Medicare Advantage and Prescription Drug Plan
(MA & PDP) CAHPS® Survey
2026 Prescription Drug Plan Survey
2026 Medicare Experience Survey
MEDICARE SURVEY INSTRUCTIONS
This survey asks about you and the health care you received in the last six months. Answer each question thinking about yourself and the times you got health care in person, by phone or by video call. Please take the time to complete this survey. Your answers are very important to us. Please return the survey with your answers in the enclosed postage-paid envelope to [Survey Vendor].
If you changed your Medicare plan for 2026, answer the questions thinking about your experiences in the last 6 months of 2025.
Answer all the questions by putting an “X” in the box to the left of your answer, like this:
Yes
Be sure to read all the answer choices given before marking your answer.
You are sometimes told not to answer some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this: [If No, Go to Question 3]. See the example below:
EXAMPLE
1. Do you wear a hearing aid now?
Yes
No If No, Go to Question 3
2. How long have you been wearing a hearing aid?
Less than one year
1 to 3 years
More than 3 years
I don’t wear a hearing aid
3. In the last 6 months, did you have any headaches?
Yes
No
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. This applies to both mandatory and voluntary collections of information. The valid OMB control number for this information collection is 0938-0732 (expires 11/30/2027). The time required to complete this information collection is estimated to average 10 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C1-25-05, Baltimore, Maryland 21244-1850.
1. Our records show that in 2025 your prescriptions were covered by the Medicare prescription drug plan named on the back page.
Is that right?
Yes If Yes, Go to Question 3
No
2. Please write below the name of the Medicare prescription drug plan you had in 2025 and complete the rest of the survey based on the experiences you had with that plan. (Please print)
___________________________
3. In the last 6 months, did anyone from a doctor’s office, pharmacy, or your prescription drug plan contact you:
Yes No
a. To make sure you
filled or refilled a
prescription?
b. To make sure you
were taking medicine
as directed?
4. In the last 6 months, how often was it easy to use your prescription drug plan to get the medicines your doctor prescribed?
Never
Sometimes
Usually
Always
I did not use my prescription drug plan to get any medicines in the last 6 months
5. In the last 6 months, did you ever use your prescription drug plan to fill a prescription at your local pharmacy?
Yes
No If No, Go to Question 7
6. In the last 6 months, how often was it easy to use your prescription drug plan to fill a prescription at your local pharmacy?
Never
Sometimes
Usually
Always
7. In the last 6 months, did you ever use your prescription drug plan to fill a prescription by mail?
Yes
No If No, Go to Question 9
8. In the last 6 months, how often was it easy to use your prescription drug plan to fill a prescription by mail?
Never
Sometimes
Usually
Always
9. Using any number from 0 to 10, where 0 is the worst prescription drug plan possible and 10 is the best prescription drug plan possible, what number would you use to rate your prescription drug plan?
0 Worst prescription drug plan possible
1
2
3
4
5
6
7
8
9
10 Best prescription drug plan possible
About You
10. In general, how would you rate your overall health?
Excellent
Very good
Good
Fair
Poor
11. In general, how would you rate your overall mental or emotional health?
Excellent
Very good
Good
Fair
Poor
12. What language do you mainly speak at home?
English
Spanish
Chinese
Korean
Tagalog
Vietnamese
Some
other language
Please
print:____________
13. In the last 6 months, did you spend one or more nights in a hospital?
Yes
No
14. In the last 6 months, did you delay or not fill a prescription because you felt you could not afford it?
Yes
No
My doctor did not prescribe any medicines for me in the last 6 months
15. Has a doctor ever told you that you had any of the following conditions?
Yes No
a. A heart attack?
b. Angina or coronary
heart disease?
c. Hypertension
or high blood
pressure?
d.
Cancer,
other
than
skin
cancer?
e. Emphysema, asthma,
or COPD (chronic
obstructive pulmo-
nary disease)?
f. Any kind of diabetes
or high blood
sugar?
16. Do you have serious difficulty walking or climbing stairs?
Yes
No
17. Do you have difficulty dressing or bathing?
Yes
No
18. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?
Yes
No
19. What is the highest grade or level of school that you have completed?
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
20. 0What is your race or ethnicity? Please mark one or more.
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
21. How many people live in your household now, including yourself?
1 person
2 to 3 people
4 or more people
22. Do you ever use the internet at home?
Yes
No
23. May the Medicare Program follow up with you to learn more about your health care, or to invite you to a group discussion or interview on topics related to health care?
Yes
No
24. Did someone help you complete this survey?
Yes
No Thank you. Please
return the completed survey in the postage-paid envelope.
25. How did that person help you?
Please mark one or more.
Read the questions to me
Wrote down the answers I gave
Answered the questions for me
Translated the questions into my language
Helped in some other way
Thank you.
Please return the completed survey in the postage-paid envelope.
[SURVEY VENDOR RETURN ADDRESS FOR MAIL PROCESSING]
Contract Name: ________________
[OPTIONAL]
You may also know your plan by one of the following:
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | 2024 PDP Survey |
| Subject | 2024 PDP CAHPS Survey |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2025-06-18 |