Health Insurance Education Initiative
Follow-up Survey
Several monthsago you attended a health insurance program, and we’d like to ask you a few follow-up questions.Your answers will not be linked to your name or any other personal information that would identify you. Thank you for taking the time to fill out this survey.
In which county did you attend the program?______
Health Insurance Decisions
- Since the program, have you made any changes to you or your family’s health insurance? (please check one response)
Yes,I enrolled in insurance through the Health Insurance Marketplace.
Yes, I enrolled in a new insurance plan through work (or through a family member’s work).
Yes, I made changes to my insurance plan through work (or through a family member’s work).
Yes, I enrolled in another type of insurance (such as Medicare, Medicaid, TriCare, etc.)
No, I did not need new insurance coverage (already had/satisfied with plan).
No, I cannot afford insurance coverage.
No, I choose not to have insurance coverage.
No, I have had difficulty using the Health Insurance Marketplace.
No, I have not made any changes for other reasons.
Other (please specify): ______
I prefer not to answer.
- If you made any health insurance decisions since attending theprogram, do you feel that…
You had enough information to make the best health insurance coverage decision?
Yes No I prefer not to answer
Your health insurance decisions were influenced by attending the program?
YesNo Unsure I prefer not to answer
- Please check one box for each statement below
Poor / Fair / Good / Very Good / Excellent / I prefer not to answer
My confidence in my ability to select the best health insurance plan for me
My satisfaction with health insurance decisions I’ve made since attending the workshop
My ability to understand health insurance and healthcare costs
My ability to compare health insurance plans
Health Insurance Education Workshop
- How was the workshop helpful to you?
- Is there any other type of health insurance information that you wish would have been covered in the workshop?
- Beforethe workshop, which of these statements best described you?
I did not have health insurance
I did have health insurance, andI was satisfied with it
I did have health insurance, andI was notsatisfied with it
I prefer not to answer
- Following the workshop, which of these statements best describes you?
I do not have health insurance
I do have health insurance, and I am satisfied with it
I do have health insurance, and I am not satisfied with it
I prefer not to answer
- Age:
Under 18
18-34
35-64
65+
I prefer not to disclose
- Please select your family size (include all those in your household).
1
2
3
4
5
6
7
8 or more
I prefer not to disclose
- About what is your total household income from all sources?
Less than $10,000
$10,000 to $14,999
$15,000 to $24,999
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 or more
I prefer not to disclose
- Are you Hispanic/Latino?
Yes
No
- What race do you identify with? (select one)
American Indian or Alaskan Native
Asian
Black
Native Hawaiian or Pacific Islander
Two or more races
White
Some other race
I prefer not to disclose