Medicare Part D Beneficiaries' Experiences with Making Complex Insurance Plan Choices: A Qualitative Interview Study

Background. The Medicare Part D program provides stand-alone prescription drug insurance to US residents aged ≥65 y and those with disabilities. Annually, they can choose to stay with their plan or to switch to one of the many alternative plans. Behavioral decision-making research has proposed various strategies for tackling such complex choices. Here, we interviewed Medicare Part D beneficiaries to understand their real-world experiences with making their plan choices and examined quotes from those who stayed with their first plan and those who had switched. Method. In July 2023, we conducted phone interviews with 20 Medicare Part D beneficiaries aged 57 to 86 y who were recruited through the US-wide Understanding America Study. Results. Eleven interviewees had stayed with their first plan, and 9 had switched. Stayers and switchers applied similar strategies, with mixed success. Using decision-support tools such as the Medicare plan-finder Web site, booklet, and mailers could be time-consuming and confusing. Recommendations were taken from insurance brokers, agents, and pharmacists, often without questioning their advice. Interviewees varied widely in the amount of information they considered, with some using heuristics to reduce their choice set and others considering only 1 recommended option. Few beneficiaries made annual plan comparisons, and while some deferred choices until necessary, others did not act even after being confronted with plan changes or negative experiences - due to knowledge and time constraints. Discussion. Medicare beneficiaries use various strategies known from the behavioral decision-making research literature for tackling complex choices between Medicare Part D stand-alone plans. Each strategy posed its own challenges. We discuss our findings in light of the behavioral decision-making literature and recommend policies for helping beneficiaries with their plan choices.

We interviewed Medicare Part D beneficiaries about how they tackled drug insurance plan choices with many options and complicated features.Interviewees reported using decision-support tools, seeking help, applying heuristics, and relying on choice deferral, but with mixed success.Qualitatively, similar experiences were described by interviewees who stayed with their initial plan and those who had switched.We recommend policies for addressing the difficulties beneficiaries had in applying these strategies.