Since its inception in 1991, the Medicare Current Beneficiary Survey (MCBS) has served as an invaluable source of information for administering, monitoring, and evaluating the Medicare program. A leading source of information on Medicare and its impact on beneficiaries, the MCBS provides important information on beneficiaries that is not otherwise collected through operational or administrative data from the Medicare program and plays an essential role in monitoring and evaluating beneficiaries’ health status and health care policy. The MCBS collects comprehensive data on beneficiaries’ health insurance coverage, health care utilization and costs, access to care, and satisfaction with care, as well as special interest topics including drug coverage, knowledge about the Medicare program, and housing characteristics.
Data from the MCBS are used to inform policy and program advancements in Medicare, including the creation of new benefits such as Medicare’s Part D prescription drug benefit. MCBS data and estimates are vital to informing the production of highly visible publications, including by the Congressional Budget Office, the Medicare Payment Advisory Commission, the Federal Interagency Forum on Aging Related Statistics, and the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, and are published in a wide array of peer-reviewed journals, including American Journal of Managed Care, Health Affairs, Health Economics, Health Services Research, Journal of General Internal Medicine, and the New England Journal of Medicine.
The MCBS is a continuous, multi-purpose longitudinal survey, representing the population of Medicare beneficiaries aged 65 and over and beneficiaries aged below 65 with certain disabling conditions, residing in the United States. It is sponsored by the Office of Enterprise Data and Analytics (OEDA) of CMS. The MCBS has been continuously conducted since 1991, completing more than 1.2 million interviews since its inception. Interviews are usually conducted in-person using computer-assisted personal interviewing (CAPI). However, due to the coronavirus disease 2019 (COVID-19) pandemic, data collection switched to phone-only interviews in March 2020 and throughout most of 2021 with a gradual return to some in-person interviewing beginning in November 2021. MCBS data collection will continue to include both in-person and phone interviewing in the future. NORC conducts the full range of MCBS survey activities including sampling, data collection, data processing, editing, imputation, and delivery of files to CMS for final processing and dissemination.
Designed to aid CMS in administering the Medicare program, the MCBS is distinguished by several unique features, including:
- Linked self-report and administrative claims data: The MCBS collects information directly from a sample of beneficiaries to understand their health care needs, costs, and experiences, and then links their responses to administrative claims, which provides researchers and policy analysts with more accurate and complete estimates of beneficiaries’ total health care costs and utilization.
- Complete source of payment information: The MCBS collects survey-reported data on all sources of payment for health care costs, including those not covered by Medicare, such as co-payments, deductibles, and uncovered services. MCBS data also reveal the extent to which retiree benefits, Medigap, VA benefits, and other sources of coverage address costs.
- Rotating panel design: The MCBS features a rotating panel design that enables users to conduct longitudinal analysis. The MCBS rotating panel is designed to be representative of the population of all Medicare beneficiaries for the survey year. Each MCBS panel, an annual statistical sample of all Medicare enrollees, is interviewed up to three times a year over a four year period. Beginning in 2018, one panel is retired at the conclusion of each winter round, and a new panel is selected to replace it each fall round.
- Inclusion of beneficiaries living in a facility: The MCBS follows beneficiaries into and out of long-term care facilities to maintain a comprehensive profile of their health care utilization and expenditures.
- Oversampling: Hispanic beneficiaries, beneficiaries with disabilities (aged below 65), and beneficiaries aged 85 and over are oversampled to ensure sufficient sample for analysis purposes due to interest in their special health care needs.
- Medicare Advantage (MA) beneficiary data: The MCBS collects comprehensive survey-reported health care utilization and cost data for beneficiaries covered by MA, allowing researchers to analyze MA beneficiary cost and utilization data in the absence of administrative claims data for MA beneficiaries. In addition, starting with data year 2019, the MCBS began to use MA encounter data in imputation procedures to account for medical events and costs.
MCBS data are available to users via two annual Limited Data Sets (LDS) – the Survey File and the Cost Supplement File. The Survey File contains information on beneficiaries’ demographic information, health insurance coverage, self-reported health status and conditions, and responses regarding access to care and satisfaction with care. Survey data are supplemented by facility (non-cost) information, Medicare administrative data, and Medicare Fee-for-Service (FFS) claims to facilitate analysis. The Cost Supplement File contains survey-reported data, linked with administrative data, on beneficiaries’ health care utilization, expenditures, and sources of payment, including out-of-pocket costs and payments. The Cost Supplement File can be linked to the Survey File to conduct analyses on health care cost and utilization. By linking survey-reported data in the Cost Supplement File to Medicare FFS claims data in the Survey File, data users can obtain a comprehensive picture of health services received, amounts paid, and sources of payment, including those not covered by Medicare.
In recent years, CMS and NORC have undertaken several improvements to increase the accessibility and utility of the MCBS.
- Starting with the 2013 data year, CMS began releasing an annual Survey File Public Use File (PUF) to allow researchers to conduct analyses on access to care, health status, knowledge of, attitudes toward, and satisfaction with health care, as well as demographic data and information on health insurance coverage for Medicare beneficiaries living in the community.
- Beginning with the 2015 data year, NORC supported CMS in releasing a new, comprehensive, and integrated suite of public resources for data users to understand the importance and complexity of the MCBS. These resources currently include three annual MCBS Data User’s Guides that accompany the LDS and PUF releases, an annual MCBS Methodology Report, an annual Chartbook, and tutorials for new and advanced data users. In addition, topic-specific MCBS infographics and an annual annotated Bibliography are also now available.
- Starting with the 2017 data year, an annual “Early Look” is released that summarizes key preliminary estimates prior to the MCBS data release and the MCBS Chartbook publication, facilitating the timely dissemination of MCBS data to the public.
- Starting with the 2019 data year, annual MCBS Variable Crosswalks are released that compare variable availability in the MCBS LDS data releases over time, supporting data users in conducting repeated cross-sectional or longitudinal analysis with MCBS data.
- In response to the COVID-19 pandemic in the U.S., NORC supported CMS in conducting a series of rapid response telephone surveys for MCBS beneficiaries who were continuously enrolled in Medicare from the beginning of 2020 and were alive, living in the community, and eligible and enrolled in Medicare at the time of their COVID-19 Supplement interview. These MCBS COVID-19 Summer 2020, Fall 2020, and Winter 2021 Community Supplements collected vital information on how the pandemic impacted the Medicare population, including preventive behaviors, forgone care, sources of COVID-19 information, and COVID-19 vaccination. Data collected from the COVID-19 Community Supplements are available in standalone PUFs as well as in the 2019 and 2020 Survey File LDS. In addition, data on beneficiaries living in facilities were collected through the MCBS COVID-19 Fall 2020 and Winter 2021 Facility Supplements for release in the 2020 and 2021 Survey File LDS.