Poor perceived understanding of the Medicare Part D program and its impact on beneficiary satisfaction with medication cost savings

Objectives: In 2006, Medicare Part D (MPD) came into effect and made it possible for millions of Medicare beneficiaries to obtain drug insurance. However, many beneficiaries are confounded by the complexity of the new drug benefit. The purpose of this study is to examine risk factors for poor perceived understanding of MPD and the impact of poor understanding on beneficiary satisfaction with cost savings from their new drug plan.

Methods: Data were drawn from the 2007 Medicare Supplemental wave of the Wisconsin Longitudinal Study (WLS), a longitudinal study of over 10,000 Wisconsin high school graduates in 1957. The selection of risk factors was guided by the Andersen Behavioral Model; all independent variables were collected prior to the outcome variables. Predisposing variables included: age, sex, marital status, education, source of MPD information (CMS, physicians, pharmacists, friends/family), and personality traits (neuroticism, environmental mastery). Enabling variables included: shared responsibility for plan choice, perceived financial difficulties, and rurality. Need variables included: physical and mental health disability (SF-12), number of diagnosed illnesses, and count of prescription medications. We conducted two multivariate logistic regression models: (1) poor perceived MPD understanding (yes/no) as a function of predisposing, enabling, and need variables; and (2) dissatisfaction with MPD medication cost savings as a function of poor perceived understanding, predisposing, enabling, and need variables.

Results: The final sample consisted of 2,401 graduates. Overall, 622 (25.9%) of graduates reported poor perceived understanding of MPD, while 835 graduates (34.8%) were dissatisfied with MPD cost savings. Adjusted logistic regression revealed the following risk factors for poor understanding: greater financial difficulties (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.44-3.00); failure to use the CMS website or 1-800 number (OR 1.52, CI 1.25-1.86); and greater physical (OR 1.02, CI 1.00-1.03) and mental health disability (OR 1.03, CI 1.01-1.04). Adjusted logistic regression revealed that poor perceived understanding of MPD was a significant risk factor for dissatisfaction with MPD cost savings (OR 3.28, CI 2.69-4.00). Greater sense of mastery and competence in managing one's environment was protective against dissatisfaction (OR 0.98, CI .93-.99).

Conclusions: Our findings indicate that older adults with greater financial difficulties and those with physical/mental health disabilities may face greater challenges in understanding the MPD drug benefit. Further, poor perceived understanding of MPD is a risk factor for beneficiary dissatisfaction with medication cost savings. Future interventions should be considered to target these vulnerable beneficiaries to increase their understanding of the new drug plan.