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Medicare beneficiary knowledge: Measurement implications from a qualitative study

Cayla R. Teal, PhD1, Dolly A. John, MPH1, Christi L. Murphy, BFA1, Debora A. Paterniti, PhD2, and Robert O. Morgan, PhD1. (1) Houston Center for Quality of Care and Utilization Studies, VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030, (713) 794-8548, cteal@bcm.tmc.edu, (2) Center for Health Services Research in Primary Care, Dept. of Int. Med., UC-Davis Medical Center, 2103 Stockton Blvd., Grange Building, Suite 2224, Sacramento, CA 95817

Medicare beneficiary knowledge has been studied extensively, specifically how much beneficiaries know about traditional, fee-for-service Medicare (FFS) versus its managed care alternative, Medicare+Choice (M+C). These studies inform policymakers about ways to reduce Medicare utilization barriers. Knowledge has generally been measured as either perceived knowledge (what beneficiaries think they know about Medicare) or actual knowledge (factual questions for which there are correct answers). Conflicting evidence exists regarding which beneficiary group (FFS or M+C) is most familiar with Medicare benefits. The pilot of a national survey of Medicare enrollment/dis-enrollment patterns included focus groups and interviews with White, Black, and Hispanic Medicare beneficiaries in FFS and M+C plans to evaluate the utility of the survey questions. The data (transcripts, staff observations) were analyzed using Atlas, with thematic codes determined through an iterative process of review by the research team. The analyses demonstrated that Medicare beneficiaries (regardless of race/ethnicity, income) were frequently confused about: a) how M+C differs from supplemental insurance or Medigap plans, b) rules regarding participation in M+C plans, c) terminology to describe FFS and M+C plans, and d) their own enrollment status. Consequently, they were unable to distinguish clearly between FFS and M+C plans. Participants found survey questions that relied on plan specific terminology difficult to answer, resulting in missing data, incorrect survey completion, and inaccurate responses to survey questions. These findings suggest that assessment of beneficiary knowledge, plan preferences, and enrollment patterns is fundamentally impacted by the absence of basic familiarity with Medicare plans, terminology, and plan differences.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Medicare,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Health Policy and Aging

The 132nd Annual Meeting (November 6-10, 2004) of APHA