Assessing beneficiary understanding of the Medicare Part D benefit: The knowledge chasm

background: Medicare beneficiaries have had access to an outpatient prescription drug benefit (Part D) since 2006. Beneficiaries are often confused by the benefit’s dynamic nature (e.g., annual plan formulary and cost-sharing changes), unique terminology (e.g., coverage gap and “extra help”), and because of introduction of a new governmental health program (Health Insurance Marketplace). This research examines beneficiaries’ knowledge of specific Part D features.  Findings will inform outreach to help beneficiaries maximize their Part D benefit. 

methods: We assisted 738 beneficiaries during 13 mobile health clinics in Northern/Central California in Fall 2014. Beneficiaries were provided Part D plan optimization, medication therapy management and healthcare screenings/services. Student pharmacists conducted structured interviews during which beneficiaries’ knowledge of the Part D benefit was assessed. Sociodemographic data were also collected.

results: Almost all (at least 90%) of beneficiary respondents correctly answered questions about the open enrollment period, and annual formulary and out-of-pocket costs changes. In contrast, just over half (54%) correctly understood that they did not need to sign up for a plan through the Health Insurance Marketplace. Beneficiary knowledge was lowest about safeguards in place for those who qualify for “extra help” and awareness of the brand name drug discount during the coverage gap; only 39% and 36%, respectively, answered those items correctly. Benefit knowledge significantly varied as a function of race, educational level and subsidy status.

conclusions: A critical need to fully educate beneficiaries about Medicare Part D remains. Well-informed beneficiaries may be better able to maximize their benefit and minimize out-of-pocket costs.