Health Insurance Decision Making in an Aging Population: A Medicare Part D Study

A consumer-driven health care system with greater competition and choice has been welcomed as a policy solution, both to control costs and improve quality. In this more consumer-centric environment, the individual bears greater responsibility to obtain, understand, and act upon health information. However, researchers have observed a range of scenarios under which individuals struggle with understanding health information and do not make what are generally considered optimal decisions. This is particularly a concern for older adults who have a higher volume of medical needs and who may experience declining cognition. There is limited understanding about how the elderly make health-related decisions and what methods are most effective in providing support. This dissertation aims to investigate health related decision making in an aging population, specifically, how adults 65 years or older select their Medicare Prescription Drug Coverage (Part D). The study uses plan-level data from the Centers for Medicare and Medicaid Services and individual-level longitudinal survey data from the Health and Retirement Study. The first chapter of this dissertation examines the role of individual preferences and non-cost related plan attributes in Part D plan selection. The second chapter provides evidence of how aspects of an individual's social environment and use of information resources factor into selecting a plan. The final chapter analyzes potential motivators for individuals to switch plans.

social Environment

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