Dissertation/Thesis Abstract

Understanding the coverage decisions of Medicare beneficiaries: An analysis of enrollment and beneficiary knowledge
by Howell, Benjamin L., Ph.D., The Johns Hopkins University, 2010, 171; 3410200
Abstract (Summary)

Objectives. To examine individual and market characteristics in relation to Medicare beneficiaries' prescription drug enrollment decisions and understanding of the Part D Program in early 2006.

Methodology. Data sources included the 2005 Medicare Current Beneficiary Survey and linked files describing sources of creditable prescription drug coverage, Part D enrollment, and features of Part D plan markets. The study sample consisted of approximately 12,000 (estimated 31.5 million) self-responding, community-dwelling beneficiaries who were continuously enrolled throughout 2005.

Primary outcomes were beneficiary Part D plan enrollment at the 2006 enrollment deadline (Aim 1; Chapter 4) and beneficiary knowledge of the Part D Program (Aim 2; Chapter 5). Frequency tabulations, stratified analyses, and multivariate regression models were used to assess whether and to what extent beneficiary and market characteristics were associated with these outcomes.

Results. An estimated 4.9 million (15.7%) beneficiaries remained without a known source of creditable drug coverage after the Part D enrollment deadline, 12.2 million (39.0%) self-enrolled into a Part D plan, 3.9 million (12.5%) were auto-enrolled in a Part D plan, and 10.3 million (32.8%) retained prescription coverage from other sources. Among beneficiaries with a salient Part D enrollment decision, 28.6% did not enroll. Beneficiaries who were under the age of 65, over the age of 85, with incomes above $25,000, with fewer chronic conditions, with no prior difficulty financing health care, with less understanding of the Part D Program, and who did not receive help with coverage decisions were less likely to enroll. Beneficiaries on average answered only half of the 7 True/False Part D knowledge test questions put to them correctly (52.3%). Socioeconomic vulnerability, better health, no prior difficulty financing care, having multiple plan options, not having a salient enrollment choice, and low levels of Readiness to Learn were negatively associated with beneficiary knowledge.

Conclusions. Beneficiaries with strong incentives to gain prescription drug coverage were both more likely to learn more about the Medicare Program and more likely to ultimately enroll in a Part D plan. Educating beneficiaries, especially those who may not yet recognize the need, about the importance of obtaining drug coverage remains a priority.

Indexing (document details)
Advisor: Wolff, Jennifer L.
School: The Johns Hopkins University
School Location: United States -- Maryland
Source: DAI-B 71/05, Dissertation Abstracts International
Subjects: Economics, Public policy, Health care management
Keywords: Beneficiaries, Drug coverage, Medicare, Prescription drug plans
Publication Number: 3410200
ISBN: 978-1-124-00595-9
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