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| FSHUNGRY | 2017 | In the last 30 days, did you lose weight because there wasn’t enough money for food? |
| FSWEIGHT | 2017 | In the last 30 days, did you lose weight because there wasn’t enough money for food? |
| MCAREPRB | 2017 | Are you covered by Medicare? |
| MCREF | 2017 | Under your Medicaid plan, if you to go to a different doctor or place for special care do you need approval or a referral? Do not include emergency care. |
| MXCHNG | 2017 | [ROUNDS 1 and 2] Was your Medicaid obtained through Healthcare.gov or the [DC/MD/VA= Health Insurance Marketplace, such as DC Health Link/ Health Insurance Marketplace, such as Maryland Health Connection/Health Insurance Marketplace]?
[ROUND 3] Was your Medicaid obtained through Healthcare.gov or a state Health Insurance Marketplace? |
| MDPRINC | 2017 | Is the premium paid for this Medicaid plan based on income? |
| PLNEXCH1 | 2017 | Was the plan obtained through the Healthcare.gov or the [DC/MD/VA= Health Insurance Marketplace, such as DC Health Link/ Health Insurance Marketplace, such as Maryland Health Connection/Health Insurance Marketplace]? |
| HDHP1 | 2017 | VERSION_A [If only 1 person is covered by the plan]: Is the annual deductible for medical care for this plan less than $1,250 or $1,250 or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
VERSION_B [If more than 1 person is covered by the plan]: Is the family annual deductible for medical care for this plan less than $2,500 or $2,500 or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here. |
| HSAHRA1 | 2017 | With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts. |
| MGCHMD1 | 2017 | Under this plan, can you choose ANY doctor or MUST you choose one from a specific group or list of doctors? |
| MGPRMD1 | 2017 | Do you have the option of choosing a doctor from a preferred or select list at a lower cost? |
| MGPYMD1 | 2017 | If you select a doctor who is not in the plan, will the plan pay for any part of the cost? |
| PRRXCOV1 | 2017 | Does the plan pay for any of the costs for medicines prescribed by a doctor? |
| CHPRINC | 2017 | Is the premium paid for this Medicaid plan based on income? |
| HINOTYR | 2017 | In the PAST 12 MONTHS, was there any time when you did NOT have ANY health insurance or coverage? |
| HINOTMYR | 2017 | In the PAST 12 MONTHS, about how many months were you without coverage? |
| HCSPFYR | 2017 | The next question is about money that you have spent out of pocket on medical care. We do NOT want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for. In the PAST 12 MONTHS, about how much did [fill 2: you/your family] spend for medical care and dental care? |
| MEDBILL | 2017 | In the past 12 months did [fill1: you/anyone in the family] have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care. |
| MEDBPAY | 2017 | Do you currently have any medical bills that are being paid off over time? This could include medical bills being paid off with a credit card, through personal loans, or bill paying arrangements with hospitals or other providers. The bills can be from earlier years as well as this year. |
| FSA | 2017 | [Rounds 1 and 2] [Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.
[Round 3] [Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their out-of-pocket expenses for health care. |
| PLAADL | 2017 | Because of a physical, mental, or emotional problem, do you need the help of other persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home? |
| PLAWKNOW | 2017 | Does a physical, mental, or emotional problem NOW keep you from working at a job or business? |
| PLAWKLIM | 2017 | Are you limited in the kind or amount of work you can do because of a physical, mental or emotional problem? |
| PLAREMEM | 2017 | Are you LIMITED IN ANY WAY because of difficulty remembering or because you experience periods of confusion? |
| PLIMANY | 2017 | Are you LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems? |
| PHSTAT | 2017 | Would you say {your} health in general is excellent, very good, good, fair, or poor? |
| SHTHEPB | 2017 | Have you EVER received the hepatitis B vaccine? |
| SHEPANUM | 2017 | How many hepatitis A shots did you receive? |
| SHINGLES | 2017 | Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since May 2006. Have you ever had the Zoster or Shingles vaccine, also called Zostavax®? |
| SHTTD | 2017 | Have you received a tetanus shot in the past 10 years? |
| TRAVEL | 2017 | Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or Canada, since 1995? |
| CANEV | 2017 | Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind? |
| DIBREL | 2017 | Has your mother, father, brother, or sister EVER been told by a doctor or other health professional that they have diabetes or sugar diabetes? |
| DIBPRE2 | 2017 | Have you EVER been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar? |
| DIBTEST | 2017 | About how long has it been since you last had a blood test for high blood sugar or diabetes? |
| DIBTYPE | 2017 | What type of diabetes do you have? |
| INSLN1 | 2017 | Insulin can be taken by shot or pump. Are you NOW taking insulin? |
| DIBINS2 | 2017 | Thinking back to when you were first diagnosed with diabetes, how long was it before you started taking insulin? |
| DIBINS3 | 2017 | Since you started taking insulin, have you ever stopped taking it for more than 6 months? |
| DIBINS4 | 2017 | Was this only during the first year after you were diagnosed with diabetes? |
| DIBGDM | 2017 | [If Female] During pregnancy, were you ever told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes? Please do NOT include diabetes that you may have known about before pregnancy. |
| DIBBABY | 2017 | [If Female] Have you EVER had a baby that weighed 9 pounds (4 kg) or more at birth? |
| DIBPRGM | 2017 | Have you EVER participated in this type of year-long program to prevent Type 2 diabetes? |
| DIBREFER | 2017 | Has a doctor or other health care professional ever referred you to such a program to prevent Type 2 diabetes? |
| DIBBEGIN | 2017 | How interested are you in beginning such a year-long program to prevent Type 2 diabetes?
Would you say… |
| LUPPRT | 2017 | Have you lost all of your upper and lower natural (permanent) teeth? |
| LUPPRT | 2017 | Have you lost all of your upper and lower natural (permanent) teeth? |
| SMKREG | 2017 | How old were you when you FIRST started to smoke fairly regularly? |
| SMKNOW | 2017 | Do you NOW smoke cigarettes every day, some days or not at all? |
| SMKQTNO | 2017 | How long has it been since you quit smoking cigarettes? |