coverage Plan                  
                         49,548                       .  Inapplicable                            
                            814                       N  Not ascertained                         
                          7,616                       1  Comprehensive insurance                 
                          1,415                       2  Dental only                             
                            347                       3  Vision only                             
                            120                       4  LTC                                     
                            465                       5  Rx only                                 
                             24                       6  Dental/Vision                           
                            146                       7  Life insurance                          
                             47                       8  Cancer/Dread disease                    
                 First available in 2015
 
BEGDATE  MMDDYYn8                      Coverage Begin Date for Year(MMDDYYYY)   
                         60,542        MMDDYYYY          Date as MMDDYYYY                        
 
ENDDATE  MMDDYYn8                      Coverage End Date for Year(MMDDYYYY)     
                         60,542        MMDDYYYY          Date as MMDDYYYY                        
 
SRCCOV01 COV2FMT                       Coverage Source Jan                      
                          1,834                       0  No Entitlement                          
                         12,534                       1  Survey Data Only                        
                         33,665                       2  CMS Administrative Data Only            
                         12,509                       3  Both Survey and Admin Data              
 
SRCCOV03 COV2FMT                       Coverage Source Mar                      
                          1,933                       0  No Entitlement                          
                         12,522                       1  Survey Data Only                        
                         33,557                       2  CMS Administrative Data Only            
                         12,530                       3  Both Survey and Admin Data              
 
SRCCOV04 COV2FMT                       Coverage Source Apr                      
                          2,003                       0  No Entitlement                          
                         12,560                       1  Survey Data Only                        
                         33,367                       2  CMS Administrative Data Only            
                         12,612                       3  Both Survey and Admin Data              
 
SRCCOV05 COV2FMT                       Coverage Source May                      
                          2,063                       0  No Entitlement                          
                         12,576                       1  Survey Data Only                        
                         33,247                       2  CMS Administrative Data Only            
                         12,656                       3  Both Survey and Admin Data              
 
SRCCOV06 COV2FMT                       Coverage Source June                     
                          2,101                       0  No Entitlement                          
                         12,581                       1  Survey Data Only                        
                         33,130                       2  CMS Administrative Data Only            
                         12,730                       3  Both Survey and Admin Data              
 
SRCCOV07 COV2FMT                       Coverage Source July                     
                          2,074                       0  No Entitlement                          
                         12,579                       1  Survey Data Only                        
                         33,120                       2  CMS Administrative Data Only            
                         12,769                       3  Both Survey and Admin Data              
 
SRCCOV08 COV2FMT                       Coverage Source Aug                      
                          2,122                       0  No Entitlement                          
                         12,590                       1  Survey Data Only                        
                         33,033                       2  CMS Administrative Data Only            
                         12,797                       3  Both Survey and Admin Data              
 
SRCCOV09 COV2FMT                       Coverage Source Sep                      
                          2,104                       0  No Entitlement                          
                         12,605                       1  Survey Data Only                        
                         33,031                       2  CMS Administrative Data Only            
                         12,802                       3  Both Survey and Admin Data              
 
SRCCOV10 COV2FMT                       Coverage Source Oct                      
                          2,147                       0  No Entitlement                          
                         12,624                       1  Survey Data Only                        
                         33,083                       2  CMS Administrative Data Only            
                         12,688                       3  Both Survey and Admin Data              
 
SRCCOV11 COV2FMT                       Coverage Source Nov                      
                          2,240                       0  No Entitlement                          
                         12,604                       1  Survey Data Only                        
                         33,229                       2  CMS Administrative Data Only            
                         12,469                       3  Both Survey and Admin Data              
 
SRCCOV12 COV2FMT                       Coverage Source Dec                      
                          2,371                       0  No Entitlement                          
                         12,581                       1  Survey Data Only                        
                         33,370                       2  CMS Administrative Data Only            
                         12,220                       3  Both Survey and Admin Data              
 
COV01    ELIGCOVF                      Monthly Eligibility Jan                  
                          3,877                       0  Ineligible / Not covered                
                         56,665                       1  Eligible / Covered                      
 
COV02    ELIGCOVF                      Monthly Eligibility Feb                  
                          3,871                       0  Ineligible / Not covered                
                         56,671                       1  Eligible / Covered                      
 
COV03    ELIGCOVF                      Monthly Eligibility Mar                  
                          3,905                       0  Ineligible / Not covered                
                         56,637                       1  Eligible / Covered                      
 
COV04    ELIGCOVF                      Monthly Eligibility Apr                  
                          3,755                       0  Ineligible / Not covered                
                         56,787                       1  Eligible / Covered                      
 
COV05    ELIGCOVF                      Monthly Eligibility May                  
                          3,724                       0  Ineligible / Not covered                
                         56,818                       1  Eligible / Covered                      
 
COV06    ELIGCOVF                      Monthly Eligibility June                 
                          3,515                       0  Ineligible / Not covered                
                         57,027                       1  Eligible / Covered                      
 
COV07    ELIGCOVF                      Monthly Eligibility July                 
                          3,354                       0  Ineligible / Not covered                
                         57,188                       1  Eligible / Covered                      
 
COV08    ELIGCOVF                      Monthly Eligibility Aug                  
                          3,373                       0  Ineligible / Not covered                
                         57,169                       1  Eligible / Covered                      
 
COV09    ELIGCOVF                      Monthly Eligibility Sep                  
                          3,334                       0  Ineligible / Not covered                
                         57,208                       1  Eligible / Covered                      
 
COV10    ELIGCOVF                      Monthly Eligibility Oct                  
                          3,447                       0  Ineligible / Not covered                
                         57,095                       1  Eligible / Covered                      
 
COV11    ELIGCOVF                      Monthly Eligibility Nov                  
                          3,776                       0  Ineligible / Not covered                
                         56,766                       1  Eligible / Covered                      
 
COV12    ELIGCOVF                      Monthly Eligibility Dec                  
                          4,288                       0  Ineligible / Not covered                
                         56,254                       1  Eligible / Covered                      
 
S_HMOPPO YESNO_HI                      Is Plan an HMO/PPO                       
                            611                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                            717                       N  Not ascertained                         
                              5                       R  Refused                                 
                          2,153                       1  Yes                                     
                          5,906                       2  No                                      
                 First available in 2015
 
S_PHREL  REL2FMT                       Policyholder relationship                
                         51,150                       .  Inapplicable                            
                            609                       N  Not ascertained                         
                          7,307                       1  Sample person                           
                          1,429                       2  Spouse                                  
                             26                      30  Father                                  
                             19                      40  Mother                                  
                              2                      56  Partner                                 
                 First available in 2015
 
S_COVNM  PEOPLE                        Total number of people covered by Plan   
                             15                       D  Don't know                              
                         51,150                       .  Missing                                 
                          1,469                       N  Not ascertained                         
                              7                       R  Refused                                 
                          4,808                       1  One person                              
                          2,869                       2  Two people                              
                            116                       3  Three people                            
                             78                       4  Four people                             
                             19                       5  Five people                             
                              5                       6  Six people                              
                              3                       7  Seven people                            
                              3                       8  Eight or more people                    
                 First available in 2015
 
S_OBTNP  MIPFMT                        How did MIP obtain Plan                  
                            162                       D  Don't know                              
                         51,150                       .  Inapplicable/Missing                    
                          1,468                       N  Not ascertained                         
                              4                       R  Refused                                 
                          3,033                       1  Directly                                
                            771                       2  Main insured person's current employer  
                          2,861                       3  Main insured person's prior employer    
                            220                       4  Union                                   
                             33                       5  Family business                         
                            273                       6  AARP                                    
                            313                       7  Deceased spouse's employer              
                             34                       8  Deceased spouse's union                 
                             21                       9  Fraternal/professional organization     
                            199                      91  Other                                   
                 First available in 2015
 
S_MSCOV  YESNO_HI                      Does Plan cover doctor visits / lab work 
                            203                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                            866                       N  Not ascertained                         
                              6                       R  Refused                                 
                          6,422                       1  Yes                                     
                          1,895                       2  No                                      
                 First available in 2015
 
S_IP     YESNO_HI                      Does Plan cover inpatient stay           
                            385                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                          1,476                       N  Not ascertained                         
                              6                       R  Refused                                 
                          5,298                       1  Yes                                     
                          2,227                       2  No                                      
                 First available in 2015
 
S_DNTAL  YESNO_HI                      Does Plan cover dental services          
                            112                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                          3,366                       N  Not ascertained                         
                              1                       R  Refused                                 
                          2,159                       1  Yes                                     
                          3,754                       2  No                                      
                 First available in 2015
 
S_COVNH  YESNO_HI                      Does Plan cover stay in nursing home     
                          1,826                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                          1,346                       N  Not ascertained                         
                             11                       R  Refused                                 
                          1,380                       1  Yes                                     
                          4,829                       2  No                                      
                 First available in 2015
 
D_COVRX  RXPLFMT                       Drug coverage for Plan                   
                              2                       D  Don't know                              
                         49,974                       .  Inapplicable/Missing                    
                            115                       N  Not ascertained                         
                              2                       R  Refused                                 
                          5,280                       1  Plan covers prescription drugs          
                          5,169                       2  Plan does not cover prescription drugs  
                 First available in 2015
 
S_TRIRX  TRIRXFMT                      Where Tricare Member obtains medicine    
                              3                       D  Don't know                              
                         59,843                       .  Inapplicable/Missing                    
                            107                       N  Not ascertained                         
                            261                       1  Tricare mail order pharmacy             
                             46                       2  Tricare retail network pharmacy         
                            166                       3  Military Treatment Facility             
                             81                       4  Non-network retail pharmacy             
                             35                      91  Other                                   
                 First available in 2015
 
S_PAYSP  YESNO_HI                      MIP pay any premium for Plan             
                            185                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                          1,479                       N  Not ascertained                         
                              7                       R  Refused                                 
                          6,384                       1  Yes                                     
                          1,337                       2  No                                      
                 First available in 2015
 
S_PREM   PREMAFMT                      Premium MIP pays for Plan                
                          1,582                       D  Don't know                              
                         54,178                       .  Inapplicable                            
                             22                       N  Not ascertained                         
                              4                       R  Refused                                 
                          1,470                   0-100  $100 or less                            
                          2,856              100.01-500  $101-$500                               
                            205             500.01-1000  $501-$1000                              
                             51            1000.01-1500  $1001-$1500                             
                             38            1500.01-2000  $1501-$2000                             
                             39            2000.01-2500  $2001-$2500                             
                             23            2501.01-3000  $2501-$3000                             
                             16            3000.01-3500  $3001-$3500                             
                             19            3500.01-4000  $3501-$4000                             
                              6            4000.01-4500  $4001-$4500                             
                              9            4500.01-5000  $4501-$5000                             
                             24                  > 5000  Over $5000                              
                 First available in 2015
 
D_ANNPRM PREMAFMT                      Annualized premium MIP pays for Plan     
                          1,582                       D  Don't know                              
                         54,172                       .  Inapplicable                            
                             60                       N  Not ascertained                         
                              4                       R  Refused                                 
                            256                   0-100  $100 or less                            
                            889              100.01-500  $101-$500                               
                            576             500.01-1000  $501-$1000                              
                            532            1000.01-1500  $1001-$1500                             
                            571            1500.01-2000  $1501-$2000                             
                            644            2000.01-2500  $2001-$2500                             
                            505            2501.01-3000  $2501-$3000                             
                            256            3000.01-3500  $3001-$3500                             
                            164            3500.01-4000  $3501-$4000                             
                             65            4000.01-4500  $4001-$4500                             
                             68            4500.01-5000  $4501-$5000                             
                            198                  > 5000  Over $5000                              
                 First available in 2015
 
S_PAYUNT PAYUNITF                      Unit of premium MIP pays for Plan        
                            229                       D  Don't know                              
                         54,158                       .  Inapplicable                            
                              3                       N  Not ascertained                         
                              6                       R  Refused                                 
                            606                       1  Per year                                
                            209                       2  Quarterly / Every 3 months              
                             55                       3  Every 2 months                          
                          4,960                       4  Per month                               
                             85                       5  Per week                                
                             42                       6  Every 6 months                          
                             62                       7  Every 2 weeks                           
                            127                      91  Other                                   
                 First available in 2015
 
S_PAYOTH YESNO_HI                      Anyone else pays a portion of Plan cost  
                            385                       D  Don't know                              
                         51,150                       .  Inapplicable                            
                          1,481                       N  Not ascertained                         
                              7                       R  Refused                                 
                          2,551                       1  Yes                                     
                          4,968                       2  No                                      
                 First available in 2015
 
S_PAYWHO PAYWHOF                       Who pays a portion of Plan cost          
                             12                       D  Don't know                              
                         57,991                       .  Inapplicable                            
                              1                       R  Refused                                 
                            503                       1  Sample person's current employer        
                          1,583                       2  Sample person's prior employer          
                            172                       3  Sample person's union                   
                             12                       4  Spouse's current employer               
                            192                       5  Spouse's former employer                
                              9                       6  Fraternal / professional organization   
                              5                       7  Medicaid / Medical assistance           
                             62                      91  Other                                   
                 First available in 2015
 
D_FCLTYF FACILTYF                      Plan information obtained from Facility  
                         49,548                       .  Inapplicable                            
                         10,506                       0  Plan not reported by a facility         
                            488                       1  Plan reported by a facility             
                 First available in 2015
 
