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1. How did you use the Booklet? (Please check all that apply) |
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Other (please specify) |
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2. Which section(s) of the Booklet did you use in counseling sessions with beneficiaries? (Please check all that apply) |
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3. Please rate each section of the Booklet on a scale of 1 to 5, with 1 being the lowest and 5 as the highest rating. Rate each section according to how clear and useful the section was for you. (If you did not use a a section, please put N/A.)
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| Section |
Rating |
I. Introduction (p. 2) |
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II. Types of Medicare Advantage Plans (p. 3-4) |
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III. Other Options (p. 4) |
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IV. Medicare Preferred Provider Organization (PPO) (p. 5-10) |
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V. Medicare Health Maintenance Organization (HMO) (p. 11-16) |
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VI. Medicare Private-Fee-for-Service (PFFS) Plans (p. 17-23) |
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VII. Medicare Special Needs Plans (SNPs) (p. 24-29) |
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VIII. Medicare Advantage (p. 30) |
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4. If you rated any section below 3, please indicate the section and briefly explain why.
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5. Please rate the usefulness of the following on a scale of 1 to 5, with 1 being the lowest and 5 being the highest rating. Rate each section according to how useful the section is in helping a beneficiary make an informed decision. (If you did not use a a section, please put N/A.)
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| Section |
Rating |
I. The questions in the Booklet |
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II. The information in the text boxes |
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III. The Action Steps |
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IV. The Notes section |
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6. If you rated any section below 3, please indicate the section and briefly explain why.
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7. In thinking about the "average" beneficiary you counsel, was the amount of information:
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8. In thinking about the "average" beneficiary you counsel, was the information explained in a way that was easy for the beneficiary to understand?
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9. Did you encounter any particular difficulties with the Booklet? If yes, please describe.
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10. What additional materials would you like to have included in the Booklet?
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11. Any additional comments?
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