Development of a Medicare Part D Beneficiary Comprehension Test (MBCT) based on the ‘Medicare & You' handbook

Introduction: Medicare Part D, a prescription drug benefit was introduced through the MMA 2003. It is assumed that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, have cognitive problems and may not have a true understanding of managed care . They are more likely to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare.

Objective: This study developed a Medicare Part D beneficiary comprehension test (MBCT) to evaluate beneficiaries' understanding of Part D concepts as presented in the 2008 ‘Medicare & You' handbook.

Methods: A 10 question MBCT survey was developed as a case vignette requiring beneficiaries to read portions of the handbook and answer questions for decision making. The test was divided into two sections – insurance concepts and utilization management and administered to 100 beneficiaries at two sites– a university geriatrics clinic and a private retirement facility.

Results: Mean score was 3.5 with no statistical difference between both sites. Content validity was assessed by ten faculty members and four graduate students. Changes were made based upon recommendations. Cronbach's alpha was 0.47. Principal components analysis with varimax rotation yielded four factors.

Implications: Beneficiaries understanding of Part D may play a key role in their management of their drug use & health and thus associated outcomes. The MBCT pending revisions can be administered to beneficiaries with differing health outcomes and comparisons made between groups to better understand how beneficiaries comprehend information and whether they are able to make truly informed choices.