Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                         62,173        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                         62,173                    2016  2016                                    
 
VERSION  VERSFMT                       Version Number                           
                         62,173                       3  Version 3                               
 
PLANNUM  RNDFKFMT                      Unique Plan Number                       
                         52,186                       .  Inapplicable                            
                          9,987        Range of values   Unique Plan Id                          
                 First available in 2015
 
PLANTYPE PLAN3FMT                      Plan Type                                
                         14,712                       1  Medicare A                              
                         14,323                       2  Medicare B                              
                          5,876                       3  Medicare C/Medicare Advantage           
                         11,910                       4  Medicare D/Part D/MAPD                  
                          4,409                       5  Medicaid                                
                            794                       6  Other Public Plan                       
                          2,919                      20  Employer-sponsored insurance (ESI)      
                          1,420                      21  Employer-sponsored (ESI) Specialty Plan 
                          3,275                      30  Self-purchased Private Plan             
                            863                      31  Self-purchased Specialty Plan           
                             51                      40  Veteran’s Affairs Plan                  
                            758                      50  Tricare plan                            
                            549                      60  Retiree Drug Subsidy Plan               
                            314                      70  Other Insurance Plan Type Unknown       
 
S_INS    INSPLFMT                      Insurance coverage Plan                  
                         51,779                       .  Inapplicable                            
                            463                       N  Not ascertained                         
                          7,398                       1  Comprehensive insurance                 
                          1,409                       2  Dental only                             
                            331                       3  Vision only                             
                            113                       4  LTC                                     
                            442                       5  Rx only                                 
                             20                       6  Dental/Vision                           
                            136                       7  Life insurance                          
                             82                       8  Cancer/Dread disease                    
                 First available in 2015
 
BEGDATE  MMDDYYn8                      Coverage Begin Date for Year(MMDDYYYY)   
                         62,173        MMDDYYYY          Date as MMDDYYYY                        
 
ENDDATE  MMDDYYn8                      Coverage End Date for Year(MMDDYYYY)     
                         62,173        MMDDYYYY          Date as MMDDYYYY                        
 
SRCCOV01 COV2FMT                       Coverage Source Jan                      
                          1,742                       0  No Entitlement                          
                         11,730                       1  Survey Data Only                        
                         35,443                       2  CMS Administrative Data Only            
                         13,258                       3  Both Survey and Admin Data              
 
SRCCOV02 COV2FMT                       Coverage Source Feb                      
                          1,759                       0  No Entitlement                          
                         11,739                       1  Survey Data Only                        
                         35,417                       2  CMS Administrative Data Only            
                         13,258                       3  Both Survey and Admin Data              
 
SRCCOV03 COV2FMT                       Coverage Source Mar                      
                          1,774                       0  No Entitlement                          
                         11,750                       1  Survey Data Only                        
                         35,309                       2  CMS Administrative Data Only            
                         13,340                       3  Both Survey and Admin Data              
 
SRCCOV04 COV2FMT                       Coverage Source Apr                      
                          1,829                       0  No Entitlement                          
                         11,765                       1  Survey Data Only                        
                         35,220                       2  CMS Administrative Data Only            
                         13,359                       3  Both Survey and Admin Data              
 
SRCCOV05 COV2FMT                       Coverage Source May                      
                          1,827                       0  No Entitlement                          
                         11,763                       1  Survey Data Only                        
                         35,184                       2  CMS Administrative Data Only            
                         13,399                       3  Both Survey and Admin Data              
 
SRCCOV06 COV2FMT                       Coverage Source June                     
                          1,825                       0  No Entitlement                          
                         11,755                       1  Survey Data Only                        
                         35,209                       2  CMS Administrative Data Only            
                         13,384                       3  Both Survey and Admin Data              
 
SRCCOV07 COV2FMT                       Coverage Source July                     
                          1,810                       0  No Entitlement                          
                         11,753                       1  Survey Data Only                        
                         35,217                       2  CMS Administrative Data Only            
                         13,393                       3  Both Survey and Admin Data              
 
SRCCOV08 COV2FMT                       Coverage Source Aug                      
                          1,861                       0  No Entitlement                          
                         11,708                       1  Survey Data Only                        
                         35,414                       2  CMS Administrative Data Only            
                         13,190                       3  Both Survey and Admin Data              
 
SRCCOV09 COV2FMT                       Coverage Source Sep                      
                          2,075                       0  No Entitlement                          
                         11,528                       1  Survey Data Only                        
                         37,501                       2  CMS Administrative Data Only            
                         11,069                       3  Both Survey and Admin Data              
 
SRCCOV10 COV2FMT                       Coverage Source Oct                      
                          2,191                       0  No Entitlement                          
                         11,483                       1  Survey Data Only                        
                         38,633                       2  CMS Administrative Data Only            
                          9,866                       3  Both Survey and Admin Data              
 
SRCCOV11 COV2FMT                       Coverage Source Nov                      
                          2,344                       0  No Entitlement                          
                         11,411                       1  Survey Data Only                        
                         39,449                       2  CMS Administrative Data Only            
                          8,969                       3  Both Survey and Admin Data              
 
SRCCOV12 COV2FMT                       Coverage Source Dec                      
                          2,488                       0  No Entitlement                          
                         11,382                       1  Survey Data Only                        
                         39,989                       2  CMS Administrative Data Only            
                          8,314                       3  Both Survey and Admin Data              
 
COV01    ELIGCOVF                      Monthly Eligibility Jan                  
                          3,202                       0  Ineligible / Not covered                
                         58,971                       1  Eligible / Covered                      
 
COV02    ELIGCOVF                      Monthly Eligibility Feb                  
                          3,229                       0  Ineligible / Not covered                
                         58,944                       1  Eligible / Covered                      
 
COV03    ELIGCOVF                      Monthly Eligibility Mar                  
                          3,165                       0  Ineligible / Not covered                
                         59,008                       1  Eligible / Covered                      
 
COV04    ELIGCOVF                      Monthly Eligibility Apr                  
                          3,172                       0  Ineligible / Not covered                
                         59,001                       1  Eligible / Covered                      
 
COV05    ELIGCOVF                      Monthly Eligibility May                  
                          3,114                       0  Ineligible / Not covered                
                         59,059                       1  Eligible / Covered                      
 
COV06    ELIGCOVF                      Monthly Eligibility June                 
                          2,957                       0  Ineligible / Not covered                
                         59,216                       1  Eligible / Covered                      
 
COV07    ELIGCOVF                      Monthly Eligibility July                 
                          2,817                       0  Ineligible / Not covered                
                         59,356                       1  Eligible / Covered                      
 
COV08    ELIGCOVF                      Monthly Eligibility Aug                  
                          2,863                       0  Ineligible / Not covered                
                         59,310                       1  Eligible / Covered                      
 
COV09    ELIGCOVF                      Monthly Eligibility Sep                  
                          3,337                       0  Ineligible / Not covered                
                         58,836                       1  Eligible / Covered                      
 
COV10    ELIGCOVF                      Monthly Eligibility Oct                  
                          3,688                       0  Ineligible / Not covered                
                         58,485                       1  Eligible / Covered                      
 
COV11    ELIGCOVF                      Monthly Eligibility Nov                  
                          4,204                       0  Ineligible / Not covered                
                         57,969                       1  Eligible / Covered                      
 
COV12    ELIGCOVF                      Monthly Eligibility Dec                  
                          4,801                       0  Ineligible / Not covered                
                         57,372                       1  Eligible / Covered                      
 
S_HMOPPO YESNO_HI                      Is Plan an HMO/PPO                       
                            318                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            576                       N  Not ascertained                         
                            342                       R  Refused                                 
                          2,023                       1  Yes                                     
                          5,532                       2  No                                      
                 First available in 2015
 
S_PHREL  REL2FMT                       Policyholder relationship                
                         53,382                       .  Inapplicable                            
                            455                       N  Not ascertained                         
                          6,966                       1  Sample person                           
                          1,300                       2  Spouse                                  
                             33                      30  Father                                  
                             31                      40  Mother                                  
                              6                      56  Partner                                 
                 First available in 2015
 
S_COVNM  PEOPLE                        Total number of people covered by Plan   
                             18                       D  Don't know                              
                         53,382                       .  Missing                                 
                            568                       N  Not ascertained                         
                              6                       R  Refused                                 
                          5,088                       1  One person                              
                          2,850                       2  Two people                              
                            130                       3  Three people                            
                             90                       4  Four people                             
                             33                       5  Five people                             
                              7                       6  Six people                              
                              1                      8+  Eight or more people                    
                 First available in 2015
 
S_OBTNP  MIPFMT                        How did MIP obtain Plan                  
                            143                       D  Don't know                              
                         53,382                       .  Inapplicable/Missing                    
                            567                       N  Not ascertained                         
                              8                       R  Refused                                 
                          3,214                       1  Directly                                
                            833                       2  Main insured person's current employer  
                          2,884                       3  Main insured person's prior employer    
                            267                       4  Union                                   
                             36                       5  Family business                         
                            328                       6  AARP                                    
                            318                       7  Deceased spouse's employer              
                             37                       8  Deceased spouse's union                 
                             25                       9  Fraternal/professional organization     
                            131                      91  Other                                   
                 First available in 2015
 
S_MSCOV  YESNO_HI                      Does Plan cover doctor visits / lab work 
                            232                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            467                       N  Not ascertained                         
                             10                       R  Refused                                 
                          5,994                       1  Yes                                     
                          2,088                       2  No                                      
                 First available in 2015
 
S_IP     YESNO_HI                      Does Plan cover inpatient stay           
                            389                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            575                       N  Not ascertained                         
                             12                       R  Refused                                 
                          5,487                       1  Yes                                     
                          2,328                       2  No                                      
                 First available in 2015
 
S_DNTAL  YESNO_HI                      Does Plan cover dental services          
                             99                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                          3,198                       N  Not ascertained                         
                              8                       R  Refused                                 
                          2,076                       1  Yes                                     
                          3,410                       2  No                                      
                 First available in 2015
 
S_COVNH  YESNO_HI                      Does Plan cover stay in nursing home     
                          1,924                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            512                       N  Not ascertained                         
                             28                       R  Refused                                 
                          1,375                       1  Yes                                     
                          4,952                       2  No                                      
                 First available in 2015
 
D_COVRX  RXPLFMT                       Drug coverage for Plan                   
                             16                       D  Don't know                              
                         52,144                       .  Inapplicable/Missing                    
                             83                       N  Not ascertained                         
                              1                       R  Refused                                 
                          4,949                       1  Plan covers prescription drugs          
                          4,980                       2  Plan does not cover prescription drugs  
                 First available in 2015
 
S_TRIRX  TRIRXFMT                      Where Tricare Member obtains medicine    
                              6                       D  Don't know                              
                         61,415                       .  Inapplicable                            
                            103                       N  Not ascertained                         
                            345                       1  Tricare mail order pharmacy             
                             43                       2  Tricare retail network pharmacy         
                            162                       3  Military Treatment Facility             
                             73                       4  Non-network retail pharmacy             
                             26                      91  Other                                   
                 First available in 2015
 
S_PAYSP  YESNO_HI                      MIP pay any premium for Plan             
                            197                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            577                       N  Not ascertained                         
                             10                       R  Refused                                 
                          6,635                       1  Yes                                     
                          1,372                       2  No                                      
                 First available in 2015
 
S_PREM   PREMAFMT                      Premium MIP pays for Plan                
                          1,665                       D  Don't know                              
                         55,540                       .  Inapplicable/Missing                    
                              2                       N  Not ascertained                         
                             32                       R  Refused                                 
                          4,934        Range of values   Premium Amount                          
                 First available in 2015
 
D_ANNPRM PREMAFMT                      Annualized premium MIP pays for Plan     
                          1,665                       D  Don't know                              
                         55,540                       .  Inapplicable/Missing                    
                             13                       N  Not ascertained                         
                             32                       R  Refused                                 
                          4,923        Range of values   Premium Amount                          
                 First available in 2015
 
S_PAYUNT PAYUNITF                      Unit of premium MIP pays for Plan        
                            143                       D  Don't know                              
                         55,538                       .  Inapplicable                            
                              9                       N  Not ascertained                         
                              4                       R  Refused                                 
                            704                       1  Per year                                
                            204                       2  Quarterly / Every 3 months              
                             67                       3  Every 2 months                          
                          5,214                       4  Per month                               
                             74                       5  Per week                                
                             51                       6  Every 6 months                          
                             64                       7  Every 2 weeks                           
                            101                      91  Other                                   
                 First available in 2015
 
S_PAYOTH YESNO_HI                      Anyone else pays a portion of Plan cost  
                            393                       D  Don't know                              
                         53,382                       .  Inapplicable                            
                            582                       N  Not ascertained                         
                             17                       R  Refused                                 
                          2,693                       1  Yes                                     
                          5,106                       2  No                                      
                 First available in 2015
 
S_PAYWHO PAYWHOF                       Who pays a portion of Plan cost          
                             21                       D  Don't know                              
                         59,480                       .  Inapplicable                            
                            597                       1  Sample person's current employer        
                          1,575                       2  Sample person's prior employer          
                            214                       3  Sample person's union                   
                             14                       4  Spouse's current employer               
                            213                       5  Spouse's former employer                
                             12                       6  Fraternal / professional organization   
                              6                       7  Medicaid / Medical assistance           
                             41                      91  Other                                   
                 First available in 2015
 
D_FCLTYF FACILTYF                      Plan information obtained from Facility  
                         51,779                       .  Inapplicable                            
                          9,987                       0  Plan not reported by a facility         
                            407                       1  Plan reported by a facility             
                 First available in 2015
 
