Table 2 Health Insurance Navigation Tool (HINT) Questionnaire Questions

Medicaid Screening

1

Do you make below $40,000 a year?

  Yes

  No

2

Are you a U.S. Citizen or Permanent Resident?

  Yes

  No

Healthcare Utilization

3

When would you go to the doctor's office?

  I almost never go to the doctor

  I only go to the doctor when I feel seriously sick

  I go to the doctor when I have questions or concerns

  I go to the doctor regularly to prevent getting sick

4

When I feel ill, I tend to:

  Brush it off if I can

  Call my family doctor's office

  Look for a doctor online to make an appointment

5

When I decide NOT to go to the doctor though I feel ill, it is mostly because:

  The cost of the visit

  I do not have time

  I cannot easily make an appointment

  I do not feel like I need to

6

(Pick the option that would most heavily influence your decision) I am more likely to go to the doctor if:

  The visits are more affordable

  Less paperwork is needed

  My plan does not restrict my choice of doctors

  None of the above will make it more likely for me to go to a doctor

14

Preventive care is:

  Very important

  Optional

  Not important/I don't know what that is

15

Regarding pharmacy use, select the option below that most accurately fits you:

  I use the pharmacy a lot because I take medications frequently

  I go to the pharmacy occasionally, when my doctor prescribes medication for me

  I almost never go to the pharmacy

Budget

7

I am willing to pay more than my ideal budget monthly for:

  More doctors to choose from

  Better coverage of individual visit costs with Primary Care doctors

  Better coverage of individual visit costs with Specialty doctors

  I would not be willing to pay over my ideal budget

8

In addition to my monthly insurance payments, I am willing to spend an additional ______ per year out of pocket for doctor's visits and services:

  Less than $200

  Up to $500

  More than $500

18

I am willing to spend ______ on my health insurance plan, per month:

  Up to $200

   Between $201 and $400

  More than $400

Healthcare Preferences

9

Select the option below that most accurately fits you:

  I would prefer to go to one general doctor for my health concerns and be referred to specialist doctors only when needed

  I would like to pick which doctor to go to based on my specific health concerns

  I don't have a preference/I don't know the difference

10

In order to minimize your monthly payment, pick the factor more important to you:

  I would like to be able to choose my family/ primary care doctor

  I would like to be able to choose my specialists

  I don't know what the difference is/No preference

  I would be willing to pay more monthly for more flexibility in choosing both

11

Regarding doctor choice, select the one option below that most accurately fits you:

  I have specific expectations for my doctor (in terms of education, training, background, experience etc.) and it can be hard to find doctors that satisfy them

  I have some specific expectations for my doctor and I can easily find doctors that can satisfy them

  I do not have expectations for my doctor other than he or she is licensed to practice

12

Which of the following factors are important in dictating whether or not you will go to a doctor?

  Education/experience

  Location/availability

  Both A and B

  Neither A or B

13

I would NOT go to a doctor that:

   (although covered by my insurance) requires payment that cost More than my budget

  Is difficult to make appointments with

  Is not covered by my insurance

  Has negative online reviews

16

Select the option below that most accurately fits you:

    I am willing to switch to a different insurance plan to see a doctor(s) of my choice

  I am not willing to switch to a different insurance plan to see a doctor(s) of my choice

  Regarding coverage, which of the following most accurately describes you?

17

Regarding coverage, which of the following most accurately describes you?

  It is important to me that my insurance covers most if not all my visits and treatments

  I would be okay with an insurance as long as it covers some of my visits and treatments

  I don't mind an insurance plan with less coverage as long as the monthly cost is low