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MEPS HC-208:
2018 Person Round Plan Public Use File
August 2020

The MEPS instrument design changed beginning in Spring of 2018, affecting Panel 23 Round 1, Panel 22 Round 3, and Panel 21 Round 5. For the Full-Year 2017 PUFs, the Panel 22 Round 3 and Panel 21 Round 5 data were transformed to the degree possible to conform to the previous design.

The Full-Year 2018 PUFs are the first year all rounds of data were collected with the re-designed instrument, and no data were transformed to conform to the previous design. In addition, the value -9 NOT ASCERTAINED was removed as an allowable value in the Full-Year 2018 PUFs. Data users should be aware of possible impacts on the data and especially trend analysis for these data years due to the design transition.

Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
5600 Fishers Lane
Rockville, MD 20857
(301) 427-1406

Table of Contents

A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Description
2.1 Complex File Structure with Examples
2.2 Identifiers
2.3 Reserved Codes
2.4 Adding the Characteristics of Covered Persons
2.5 Adding the Policyholder’s Characteristics
2.6 Choosing PRPL Records for Your Research Question
3.0 Data File Contents
3.1 ID Variables
3.2 Person Variables
3.3 Policyholder Variables
3.4 Establishment Variables
3.4.1 Employers, Exchanges, and Other Establishments
3.4.2 Types of Coverage through the Establishment
3.4.3 Out-of-Pocket Premiums
3.5 Plan Variables
3.5.1 Household Reports of HMOs
3.5.2 Change in Plan Name
3.6 Links to Job Providing Insurance
4.0 Linking to Other Files
4.1 National Health Interview Survey
4.2 Longitudinal Analysis
5.0 Using MEPS Data for Trend Analysis
References
D. Variable-Source Crosswalk

A. Data Use Agreement

Individual identifiers have been removed from the micro-data contained in these files. Nevertheless, under sections 308 (d) and 903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1), data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or the National Center for Health Statistics (NCHS) may not be used for any purpose other than for the purpose for which they were supplied; any effort to determine the identity of any reported cases is prohibited by law.

Therefore in accordance with the above referenced Federal Statute, it is understood that:

No one is to use the data in this data set in any way except for statistical reporting and analysis; and
If the identity of any person or establishment should be discovered inadvertently, then (a) no use will be made of this knowledge, (b) the Director Office of Management AHRQ will be advised of this incident, (c) the information that would identify any individual or establishment will be safeguarded or destroyed, as requested by AHRQ, and (d) no one else will be informed of the discovered identity; and
No one will attempt to link this data set with individually identifiable records from any data sets other than the Medical Expenditure Panel Survey or the National Health Interview Survey. Furthermore, linkage of the Medical Expenditure Panel Survey and the National Health Interview Survey may not occur outside the AHRQ Data Center, NCHS Research Data Center (RDC) or the U.S. Census RDC network.

By using these data you signify your agreement to comply with the above stated statutorily based requirements with the knowledge that deliberately making a false statement in any matter within the jurisdiction of any department or agency of the Federal Government violates Title 18 part 1 Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5 years in prison.

The Agency for Healthcare Research and Quality requests that users cite AHRQ and the Medical Expenditure Panel Survey as the data source in any publications or research based upon these data.

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B. Background

1.0 Household Component

The Medical Expenditure Panel Survey (MEPS) provides nationally representative estimates of health care use, expenditures, sources of payment, and health insurance coverage for the U.S. civilian non-institutionalized population. The MEPS Household Component (HC) also provides estimates of respondents’ health status, demographic and socio-economic characteristics, employment, access to care, and satisfaction with health care. Estimates can be produced for individuals, families, and selected population subgroups. The panel design of the survey, which includes 5 Rounds of interviews covering 2 full calendar years, provides data for examining person level changes in selected variables such as expenditures, health insurance coverage, and health status. Using computer assisted personal interviewing (CAPI) technology, information about each household member is collected, and the survey builds on this information from interview to interview. All data for a sampled household are reported by a single household respondent.

The MEPS HC was initiated in 1996. Each year a new panel of sample households is selected. Because the data collected are comparable to those from earlier medical expenditure surveys conducted in 1977 and 1987, it is possible to analyze long-term trends. Each annual MEPS HC sample size is about 15,000 households. Data can be analyzed at either the person or event level. Data must be weighted to produce national estimates.

The set of households selected for each panel of the MEPS HC is a subsample of households participating in the previous year’s National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics. The NHIS sampling frame provides a nationally representative sample of the U.S. civilian non-institutionalized population and reflects an oversample of Blacks and Hispanics. In 2006, the NHIS implemented a new sample design, which included Asian persons in addition to households with Black and Hispanic persons in the oversampling of minority populations. NHIS introduced a new sample design in 2016 that discontinued oversampling of these minority groups. The linkage of the MEPS to the previous year’s NHIS provides additional data for longitudinal analytic purposes.

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2.0 Medical Provider Component

Upon completion of the household CAPI interview and obtaining permission from the household survey respondents, a sample of medical providers are contacted by telephone to obtain information that household respondents cannot accurately provide. This part of the MEPS is called the Medical Provider Component (MPC) and information is collected on dates of visit, diagnosis and procedure codes, charges and payments. The Pharmacy Component (PC), a subcomponent of the MPC, does not collect charges or diagnosis and procedure codes but does collect drug detail information, including National Drug Code (NDC) and medicine name, as well as amounts of payment. The MPC is not designed to yield national estimates. It is primarily used as an imputation source to supplement/replace household reported expenditure information.

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3.0 Survey Management and Data Collection

MEPS HC and MPC data are collected under the authority of the Public Health Service Act. Data are collected under contract with Westat, Inc. (MEPS HC) and Research Triangle Institute (MEPS MPC). Data sets and summary statistics are edited and published in accordance with the confidentiality provisions of the Public Health Service Act and the Privacy Act. The National Center for Health Statistics (NCHS) provides consultation and technical assistance.

As soon as data collection and editing are completed, the MEPS survey data are released to the public in staged releases of summary reports, micro data files, and tables via the MEPS website.

Additional information on MEPS is available from the MEPS project manager or the MEPS public use data manager at the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857 (301-427-1406).

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C. Technical and Programming Information

1.0 General Information

This public use data file contains data for each person with private health insurance reported in Rounds 3, 4, and 5 of Panel 22 and Rounds 1, 2, and 3 of Panel 23 (i.e., the rounds for the survey panels covering calendar year 2018) of the Medical Expenditure Panel Survey Household Component (MEPS HC). Released as an ASCII file (with related SAS, SPSS, and Stata programming statements and data user information) and in SAS transport format, this public use file (PUF) provides information collected on a nationally representative sample of the civilian noninstitutionalized population of the United States during the calendar year 2018. The HC-208 file (Person-Round-Plan Public Use File) contains records for persons insured through private establishments providing hospital/physician, Medigap, dental, vision, or prescription medication coverage and includes variables pertaining to HMOs. The file contains 77 variables and has a logical record length of 346 with an additional 2-byte carriage return/line feed at the end of each record.

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2.0 Data File Description

The Person-Round-Plan (PRPL) file for 2018 is a complex file of privately insured persons and their private health insurance plans and links to any jobs providing insurance. The PRPL file is designed to facilitate research on the sometimes complex and dynamic relationships between consumers and their private insurance. It is not a person-level file, and linking the PRPL file to a person-level file (such as HC-196, the Point-in-Time Public Use File, and HC-204, the Full-Year Population Characteristics File) requires users to make analytic decisions based on understanding the complexity of the PRPL file.

Records contain the following types of information (Figure 1):

Covered person
- Flags for whether the person is the policyholder or a dependent
- Whether enrolled at time of interview
- Months enrolled during the reference period of the interview
Interview Round
Policyholder
Establishment providing insurance
- Type of establishment (employer, union, insurance agent, etc.)
- Types of coverage (hospital/physician, Medigap, dental, vision, prescription medication, Consolidated Omnibus Budget Reconciliation Act (COBRA), single or family)¹
Out-of-pocket premiums and employee contributions
Links to the job providing insurance (for employment-based insurance only, HC-203, the JOBS Public Use File)
Plan (for hospital/physician and Medicare supplemental insurance coverage only)
Household reports of health maintenance organizations (HMOs)
High deductibles and Health Savings Accounts (HSAs) for hospital/physician insurance coverage only

¹ No effort has been made to validate variables representing type of coverage with external sources.

FIGURE 1
CONCEPTUAL OVERVIEW OF PRPL

“Flowchart depicting five types of record information for covered persons.”

For employer sponsored health insurance coverage, on the records for dependents, variables link to the policyholder’s job providing insurance, rather than the dependent’s job.

“Establishment” refers to the organization through which the policyholder obtains private insurance. The establishment may be an employer, a union, an insurance agent, an insurance company, a professional association, or another type of organization. Many questions in the MEPS HC instrument were asked in reference to the establishment providing insurance to the policyholder. For example, the MEPS HC asked about the “types of health insurance” or covered services, such as hospital/physician and dental coverage, the policyholder gets through the establishment.

For each establishment, a “plan” is the insurance company or HMO or self-insured company from which the policyholder receives hospital/physician or Medicare supplemental (Medigap) coverage. For some focused analyses, it may be important to recognize that information collected at the establishment level does not necessarily pertain to the plan level. For example, if a policyholder obtains from the establishment two separate plans, a hospital/physician plan and a dental plan, then the dental plan may not have the same HMO characteristics as the hospital/physician plan.

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2.1 Complex File Structure with Examples

The PRPL file is designed to reflect the sometimes complex and dynamic relationships between people and their private insurance. It allows maximum flexibility for researchers, but it also requires that they make analytical decisions in their research.

The PRPL file is a person-round-policyholder-establishment-insurance plan level file. Prior to 2018, there was one record for each unique combination of establishment (source of private insurance), policyholder, interview round, and covered person (policyholder or dependent). Beginning in FY2018, PRPL records are further defined by a 3-byte insurance plan number. This number is helpful in differentiating between plans when more than one is reported through the same establishment-policyholder-interview round. Thus, the PRPL file contains at least one record for each person in each round with private health insurance, or 60,263 total records. The PRPL file contains records for persons insured through establishments providing hospital/physician, Medigap, dental, vision, or prescription medication coverage. In most cases in this file, one person in the family has insurance from his or her employer, and this insurance covers everyone in the family. In this case, there is one record for each family member in each round, and each record flags the policyholder’s current main job and links to one job record in HC-203. However, other cases are more complex, and some hypothetical examples follow.

Multiple Establishments

Juan and Maria are both employed parents, both have health insurance through their employers, and both parents choose family coverage. In this case, there are two PRPL records for each family member in each round.
Fatema and Ali are both employed parents. Ali has single coverage from his employer. Fatema has family coverage from her employer covering the entire family. In this case, Fatema and the children each have one PRPL record for each round. Ali has two records for each round.
Dexter has Medicare and Medicare supplemental insurance. In this case, Dexter has one PRPL record in each round for the Medicare supplemental insurance. There is no record for Medicare, because it is public insurance.
Arlene is a child living with her mother. Both have Medicaid. Arlene’s father, who does not live with them, has private insurance that covers Arlene. Arlene has one PRPL record in each round for the private insurance. There is no record for Medicaid, because it is public insurance.

No Private Insurance

Jamie is uninsured. In this case, Jamie does not have any PRPL records.
Cecilia has Medicaid instead of private coverage. In this case, Cecilia does not have any PRPL records.

Sources of Insurance: Employers and Other Establishments

Rochelle is an employed parent with family coverage through her current main job. In this case, each family member’s PRPL record flags Rochelle’s current main job as the source of insurance, and each family member’s PRPL record links to that job record in PUF HC-203.
Claire is employed, but she does not have insurance through her job. Instead she buys a plan directly from an HMO. In this case, Claire has one PRPL record that does not flag her current main job and does not link to any job records in PUF HC-203.
Felix has hospital/physician insurance through his employer, and he buys dental insurance through an insurance agent. In this case, Felix has two PRPL records, and only the employment-based insurance flags his current main job and links to a job record in PUF HC-203.

Policyholders Not in the Household

Edith is a widow and has retiree insurance from her deceased husband’s former job. In this case, Edith’s PRPL record does not link to any employment information in the MEPS. There is also a PRPL record for Edith’s deceased husband, where he is flagged as the policyholder and flagged as deceased, but this record does not link to any records on any other MEPS PUFs.
Matilda’s parents are divorced. She lives with her father, but her insurance is through her mother’s job. In this case, Matilda’s PRPL record does not link to any employment information in the MEPS. There is also a PRPL record for Matilda’s mother, where she is flagged as the policyholder and not residing in the Reporting Unit (RU), but this PRPL record does not link to any records on any other MEPS PUFs.

Changes in Insurance

Isaac changes jobs between January 1st, 2018 and the date of his MEPS interview, and both jobs provide health insurance. In this case, Isaac has two PRPL records for the round, one for each source of coverage through a job. EVALCOVR shows whether one or both plans covered Isaac on the interview date.
Julie reports that she worked at a job in Round 1 (Panel 23) but that she quit sometime before the interview. She began paying her previous employer to continue her health insurance while she looks for another job during Round 2. In this case, Julie’s Round 1 PRPL record links to a job record in PUF HC-203. The Round 2 PRPL record has no job to link to in Round 2. Instead, the PRPL record is set to link with the Round 1 job. Even though she was actively employed at some point in Round 1, the PRPL record is not flagged as being through a current main job since she is not employed at the end of Round 1. The same is true for her Round 2 PRPL record.

Same Insurance Source Providing Multiple Plans

Savannah reports working for a company that provides health insurance that she enrolls in. During the Round 2 interview, Savannah reports retiring from the job. Also in Round 2, her employer hires her back as a consultant. When reporting each job, Savannah indicates that she has insurance through both jobs. Therefore, in Round 2, Savannah has two unique PRPL records that are each linked to a separate job. Both 'plans' are through the same establishment-policyholder-round but each has its own unique insurance plan identifier.

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2.2 Identifiers

Beginning in 2018, as variable collection, universe, or categories are altered, the variable name will be appended with “_Myy” to indicate in which year the alterations took place. Details about these alterations can be found throughout this document, if applicable. Also beginning in 2018, all identifiers begin with the two-byte panel number.

Each record contains the following ID variables:

DUPERSID is the person identifier (either a dependent or a policyholder).

RN is the round of the interview in which the enrollment data were collected.

PHLDRIDX is the person identifier of the policyholder.

ESTBIDX is an ID number for the establishment – employer, union, insurance company, or other – i.e., the source of insurance coverage on the record.

InsurPrivIDEX is a new identifier added in 2018 consisting of the concatenation of ESTBIDX and a 3-byte insurance number. It uniquely identifies establishment-insurance plans in a responding unit.

EPRSIDX is the concatenation of ESTBIDX, PHLDRIDX, RN, and 3-byte insurance number and it uniquely identifies the insurance plan that a policyholder obtains from an individual establishment.

EPCPIDX is the concatenation of EPRSIDX and DUPERSID, and it uniquely identifies each record.

JOBSIDX is the concatenation of the PHLDRIDX, a round identifier (RN), and a job number, and it uniquely identifies the policyholder’s job at the establishment that provided insurance (for employment-based coverage).

For each person covered by a policyholder-establishment combination, the PHLDRIDX, ESTBIDX, EPRSIDX, and InsurPrivIDEX appear on each plan record for that coverage.

A person (DUPERSID) can be listed more than once on this file if (1) they are covered (as a policyholder or a dependent) by insurance policies from more than one establishment, (2) they are covered by multiple insurance policies from the same establishment, or (3) they are covered in more than one round. Within each round, establishment-policyholder pairs (EPRSIDXs) can be listed more than once if the health plan a policyholder obtains from a given establishment also covers his/her dependents.

As noted above, there is a PRPL record for each unique combination of establishment (source of insurance), round, insurance number, and covered person (policyholder or dependent).

The following table presents a hypothetical example that illustrates the relationship between the ID variables on this file.
	ESTBIDX	DUPERSID	PHLDRIDX	RN	Insurance #	EPRSIDX PANEL #+ ESTBIDX+ PHLDRIDX+ RN+ Insurance #	EPCPIDX PANEL #+ ESTBIDX+ PHLDRIDX+ RN+Insurance #+ DUPERSID	JOBSIDX PANEL # + PHLDRIDX+ RN+Job #
	A RU = 1
1	101	104	104	1	101	231011041101	231011041101104	231041101
2	101	104	104	2	101	231011042101	231011042101104	231042101
3	101	104	104	3	101	231011043101	231011043101104	231043101
	B RU = 2
4	201	206	206	1	202	232012061202	232012061202206	232061201
5	202	206	206	1	203	232022061203	232022061203206	-1
	C RU = 3
6	301	301	301	3	302	233013013302	233013013302301	233013301
7	301	301	301	3	303	233013013303	233013013303301	233013301
8	301	302	301	3	303	233013013303	233013013303302	233013301
9	301	303	301	3	303	233013013303	233013013303303	233013301
	D RU = 4
10	401	401	401	1	402	234014011402	234014011402401	234011401
11	401	402	401	1	402	234014011402	234014011402402	234011401
12	401	403	401	1	402	234014011402	234014011402403	234011401
	E RU = 5
13	501	503	503	1	501	235015031501	235015031501503	235031502
14	501	503	503	2	501	235015032501	235015032501503	235032502

*NOTE: Panel number for the records are added as prefixes to each of these identifiers in the actual PRPL data.

The first three rows of the table represent a situation where a person (DUPERSID=104) is listed three times in the PRPL file because she obtains insurance from the same establishment in all three rounds. Since the person is the policyholder, her DUPERSID is the same as the PHLDRIDX, which is repeated in the EPRSIDX, EPCPIDX, and JOBSIDX.

The fourth and fifth rows of the table represent a situation where a person (DUPERSID=206) is listed twice in the PRPL file because she obtains insurance from more than one establishment. In this example, the second establishment is not an employer or union, so JOBSIDX is -1 INAPPLICABLE.

The sixth, seventh, eighth, and ninth rows of the table represent a situation where a policyholder obtains coverage for themselves under one policy and obtains separate coverage for two dependents under another policy. Both policies are through the same ESTBIDX. The policyholder’s PHLDRIDX appears in both EPRSIDX. These different plans are uniquely identified by the insurance number (EPRSIDX=233013013302 and 233013013303). PRPL will create a policyholder record for situations where the policyholder is not covered under the plan.

The tenth, eleventh, and twelfth rows of the table represent a situation where a policyholder and two dependents obtain coverage through the policyholder’s employer (a unique establishment-policyholder pair within each round, EPRSIDX=234014011402). The policyholder’s PHLDRIDX appears in the EPRSIDX and the JOBSIDX for all three covered persons.

The last two rows of the table represent a situation where a person is retired and has retiree insurance through a job that ended prior to 2018. In Panel 23, Round 1, the respondent reported the job from which the sample member retired, and MEPS does not ask about that job again.

However, in each round we ask about the health insurance. So in Round 2, the JOBSIDX contains round number 1, when the jobs data were last collected.

Finally, note that EPCPIDX uniquely identifies each record on the file.

In order to conduct person-level analyses, it is necessary to identify all policies that cover each individual either as a policyholder or as a dependent. Since each person in the PRPL file is uniquely identified by the variable DUPERSID, person-level analyses can be conducted by examining all PRPL records containing each DUPERSID.

Because identifier structures changed between 2017 and 2018, in order to conduct cross-year analyses using 2017 records, a linking identifier is required. For each Panel 22 record contained in both 2017 and 2018 PRPL file, linking identifiers are available for Round 3 records in this file as follows:

EPCPIDX_17
DUPERSID_17
PHLDRIDX_17
ESTBIDX_17
EPRSIDX_17
JOBSIDX_17*

*Additionally, to facilitate jobs linkages for data users, JOBSIDX_17 is copied from Panel 22 Round 3 PRPL records to Round 4 and Round 5 records in cases where insurance coverage continues in Rounds 4 and 5 through a former job that ended in Round 1 or Round 2.

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2.3 Reserved Codes

The following reserved code values are used:
Value	Definition
-1 INAPPLICABLE	Question was not asked due to skip pattern
-7 REFUSED	Question was asked and respondent refused to answer question
-8 DK	Question was asked and respondent did not know answer or the information could not be ascertained
-15 CANNOT BE COMPUTED	Value cannot be derived from data

Beginning in 2018, cases that used to contain -9 (NOT ASCERTAINED) in MEPS variables are distributed between -8 (DK) and -15 (CANNOT BE COMPUTED). Most of the cases that were previously -9 (NOT ASCERTAINED) will now be assigned -8 (DK). However, -15 (CANNOT BE COMPUTED) will be assigned for MEPS variables that are constructed from MEPS instrument variables in cases where there is not enough information from the MEPS instrument to calculate the constructed MEPS variables. Lack of information is often the result of skip patterns in the data or from missing information resulting from -7 (REFUSED) or -8 (DK). Also note that reserved code -8 previously identified cases where respondent chose “don’t know” to a question. It now represents a broader category that includes cases where either the information from the question was not ascertained or the respondent chose “don’t know.”

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2.4 Adding the Characteristics of Covered Persons

The DUPERSID allows you to link on the age, sex, race, health status, or other person-level variables from the other HC files. However, this will result in multiple records per person, and estimates will not be nationally representative unless you use one PRPL record per person or summarize PRPL records to the person level (and use weights).

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2.5 Adding the Policyholder’s Characteristics

The PHLDRIDX allows you to link characteristics of the policyholder onto the records of every person covered by the plan. For example, suppose you wanted to study persons whose private employment-based insurance is through an employee working full time at a current main job as of the first interview of 2018 (Panel 23 Round 1 or Panel 22 Round 3). Then you would select PRPL records matching HC-196 (PITFLG=1) where the insurance is through a current main job (CMJINS=1) and [(PANEL=23 and RN=1) or (PANEL=22 and RN=3)]. From HC-196, select the DUPERSID and HOUR13 variables and rename DUPERSID to PHLDRIDX. Merge HOUR13 onto the PRPL file by PHLDRIDX.

Some policyholders do not have records on HC-196 or HC-204. These include deceased policyholders and policyholders residing outside the RU. For these policyholders, PITFLG and FYFLG may be equal to 0, depending on when the policyholder left the RU. All of the covered person records for these establishment-policyholder pairs are flagged with DECPHLDR, OUTPHLDR, or NOPUFLG equal to 1. Deceased policyholders complicate the estimation of nationally representative statistics on active policies. For these establishment-policyholder pairs, users must choose a covered person with a positive weight. However, when creating nationally representative estimates of policies and policyholders, establishment-policyholder pairs where the policyholder resides outside the RU should not be included in estimates. This is because MEPS policyholders include policies covering dependents outside the RU, and including RU members covered by a policyholder outside the RU will result in double counting policies that span RUs. Alternatively, a researcher could create nationally representative estimates of covered persons, regardless of whether the policyholder was in the RU, using all the covered persons in the MEPS.

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2.6 Choosing PRPL Records for Your Research Question

In order to produce estimates from the data in this file, researchers must use the person-level or family-level weights released in either of two previously released PUFs, HC-196 or HC-204. Researchers must consult the documentation for these PUFs for guidance on creating nationally representative estimates for different time periods.

Note that if there are multiple records per person (DUPERSID) when you merge on weights, you will double count some people, and your estimates will not be nationally representative. There are two solutions: select only one record per person, or aggregate information across PRPL records.

How you develop your analytical file depends on your research question. The PRPL file is designed to help answer a wide variety of research questions. AHRQ cannot anticipate all these questions, so this section provides examples of how to use the PRPL file for four research questions.

How many people were covered by two or more private hospital/physician insurance plans at the end of 2018?

Select the Panel 23 Round 3 and Panel 22 Round 5 records with PrivateCat>0 and MSUPINSX ne 1 and EVALCOVR=1. Count the number of records for each person (DUPERSID). Create one person-level record for each DUPERSID that has the number of plans (PRPL records). Merge the count variable onto PUF HC-204 and use weights, strata, and PSUs to create nationally representative estimates. Note that as of 2018 the variable PrivateCat replaces the variable PRIVCAT. Both are delivered on the 2018 file to assist the transition from PRIVCAT to PrivateCat. Differences are addressed in later sections of this document.

How many people reported private dental coverage from an employer at the end of 2018?

Select the Panel 23 Round 3 and Panel 22 Round 5 records with DENTLINS=1 and PrivateCat in (1, 4) and EVALCOVR=1. Among these records, select one record for each person (DUPERSID). Merge each record onto PUF HC-204 and use weights, strata, and PSUs to create nationally representative estimates.

At the time of the first interview, how many private insurance policies for hospital/physician were not employment-based?

Select the Panel 23 Round 1 and Panel 22 Round 3 records with PrivateCat in (2, 3, 5, 6) and MSUPINSX ne 1 and EVALCOVR=1. Select one record for each policyholder-establishment pair (EPRSIDX). To have a positive weight for the final count, we recommend choosing the covered person record of the policyholder (PHOLDER=1), unless the policyholder is deceased (DECPHLDR=1), in which case then the researcher should choose a different covered person’s record. Merge each record onto PUF HC-196 and use weights, strata, and PSUs to create nationally representative estimates.

At the time of the first interview of 2018, how many people had insurance from jobs from which they retired?

Select the PRPL records for policyholders of employment-related insurance at the time of the first interview [(Panel 23 Round 1 or Panel 22 Round 3) and PHOLDER=1 and PrivateCat =1 and EVALCOVR=1]. From the 2018 JOBS file, PUF HC-203, using JOBSIDX, select the records with jobs from which the person retired (SUBTYPE=6 or RETIRJOB=1 or YNOBUSN_M18=2 or WHY_LEFT_M18=3). Persons in Panel 22 may have reported retiring from a job in 2017, so, from the 2017 JOBS file, PUF HC-195, using JOBSIDX_17, renaming to JOBSIDX since that is the identifier in 2017 JOBS file, select the records with PANEL=22 and (SUBTYPE=6 or RETIRJOB=1 or YNOBUSN=2 or WHY_LEFT=3). Combine the records from the two JOBS files, keeping only one record per JOBSIDX. Using the JOBSIDX, merge the selected JOBS records onto the selected PRPL records. Select the PRPL records with SUBTYPE=6 or RETIRJOB=1 or YNOBUSN_M18=2 or WHY_LEFT_M18=3 or EMPLSTAT=2. Select one record for each DUPERSID. Merge each record onto PUF HC-204 and use weights, strata, and PSUs to create nationally representative estimates of the number of people with one of these PRPL records.

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3.0 Data File Contents

3.1 ID Variables

In the MEPS Household Component, the definitions of Dwelling Units (DUs) and Group Quarters are generally consistent with the definitions employed for the National Health Interview Survey. The dwelling unit ID (DUID) is, as of 2018, a seven-digit random ID number assigned (see below) after the case was sampled for MEPS. The three-digit person number (PID) uniquely identifies each person within the dwelling unit. The ten-character variable DUPERSID uniquely identifies each person represented on the file and is the combination of the variables DUID and PID. As part of the CAPI redesign beginning with the 2018 data, the lengths of the ID variables have changed in the file. The additional 2 bytes in the IDs resulted from adding a 2-digit panel number to the beginning of all the IDs. Analysts wishing to link person-level data between 2017 and 2018 should add panel numbers to the beginning of Panel 22 Year 2017 DUPERSID variable, or remove the 2-digit panel number at the beginning of Panel 22 Year 2018 DUPERSID variable to ensure they identify the same person. Likewise, pooling multiple data years would require adding panel numbers to DUPERSID variable in years 2017 and earlier or removing them from years beginning with 2018. The MEPS HC-208 PRPL file can be linked to other public use files such as MEPS HC-196 by using the DUPERSID.

For detailed information on dwelling units and families, please refer to the documentation for the 2018 Full-Year Population Characteristics File.

PHLDRIDX is the person identifier (DUID + PID) of the policyholder of the private health insurance plan. Generally, the characteristics of the policyholder can be linked from person-level public use files by using the PHLDRIDX to match the DUPERSID on the person-level files. However, when the policyholder is deceased or resides outside the RU, then there are no person-level variables on public use files. Where the policyholder was alive and resided in the household at some point during the time periods covered by the interviews, the policyholder identifier in the EPRSIDX will change between rounds. InsurPrivIDEX can be used to track the insurance across rounds. The InsurPrivIDEX will identify all records, including the first reported through the plan so can be used to track the change in policyholder. A more in-depth discussion of this can be found in Section 3.3.

As of 2018, ESTBIDX is a combination of DUID, “0”, and a three-byte establishment number. The three-byte establishment number consists of the RU number of the RU where the establishment was reported, followed by a two-digit counter. It is assigned to place of employment and to sources of insurance. Beginning in 2018, the RU letter has been dropped from the variable and the RU number and counter digits were shifted. For instance, "A0011" becomes "0101" and "A0021" becomes "0102." The combination of these elements ensures uniqueness within the RU.

EPRSIDX is a combination of ESTBIDX, PHLDRIDX, RN, and insurance number. In a few cases, more than one EPRSIDX may identify a policyholder-source of coverage pair. For example, when an RU splits, through divorce or because a child goes to college, each new RU separately reports insurance information, and hence MEPS cannot determine with certainty whether members in both RUs have the same policy. Although both RUs may report coverage through the same policyholder, the RUs may have different EPRSIDXs and ESTBIDXs. (The RU number is embedded in the ESTBIDX and EPRSIDX.) For each RU (EPRSIDX), there is a PRPL record for the policyholder as a covered person, but for only one of the EPRSIDXs (the one in which the policyholder resides) is the policyholder coded as having coverage in the STATUS or EVALCOVR variables.

InsurPrivIDEX is new to the PRPL file and uniquely identifies insurance policies from the same establishment. It is a combination of ESTBIDX and a 3-byte insurance number within CAPI. The first byte of the CAPI-generated insurance identifier represents the RU in numeric format (e.g. an A RU plan begins with ‘1’ and a D RU plan begins with ‘4’). The last two bytes are generated from a counter within the RU. Thus, these last 3 bytes are unique, RU-level insurance identifiers. InsurPrivIDEX is particularly helpful when tracing the history of a plan where a policyholder leaves a household (PID changes to 902) or returns to a household (PID changes from 902 to an RU member’s PID). Therefore, these records will not link based on ESTBIDX-PHLDRIDX. InsurPrivIDEX is the most reliable way to identify all records across rounds. Users will note that there are 13 pairs of insurance plans in this file that have the same establishment-policyholder but different insurance plan identifiers.

JOBSIDX is a combination of the PHLDRIDX, a round identifier (RN), and a three-byte job number, and it uniquely identifies the policyholder’s job at the establishment that provided insurance (for employment-based coverage). Beginning in 2018, the job number is composed of the RU number of the RU where the job was reported, followed by a two-digit counter. The combination of these three preclude re-use of the two-digit counter. The round identifier embedded in JOBSIDX is the round in which the job was last reported, which is not necessarily the round in which the insurance was last reported (for example, when the job ended but the insurance continued). JOBSIDX can be used to link on characteristics of the policyholder’s job providing insurance from the JOBS Public Use File (HC-203).

Users should take special care when working with EPRSIDX and EPCPIDX in Excel. While these variables are formatted character values, Excel will interpret them as numeric since no character is part of the identifier. Excel uses the floating point standard, truncating after the 15^th number. It rounds these identifiers (thus losing the complete identifier) and represents them in scientific notation. When importing into Excel, users should make sure to select a text data format within the import wizard for each identifier. Similarly, programmers should incorporate specific text formatting statements when importing and exporting in SAS, Stata, SPSS, and R. Lastly, if copying and pasting identifiers in Excel, a cell must be formatted as “Text” prior to pasting.

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3.2 Person Variables

There are four person-level variables. Binary variables indicate whether the person is the policy holder (PHOLDER) or a dependent (DEPNDNT) on the coverage through the establishment. The variable PITFLG indicates whether the person has a record on HC-196, and FYFLG indicates whether the person has a record on HC-204.

There are 25 person-round-level variables. EVALCOVR is a binary variable indicating whether the person was covered by insurance from the establishment at the time of interview (Rounds 3 and 4 of Panel 22 and Rounds 1 and 2 of Panel 23) or on December 31 (Round 5 of Panel 22 and Round 3 of Panel 23). The variables STATUS1-STATUS24 indicate whether the respondent reported the person was covered by insurance from the establishment for at least one day during the month. For Panel 23, STATUS1-STATUS12 represent coverage from January 2018 through December 2018, and STATUS13-24 are inapplicable because this information is in the year 2019. For Panel 22, STATUS13-STATUS24 represent coverage from January 2018 through December 2018, and STATUS1-STATUS12 are inapplicable because this information is in the year 2017. Coverage is reported only for the interview reference period. For example, if a person from Panel 23 was first interviewed in February and reported she was covered in January and February, and then in the second interview in August she reported she was covered from March through August, then the PRPL record for the first round will have STATUS1 and STATUS2 set to 1 YES and the rest set to -1 INAPPLICABLE, and the PRPL record for the second round will have STATUS3 through STATUS8 set to 1 YES and the rest set to -1 INAPPLICABLE .

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3.3 Policyholder Variables

The values of three variables describing the policyholder do not vary across the records of the persons covered by the plan, regardless of whether the covered person is the policyholder. The variable DECPHLDR indicates the policyholder is deceased. The variable OUTPHLDR indicates the policyholder resides outside the RU. In each case, there are no person-level records for the policyholder on any of the person-level PUF files, even though the PRPL file has a record for the policyholder as a covered person (that is, a record where PHOLDER=1). Instead, the person identifier portion of the coverage record identifier is set to either ‘901’ indicating a deceased policyholder or ‘902’ indicating a policyholder residing outside the RU.

Beginning in Panel 22 Round 3 and Panel 21 Round 5, where a policyholder does not reside in the RU, and, in the next round, a member of the dwelling unit is selected as the policyholder at OE10, the person identifier of the policyholder will change from ‘902’ to the person identifier of the selected dwelling unit member. This differs from prior versions of CAPI where the person identifier remained ‘902’ on reviewed coverage, no matter the policyholder selection at OE10. As noted above, InsurPrivIDEX does not change across rounds for the same policy and thus may be used to link coverage records across rounds.

OUTPHLDR continues to identify only those policies where the person identifier of the policyholder is set to “902”; OUTPHLDR will be set to 2 NO in cases where a member of the dwelling unit is selected as the policyholder at OE10 in a subsequent round. The variable PHLDRCHNG has been added to the file to indicate if a policyholder changed in the current round from the previous round.

It is set as follows:
PHLDRCHNG	Description
-1	No previous-round coverage exists or policyholder did not change from the previous round
1	Policyholder changed from 902 in previous round to non-902 in current round
2	Policyholder changed from non-902 in previous round to 902 in current round
3	Policyholder changed from non-902 in previous round to 901 in current round
4	Policyholder changed from non-902 in previous round to a different non-902 in current round
5	Dependents in different RUs review the same plan and report different persons at OE10 as policyholder

Policyholders that are “non-902” include both deceased policyholders and not deceased in-RU policyholders.

The variable NOPUFLG indicates there is another reason the policyholder does not have a record on a person-level PUF. The purpose of these flags is to explain any difficulty users may have linking policyholder information onto the PRPL file. These variables do not, however, measure mortality or policyholders’ leaving the household, which should instead be obtained from the PSTATS variables on the person-level files. (For example, policyholders who die between Round 1 (Panel 23) or 3 (Panel 22) and the end of 2018 will have records on HC-196 and HC-204, and PITFLG and FYFLG will be set to 1 YES.)

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3.4 Establishment Variables

The values of establishment-level variables do not vary across the records of the persons insured through the policyholder-establishment pair.

3.4.1 Employers, Exchanges, and Other Establishments

The type of establishment providing coverage (TYPEFLAG) is on the record. This variable is the source for types of establishments providing employer-based and non-employer-based, private coverage. In this file, TYPEFLAG includes the answers to HX200, HX300, and HP40. TYPEFLAG reflects the type of establishment when the establishment was first reported, but it is not necessarily updated. For example, users must link to the JOBS file to obtain information on employees who left their job since the interview in which the employer was first reported (see Section 3.6). For employment-based coverage through both an employer and a union (such as insurance through a labor-management committee), for most cases, only the coverage record through the employer establishment is retained. These cases are identifiable through the PROVDINS variable on the JOBS File. In some cases, the union and employer may provide different types of coverage. It is important for researchers to review coverage type variables - HOSPINSX, MSUPINSX, PMEDINS, DENTLINS, VISIONIN, and COBRA - to determine which establishment would be most helpful in answering analytic questions.

Beginning in Panel 23 Round 1, Panel 22 Round 3, and Panel 21 Round 5, CAPI no longer differentiates types of private coverage as COBRA or not COBRA when selecting a type of coverage at HP40, HX200, and HX300. Instead, respondents may select FROM ANYONE’S PREVIOUS EMPLOYER at HP40/HX200/HX300 followed by a question at HP140 to determine if it is COBRA coverage. This change is reflected in values of TYPEFLAG. Instead of having separate values for “8 PREVIOUS EMPLOYER – COBRA” and “9 PREVIOUS EMPLOYER – NOT COBRA,” one value TYPEFLAG =“8 PREVIOUS EMPLOYER” is now used. Some records with TYPEFLAG=9 that were first reported in Panel 22 Round 1 or Round 2 will reflect the value “8 PREVIOUS EMPLOYER”. Users should use the variable COBRA to make the required analytic distinction.

Note that when TYPEFLAG has a value of 10, “SPOUSE PREVIOUS EMPLOYER,” and the spouse resides in the RU, and the respondent selects the spouse as the policyholder at HP90, then the policyholder’s ID (PHLDRIDX) is the spouse’s person ID (DUPERSID).

As of Panel 14 Round 5 and Panel 15 Round 3, “High Risk Pool” (TYPEFLAG = 20) was added to the list of sources of coverage at HX200, HX300, and HP40, where information is collected about purchased insurance associated with a self-employed job and firm size = 1, and privately purchased health insurance not obtained through an employer. Beginning in Panel 22 Round 3/ Panel 23 Round 1, TYPEFLAG=“20 HIGH RISK POOL” is no longer an allowed CAPI value at HX200, HX300, and HP40. Some records with TYPEFLAG=20 in the 2018 file that were first reported in Panel 22 Round 1 or Round 2 will continue to reflect this value.

The MEPS HC asks about State Exchanges, so the PRPL File has four variables and one TYPEFLAG (HX200, HX300, and HP40) value related to State Exchanges. These variables and value pertain to sources of health insurance coverage created as part of the 2010 Affordable Care Act. The exchanges were launched in 2014 to simplify shopping for private health insurance coverage. Note that the terms “marketplace” and “exchange” are interchangeable.

Individuals may purchase coverage directly from a State Exchange for themselves or family members. The Small Business Health Options Program (SHOP) Marketplaces help small businesses offer health insurance to their employees. For more information, please see the Health Insurance Marketplaces page on the Centers for Medicare & Medicaid Services (CMS) website.

The questions about State Exchanges and SHOPs are asked of respondents in every state. The name of the exchange in the respondent’s state is used in the questions, but states are not identified on this file.

The variables are as follows:

Coverage through a State Exchange

STEXCH

Beginning with the 2018 CAPI instrument, StExCovg (HP50) and OESTEXCH (OE40) indicate whether insurance was obtained through an exchange. This is instead of the three variables used prior to 2018: STEXCH03, STEXCH23, and OESTEXCH. StExCovg provides this information for insurance obtained by a self-employed person with firm size = 1 reported through that job in the Employment section, as well as all other insurance not reported in the Employment section of CAPI. OESTEXCH (OE40) is asked in Round 3 where coverage is reported as “DIRECTLY FROM AN INSURANCE AGENT,” “DIRECTLY FROM INSURANCE COMPANY,” or “DIRECTLY FROM AN HMO” at HX200, HX300, or HP40 and no State Exchange was reported through the establishment in the previous round. StExCovg and OESTEXCH are set to -1 INAPPLICABLE for insurance obtained through a current or former employer, union, school, high risk pool, or unknown source. Applicable values exist only for insurance obtained through other groups, insurance companies, insurance agents, HMOs, State Exchanges, or other private sources. These variables are automatically set to 1 YES, indicating that the source of coverage was from a State Exchange when State Exchange was selected as the source of insurance at HX200, HX300, or HP40. Otherwise, these variables are the responses to HP50 or OE40.

After the interview, StExCovg and OESTEXCH were edited to 2 NO, indicating that the source of coverage is not from a State Exchange, when either of the following was true:

The respondent reported Medigap coverage (MSUPINSX = 1) was obtained through the State Exchange, or
For persons 65 years and older, the person had Medicare (reported elsewhere in the Health Insurance section of the survey).

Thus, these records are no longer included as State Exchange coverage.

Instead of delivering multiple State Exchange variables, the PRPL File creates one variable,STEXCH, to summarize whether coverage is through a State Exchange, using StExCovg and OESTEXCH. STEXCH is set to -1 INAPPLICABLE for insurance obtained through a current or former employer, union, school, high risk pool, or unknown source. STEXCH is set to 1 YES, EXCHANGE COVERAGE if any of the three following conditions are met:

The respondent said a State Exchange is the source of insurance through a self-insured firm with firm size=1 (HP40).
The respondent said a State Exchange is the source of insurance not elsewhere reported (HX200/HX300).
The respondents said the insurance was through a group, association, insurance company, insurance agent, HMO, or other private source and the respondent said 1 YES, STATE EXCHANGE COVERAGE to “Is this coverage through STATE EXCHANGE NAME?” either in the interview the insurance was first reported (HP50) or in Round 3 for insurance reported in an earlier round as non-Exchange coverage (OE40).

All others are set to 2 NO, NOT EXCHANGE COVERAGE.

PLANMETL

There are five levels or “tiers” of coverage available through the Marketplace that identify how the policyholder and the insurance plan will split costs. To assist consumers in selecting a level of coverage, the tiers are named Catastrophic, Bronze, Silver, Gold, and Platinum, reflecting a graduated level of cost to the consumer for deductibles, copayments, coinsurance, and out-of-pocket maximums.

Persons are asked to identify the “metal” plan if 1) State Exchange coverage is indicated at HP40, HX200, HX300, HP50, or OE40; 2) the coverage provides hospitalization and physician benefits; and 3) the person is less than 65 years of age.

During editing, PLANMETL is set to -8 DON’T KNOW if hospitalization/physician benefit coverage is -7 REFUSED or -8 DON’T KNOW.

PREMSUBZ

PREMSUBZ (HX690 and OE200) indicates whether insurance was subsidized based on family income. PREMSUBZ is set to -1 INAPPLICABLE for insurance obtained through a current or former employer, union, school, high risk pool, or unknown source. Applicable values exist only for insurance obtained through other groups, insurance companies, insurance agents, HMOs, State Exchanges, or other private sources. For these sources of insurance, respondents are asked each round whether the insurance is subsidized, with one exception. The exception is that subsidy information is not collected in Round 5 for insurance first reported in a prior round.

Coverage through the Small Business Health Options Program

STSHOP

STSHOP (HP150 and OE150) indicates whether employment-related health insurance coverage with a change in plan name is related at all to a SHOP marketplace. This information is collected for employment-related insurance through a current main job at a small employer. For this part of the survey, a small business establishment is defined differently for the self-employed and those working for others. For the self-employed, a small business is defined as an establishment with more than one but fewer than 200 employees. For jobholders working for others, a small business is defined as an establishment having only one location and fewer than 200 employees or the respondent estimated the establishment had 100 or fewer employees.

It is important to note that a person may have SHOP and State Exchange coverage in the same round; however, these are through different establishments.

Beginning in Panel 23 Round 3, and Panel 22 Round 5, HP150 and OE150 are no longer collected in CAPI.

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3.4.2 Types of Coverage through the Establishment

The establishments in the PRPL file provide private health insurance covering hospital/physician, Medicare supplemental insurance, dental, vision, or prescription medication insurance. The variable PrivateCat identifies the type of source for hospital and physician or Medicare supplemental insurance. As of the 2018 PRPL file, the variable PrivateCat replaces the variable PRIVCAT. Both are delivered in this file to assist analysts. There are three main differences between the two variables.

Incorporation of HP130 – Direct purchase coverage that is through a policyholder living outside the family now indicate if the coverage is employer-sponsored insurance (ESI) or not, based on the response to HP130 (Is the health coverage through an employer or previous employer?). Therefore, PRIVCAT=4 OUTSIDE OF HOUSEHOLD is now broken into three categories – PrivateCat “4 ESI, PHOLDER OUTSIDE RU,” “5 NON-ESI, PHOLDER OUTSIDE RU,” and “99 DON’T KNOW WHAT KIND OF PRIV COV.” With this approach, analysts who have historically used the “out of RU” value will still be able to do so (with the exception of the out-of-RU don’t know category, which is typically small). At the same time, analysts will now be able to develop overall ESI, as well as overall non-ESI figures incorporating coverage through a policyholder not living in the RU.
Insurance associated with a self-employed job and firm size = 1 – Instead of having one larger category for this type of coverage, it has been broken into the existing Non-group, Other group, ESI, and Unknown categories.
“Don’t Know” responses – Combine Self-employed and Out-of-RU coverage responses of “DON’T KNOW” with the existing category “99 DONT KNOW WHAT KIND PRIVATE COVERAGE,” that in the past had consisted of Private coverage “Don’t know” only.

PRIVCAT	PrivateCat	Differences
0 NOT HOSP/PHYS OR MEDIGAP COVERAGE	0 NOT HOSP/PHYS OR MEDIGAP COVERAGE	No change
1 EMPLOYER/UNION	1 EMPLOYER/UNION	Beginning in 2018, includes reports of coverage in the Employment section identified as self-employed firm size=1 that are reported as from a union or previous employer
2 NONGROUP	2 NONGROUP	Beginning in 2018, includes reports of coverage in the Employment section identified as self-employed firm size=1 that are reported as from an insurance agent, an insurance company, or an HMO
3 OTHER GROUP	3 OTHER GROUP	Beginning in 2018, includes reports of coverage in the Employment section identified as self-employed firm size=1 that is reported as from a professional association or small business group
4 OUT OF HOUSEHOLD	4 ESI, PHOLDER OUTSIDE RU	Includes coverage from a policyholder not living with the family that is reported as coverage through an employer or previous employer at HP130 (is the health coverage through an employer or previous employer?) (formerly included in PRIVCAT=4)
	5 NON-ESI, PHOLDER OUTSIDE RU	Includes coverage from a policyholder not living with the family where coverage is reported as not through an employer or previous employer at HP130 (is the health coverage through an employer or previous employer?) (formerly included in PRIVCAT=4)
5 SELF-EMPLOYED	dropped	Values distributed in PrivateCat 1-3 and 99
6 STATE EXCHANGE	6 STATE EXCHANGE	No change
99 DONT KNOW WHAT KIND PRIV COV	99 DONT KNOW WHAT KIND PRIV COV	Beginning in 2018, includes reports of coverage in the Employment section identified as self-employed firm size=1 where coverage source is unknown, or Employment status of coverage from a policyholder not living with the family is unknown based on response at HP130 (Is the health coverage through an employer or previous employer?)

HOSPINSX and MSUPINSX are edited establishment-policyholder flags for whether the policyholder has physician/hospital and Medigap coverage, respectively, through the establishment. However, even when PrivateCat indicates there is either hospital/physician or Medigap coverage, both HOSPINSX and MSUPINSX may have missing values. Note also that both HOSPINSX and MSUPINSX may be coded 1 YES on the same record. DENTLINS, VISIONIN, and PMEDINS flags indicate the establishment provides coverage for dental care, vision care, and prescription medications, respectively.

Below are examples of how to use these variables to identify types of insurance:
Identifying Types of Insurance	Variable and Values
Hospital and physician or Medicare supplemental insurance	PrivateCat in (1, 2, 3, 4, 5, 6, 99)
Medicare supplemental insurance	MSUPINSX = 1
Hospital and physician insurance	PrivateCat in (1, 2, 3, 4, 5, 6, 99) & MSUPINSX ne 1
Dental insurance	DENTLINS = 1

The variable COBRA is a flag for whether the respondent reported that the coverage was obtained through the requirements of the COBRA of 1986. This act requires that certain employers allow some former employees to continue their employment-based coverage by paying the employer the premium (U.S. Department of Labor). This flag does not, however, indicate all the coverage through former employers, which can be determined using TYPEFLAG and links to former jobs in the JOBS file.

Beginning in Panel 22 Round 3 and Panel 21 Round 5, CAPI no longer differentiates types of private coverage as COBRA or not COBRA when selecting a type of coverage at HP40, HX200, or HX300. Instead, respondents may select FROM ANYONE’S PREVIOUS EMPLOYER, FROM SPOUSE’S/DECEASED SPOUSE’S PREVIOUS EMPLOYER, or OTHER SOURCE at HP40/HX200/HX300 followed by a question at HP140 to determine if it is COBRA coverage. This change is taken into account when setting COBRA.

In the PRPL file, COBRA is set to 1 YES when COBRA coverage is indicated at HP140. COBRA is set to 2 NO when the insurance was not COBRA coverage. COBRA is set to -1 INAPPLICABLE when the coverage was not employment-based, and when the coverage was through a current job. COBRA is set to -15 CANNOT BE COMPUTED for retirement jobs first reported in the Employment section in Round 1 (EM380 or EM390), retirement jobs first reported in the Employment section for new RU members (EM380 or EM390), and insurance through unions reported in the Insurance section (HX200/HX300). In a few cases, self-employed persons with firm size = 1 reported buying coverage through a previous job, and these cases are coded as yes or no, while other insurance through self-employment with firm size = 1 is coded -1 INAPPLICABLE.

Prior to Panel 22 Round 3 and Panel 21 Round 5, COBRA is set to 1 YES if any of the three following conditions are met:

The respondent said insurance from a previous job is the source of coverage and the respondent answered 1 YES to either formerly HP14 or formerly OE14 (depending on when the job ended):
Some employer insurance can be continued after leaving the company by continuing to pay the premium. This is sometimes referred to as a COBRA plan.

{Is/Was} (POLICYHOLDER)’s (ESTABLISHMENT) insurance like that {on (END DATE)}?

Or

Did that health insurance continue through COBRA?
The respondent said COBRA is the source of insurance through a self-employed firm with firm size = 1 (formerly HX03)
The respondent said COBRA is the source of insurance not elsewhere reported (formerly HX23)

The variable COVTYPIN flags whether coverage was single or family, based on the number of persons covered in the RU, whether the establishment’s insurance covers someone outside the household, and whether the policyholder is outside the household. For Panel 23 Rounds 1 and 2, and Panel 22 Rounds 3 and 4, the number of covered persons was measured at the time of the interview (or end of the reference period). For Panel 23 Round 3 and Panel 22 Round 5, the number is as of December 31^st. When coverage ceased before the end of the reference period for every co-residing family member, COVTYPIN is set based on the number of persons ever covered during the round.

The variable COVROUT_M18 indicates whether out-of-RU persons were covered by the plan. Beginning in Panel 23 Round 1, Panel 22 Round 3, and Panel 21 Round 5, CAPI changed the universe of respondents for this question. Specifically, COVROUT_M18 is not asked if there is only one member of an RU and that person is covered by a policyholder who is deceased, no longer in the household, or not listed in the dwelling unit. Additionally, whether the policy covers dependents outside the RU is only asked if there are no dependents living in the RU covered under that policy. Consequently, researchers will note differences in the frequency of COVROUT_M18 compared with previous years.

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3.4.3 Out-of-Pocket Premiums

In the MEPS, questions on out-of-pocket premiums were asked of all policyholders with private insurance coverage for all establishments. The variable OOPPREM provides the monthly out-of-pocket premium paid by the policyholder for coverage through the establishment for Panel 23 as of Round 1 and Panel 22 as of Round 3. OOPELIG flags these covered-person-policyholder-establishment triples. OOPPREMX provides an edited version of OOPPREM and the variable OOPFLAG identifies which records were edited. OOPX12X is provided as a convenience to researchers and contains the edited monthly out-of-pocket premium amount multiplied by 12, representing the annual amount.

The edited variable OOPPREMX includes imputed values for records which contained missing values as well as for a limited number of records with values that were implausibly low or high. For policyholders in Panel 22 Round 3 with missing out-of-pocket premiums, if coverage is through a continuation job which was originally reported in Panel 22 Round 1 and type of coverage (COVTYPIN) is the same as in Panel 22 Round 1, then OOPPREMX is set equal to OOPPREMX from Panel 22 Round 1 times the growth rate in out-of-pocket premiums from 2017 to 2018. The growth rate is assigned by type of coverage and is based on private sector out-of-pocket premiums reported in the MEPS Insurance Component in 2017 and 2018. For all other cases, imputed values were assigned by one of several imputation methods – hot-deck imputation or MEAN substitution, both of which consider the following person/plan characteristics: source of insurance (private employer, state and local government, federal government, Medigap, other non-group policy, State Exchanges), age of policyholder, educational attainment of policyholder, number of persons covered by the policy, if there is a high family deductible, size of employer, region and MSA, presence of supplemental benefits such as drug, dental and vision, whether the insurance was through a current or former job, and active or retired job. In 2018, hotdeck imputation parameters were modified for group policies. As a result, the number of instances where the same donor is used multiple times was reduced and no MEAN substitution was required. Missing premium amounts on coverage purchased through a State Exchange are hot-deck imputed in a separate process.

Both OOPPREM and OOPPREMX are coded as zero for group policyholders who reported paying none of their premium.

OOPPREM is created using the out-of-pocket amount reported and the frequency of payments (HX670, HX680, and HX680OS):

HX670

How much {{do/does}/did} {you/{POLICYHOLDER}} pay for the {INSURANCE SOURCE NAME}coverage?

ENTER AMOUNT

HX680/HX680OS

{Is/Was} that per year, per month, per week, or what?

UNIT OF COVERAGE:

SPECIFY: UNIT OF COVERAGE

PREMLEVX shows whether OOPPREM was the full premium or part of it. The PREMLEVL (HX660 or OE170) question is asked in all rounds for insurance obtained through other groups, insurance companies, insurance agents, HMOs, State Exchanges, or other private sources, but not insurance obtained through a current or former employer, union, school, high risk pool, or unknown source. Note that the premium amount is not collected in Rounds 2, 4, and 5.

For the entire set of 6 variables (OOPPREM, OOPPREMX, OOPX12X, OOPELIG, OOPFLAG, PREMLEVX), the same values are reported on the records of each dependent person covered through the policyholder’s establishment, but the policyholder paid only once per establishment-policyholder.

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3.5 Plan Variables

The values of plan-level variables do not vary across the records of the persons insured through the policyholder-establishment pair.

Beginning in Panel 23 Round 1, Panel 22 Round 3, and Panel 21 Round 5, CAPI flow was modified to ask plan information in situations where coverage status was unknown or refused. Prior to that, only coverage confirmed as continuing from the prior round was asked follow-up questions.

The following PRPL variables are impacted by the new instrument flow:
Variable Name	Question #
ANNDEDCT	OE210
COBRA	OE70
COVROUT_M18	HP170 OE50 OE100
HOSPINSX, MSUPINSX, DENTLINS, PMEDINS, VISIONIN	OE130
HSAACCT	OE220
NAMECHNG	OE110
OESTEXCH	OE40
OOPPREM/OOPPREMX/OOPX12X/OOPFLAG	OE180 OE190 OE190OS
PLANMETL	OE160
PREMLEVLX	OE170
PREMSUBZ	OE200
UPRHMO	MC10

Users may see proportional changes on these variables.

The variables ANNDEDCT (HX700/OE210) and HSAACCT (HX710/OE220) capture whether a private health plan has a high deductible and whether that plan is associated with a Health Savings Account (HSA) or a similar special fund/account. These questions are asked during the first report and during the review of insurance in Rounds 1 and 3 for all private plans except for individuals covered by disability, Workers’ Compensation, accident insurance, or any combination thereof, and/or individuals covered by Medicare supplement/Medigap plans.

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3.5.1 Household Reports of HMOs

The variable UPRHMO identifies records for HMO coverage when the household respondent reported that the insurance was purchased through an HMO, reported the insurance company was an HMO, or described the plan as an HMO. In all cases the respondent answered a question using the term “HMO.” UPRHMO is set to 1 YES if any of the three following conditions are met:

If the respondent reported insurance purchased directly through an HMO (HX200, HX300, HP40)
If the respondent answered 1 YES to the following question (MC10):

{Is/Was} {your/{POLICYHOLDER}’s } {NAME OF INSURER} an HMO {as of (END DATE)}? {When answering this question, do not consider {your/his/her} insurance through Medicare.}

[With an HMO, you must generally receive care from HMO physicians. For other doctors, the expense is not covered unless you were referred by the HMO or there was a medical emergency.]

UPRHMO is set to 2 NO when the plan was not an HMO. UPRHMO is set to -1 INAPPLICABLE when the plan was not hospital/physician or Medicare supplemental coverage.

Beginning in Panel 23 Round 1, Panel 22 Round 3, and Panel 21 Round 5, CAPI was modified so that the HMO question is asked of all private coverage records, even if the person also reports Medicaid or another government-sponsored plan with hospital/physician coverage in the round.

Researchers should also note that, due to a processing error in Panel 22 Round 3, the HMO question was skipped in CAPI where the insurer’s name was auto-coded. For these records, UPRHMO has been set to -15 CANNOT BE COMPUTED.

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3.5.2 Change in Plan Name

The variable NAMECHNG indicates whether the name of the plan obtained through the establishment changed from the prior round. For Panel 23 Rounds 2 and 3 and Panel 22 Rounds 3, 4 and 5, NAMECHNG is set to 1 YES if three conditions were met: 1) someone in the RU had coverage through the establishment in the prior round; 2) either still had coverage at the time of the interview or the coverage status was unknown or refused; and 3) the respondent answered 1 YES to the following question (OE110):

{Last time we recorded that {you/{POLICYHOLDER}} (were/was) covered by {PRELOAD.INSURANCE.INSURER}.}

{Since (START DATE), has there been/Between {START DATE} and {END DATE}, was there} any change in the plan name of the health insurance {you/{POLICYHOLDER}} {{have/has}/had}through {PRELOAD.INSURANCE.HISRCNAME}?

If the respondent answered no, then NAMECHNG is coded 2 NO. If no one in the RU had coverage through the establishment in the prior round, no one had coverage at the time of the interview, or it is a Round 1 record, then NAMECHNG is set to -1 INAPPLICABLE.

When the respondent answered 1 YES, then MEPS HC asked about types of benefits (OE130), which are updated on the PRPL file.

There are two important caveats to this variable. First, changes in plan name do not necessarily imply the plan itself changed. For example, the plan may have merely changed its name for marketing purposes. Second, the variable NAMECHNG pertains only to changes in plan names at the same establishment; a policyholder may switch plans if she or he switches the establishment (including employer) through which she or he obtains insurance. Switches in EPRSIDs and ESTBIDs between rounds indicate those other types of changes.

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3.6 Links to Job Providing Insurance

For employment-based insurance, there are two variables linking the insurance to details about the jobs through which the insurance was obtained, CMJINS and JOBSIDX.

Most people with employment-based insurance have it through current main jobs. The variable CMJINS indicates whether the insurance is through a current main job. When insurance is through a previous job or through self-employment and there is only one employee, then CMJINS is set to 2 NO. When the insurance is not employment-based, CMJINS is set to -1 INAPPLICABLE. Generally, many edited and imputed variables describing policyholders’ current main jobs are available on HC-196 and HC-204. If CMJINS = 1 and the policyholder has a PUF record (PITFLG or FYFLG = 1), then edited and imputed current main jobs variables are available on the indicated PUF.

For other types of jobs (for example, former jobs), the JOBS files (HC-203 and HC-195) contain edited variables describing the job. JOBSFILE indicates which JOBS file contains information about the source of coverage. In most cases, information about the job is in HC-203, but for Panel 22, if the job ended before 2018, information about the job is contained in HC-195.

For Panel 23 PRPL records in the 2018 delivery, JOBSIDX is the link to the 2018 JOBS file for jobs that are the source of coverage. For Panel 22 records, JOBSIDX_17 is the link to jobs in the 2017 JOBS file. The two variables are necessary because identifiers in 2017 and 2018 are constructed differently as previously described. For Panel 22 PRPL records, jobs may be in either the 2017 or 2018 JOBS files, or both, depending on when the job ended. If a job is in both the 2017 and 2018 JOBS files, both JOBSIDX and JOBSIDX_17 are set. If the job ended before 2018, only JOBSIDX_17 is set.

Linking coverage to a job is slightly complicated using the PRPL file, because the variable JOBSINFR indicates links that were inferred, rather than obtained directly from the respondent. Prior to Panel 22 Round 5 and Panel 23 Round 3, links were inferred when persons reported employment-based health insurance at the end of the Insurance section (HX200, HX300, or HP40). This was because there was no direct link by establishment IDs within CAPI. Beginning in Panel 22 Round 5 and Panel 23 Round 3, coverage can now be directly linked to a job through the employer establishment ID. As in the past, other cases required inferences based on whether the insurance was through a current or former job (EMPLSTAT), and some could not be linked at all.

Due to a processing error in Panel 22 Round 3, questions RJ70, RJ80, RJ90, and RJ100 regarding insurance status at a continuing main job were skipped in the Review of Jobs section. To address this, some directly purchased private plans were converted to coverage directly associated with a job. This edit was only performed if respondents reported new directly purchased coverage through the same employer where the jobholder is the policyholder and the type of coverage is employer based.

The variable EMPLSTAT contains the answer to question HP120, which is asked only about the policyholders of employment-related insurance first mentioned at the end of the Insurance section of the interview (HX200/HX300), and it is asked only in the interview round where the insurance was first reported. Thus, it is useful only for the cases where links to jobs could not be inferred. EMPLSTAT does not contain updated information about the policyholder’s employment at each interview. Beginning in 2018, this variable is now set to the value from the round where coverage was first reported.

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4.0 Linking to Other Files

4.1 National Health Interview Survey

The set of households selected for MEPS is a subsample of those participating in the National Health Interview Survey (NHIS), thus, each MEPS panel can be linked back to the previous year’s NHIS public use data files. For information on obtaining MEPS/NHIS link files please see the AHRQ website.

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4.2 Longitudinal Analysis

Panel-specific longitudinal files are available for downloading in the data section of the MEPS website. For each panel, the longitudinal file comprises MEPS survey data obtained in Rounds 1 through 5 of the panel and can be used to analyze changes over a two-year period. Variables in the file pertaining to survey administration, demographics, employment, health status, disability days, quality of care, health insurance, and medical care use and expenditures were obtained from the MEPS full-year Consolidated files from the two years covered by that panel.

For more details or to download the data files, please see Longitudinal Weight Files on the AHRQ website.

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5.0 Using MEPS Data for Trend Analysis

MEPS began in 1996, and the utility of the survey for analyzing health care trends expands with each additional year of data; however, there are a variety of methodological and statistical considerations when examining trends over time using MEPS. Tests of statistical significance should be conducted to assess the likelihood that observed trends are not attributable to sampling variation. The length of time being analyzed should also be considered. In particular, large shifts in survey estimates over short periods of time (e.g. from one year to the next) that are statistically significant should be interpreted with caution unless they are attributable to known factors such as changes in public policy, economic conditions, or MEPS survey methodology.

With respect to methodological considerations, in 2013 MEPS introduced an effort to obtain more complete information about health care utilization from MEPS respondents with full implementation in 2014. This effort likely resulted in improved data quality and a reduction in underreporting starting in the 2014 full year files and have had some impact on analyses involving trends in utilization across years. The aforementioned change in the NHIS sample design in 2016 could also potentially affect trend analyses. The new NHIS sample design is based on more up-to-date information related to the distribution of housing units across the U.S. As a result, it can be expected to better cover the full U.S. civilian, noninstitutionalized population, the target population for MEPS, as well as many of its subpopulations. Better coverage of the target population helps to reduce the potential for bias in both NHIS and MEPS estimates.

Another change with the potential to affect trend analyses involved modifications to the MEPS instrument design and data collection process. These were introduced in the Spring of 2018 and thus affected data beginning with Round 1 of Panel 23, Round 3 of Panel 22, and Round 5 of Panel 21. Since the Full Year 2017 PUFs were established from data collected in Rounds 1-3 of Panel 22 and Rounds 3-5 of Panel 21, they reflected two different instrument designs. In order to mitigate the effect of such differences within the same full year file, the Panel 22, Round 3 data and the Panel 21 Round 5 data were transformed to make them as consistent as possible with data collected under the previous design. The changes were designed to make the data collection effort more efficient and easy to administer.

There are also statistical factors to consider in interpreting trend analyses. Looking at changes over longer periods of time can provide a more complete picture of underlying trends. Analysts may wish to consider using techniques to smooth or stabilize analyses of trends using MEPS data such as comparing pooled time periods (e.g. 1996-97 versus 2011-2013), working with moving averages or using modeling techniques with several consecutive years of MEPS data to test the fit of specified patterns over time. Finally, researchers should be aware of the impact of multiple comparisons on Type I error. Without making appropriate allowance for multiple comparisons, undertaking numerous statistical significance tests of trends increases the likelihood of concluding that a change has taken place when one has not.

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References

U.S. Department of Labor. Employee Benefits Security Administration. 2019. An Employee’s Guide to Health Benefits under COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1986. Washington, DC.

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D. Variable-Source Crosswalk

VARIABLE TO SOURCE CROSSWALK

FOR MEPS PUBLIC USE FILE HC-208: 2018 Person Round Plan

**Health Insurance Variables**
Variable	Description	Source
EPCPIDX	Unique record identifier (DUPERSID + EPRSIDX)	Constructed
DUPERSID	Person identifier of policyholder or dependent covered by policyholder (DUID+PID)	Constructed
PHLDRIDX	Person identifier of the policyholder	Constructed
ESTBIDX	Insurance source identifier	Constructed
EPRSIDX	Uniquely identifies insurance policy from an insurance source in a round (ESTBIDX+PHLDRIDX+RN+3-byte InsuranceID)	Constructed
InsurPrivIDEX	Uniquely identifies insurance policy from an insurance source (ESTBIDX+ 3-byte InsuranceID)	Constructed
EPCPIDX_17	EPCPIDX from 2017 PRPL file	Constructed
DUPERSID_17	DUPERSID from 2017 PRPL file	Constructed
PHLDRIDX_17	PRPL PHLDRIDX from 2017 PRPL file	Constructed
ESTBIDX_17	PRPL ESTBIDX from 2017 PRPL file	Constructed
EPRSIDX_17	PRPL EPRSIDX from 2017 PRPL file	Constructed
JOBSIDX_17	PRPL JOBSIDX from 2017 PRPL file	Constructed
PANEL	Panel number	Constructed
RN	Round number	Constructed
JOBSIDX	Link to JOBS file that uniquely identifies policyholder’s job at the establishment that provided insurance	Constructed
JOBSINFR	JOBSIDX inferred rather than reported	Constructed
JOBSFILE	Public use Jobs file number indicating source of jobs information	Constructed
PITFLG	Person in point-in-time public use file	Constructed
FYFLG	Person in full year public use file	Constructed
CMJINS	Current main job is the source of plan	PrivateCat, RJ20, EM50, EM80
EMPLSTAT	Policyholder’s employment status at employer insurance coverage not reported in Employment section	HP120
PHOLDER	Policy holder record flag	HP70
DEPNDNT	Dependent of policy holder record flag	PrivateCat, PHOLDER
PHLDRCHNG	Flag indicates policyholder identifier changed from prior round because policyholder left/returned to DU	OE10 Constructed
EVALCOVR	Covered at interview or on December 31st	HQ10_01,10_02
STATUS1 – STATUS24	Insurance active in month 1 through month 24	HQ10_01, 10_02, 10_03,10_04, 10_05
DECPHLDR	Deceased policyholder flag	Constructed
OUTPHLDR	Policyholder is not in RU	Constructed
NOPUFLG	Policyholder not in full year or point-in-time public use file	Constructed
COVROUT_M18	For policies without dependents covered in RU, identifies policy covers person not in RU	Constructed HP170, 180; OE100
TYPEFLAG	Type of insurance source	HP40; HX50_01, 60, 100_01, 120_01, 140, 170, 200, 225, 230, 270_01, 300_01, 320_01; EM50, 80, 100, 120, 180, 240, 340, 390, 720
STEXCH	Coverage obtained through State exchange	HP50; HX200, 300; OE40
STSHOP	Reported as small business establishment-related health insurance	HP150; OE150
PrivateCat	Category of private coverage (beginning in 2018)	Constructed HP40, 50, 130; HX200, 300, 620; OE40; EM710
PRIVCAT	Category of private coverage (prior to 2018)	Constructed HP40, 50, 130; HX200, 300, 620; OE40; EM420, 420, 440,710, 740
HOSPINSX	Type of health insurance coverage received through plan: hospitalization & physician/HMO (edited)	HX620; OE130
MSUPINSX	Type of health insurance coverage received through plan: Medigap	HX620; OE130
DENTLINS	Type of health insurance coverage received through plan: dental	HX620; OE130
VISIONIN	Type of health insurance coverage received through plan: vision	HX620; OE130
PMEDINS	Type of health insurance coverage received through plan: prescription drug	HX620; OE130
COBRA	COBRA Coverage	HP40,120, 140; HX200, 300; OE70, 90; EM50, 80, 100, 270, 390; RJ20;PrivateCat
PLANMETL	Plan metal level	OE160
COVTYPIN	Coverage is single or family, based on number of persons within the RU	HP160, 170, 180; OE100
OOPELIG	Flag indicates that the policyholder-insurance source has premium in the PRPL file	RN; TYPEFLAG; HP40, 160; HX200, 300
OOPPREM	Monthly out-of-pocket premium amount paid by policyholder	HX660, 670; OE170, 180
OOPPREMX	Monthly out-of-pocket premium amount paid by policyholder (edited/imputed)	Constructed
OOPX12X	Annual out-of-pocket premium amount paid by policyholder (edited/imputed)	Constructed
OOPFLAG	Flag indicates if premium was edited/imputed	Constructed
PREMLEVX	Portion of premium paid by family (edited)	HX660, 670; OE170, 180
PREMSUBZ	Cost of premium is subsidized based on family income	HX690; OE200
ANNDEDCT	Plan has high, low, or no deductible	HX700; OE210
HSAACCT	Plan is associated with Health Savings Account or similar special fund/account	HX710; OE220
UPRHMO	Coverage purchased through HMO, insurance company was an HMO, or insurance name indicates HMO	HP40; HX200, 300; MC10
NAMECHNG	Change in plan name from prior round	OE110

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MEPS HC-208: 2018 Person Round Plan Public Use File August 2020

VARIABLE TO SOURCE CROSSWALK FOR MEPS PUBLIC USE FILE HC-208: 2018 Person Round Plan

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MEPS HC-208:
2018 Person Round Plan Public Use File
August 2020

VARIABLE TO SOURCE CROSSWALK

FOR MEPS PUBLIC USE FILE HC-208: 2018 Person Round Plan