Flipping the switch: Enlightening beneficiaries about potential cost savings opportunities and examining factors associated with making a Medicare Part D plan change

background: All Medicare beneficiaries have at least 24 stand-alone prescription drug plans (PDPs) from which to choose in 2015. Beneficiaries can also receive prescription drug coverage from a Medicare Advantage prescription drug plan (MA-PD) which also includes hospital and medical benefits. Each PDP/MA-PD can change its formulary and cost-sharing structure every year. We sought to examine potential cost savings of Part D plan optimization, and identify factors that explained who switched plans onsite.

methods: A series of 13 Mobile Medicare clinics were held throughout Northern/Central California during Fall 2014. Beneficiaries were offered Part D plan assistance at each clinic by trained student pharmacists/pharmacists. An interview was conducted with each beneficiary during which demographic, health, and attitudinal data were collected. In addition, we recorded whether the beneficiary switched plans onsite, and if so reasons behind such a switch.

results: Potential out-of-pocket cost savings were available for 446 (69.4%) of 643 assisted beneficiaries. Mean (SD) and median annual out-of-pocket cost savings were $1,623 ($5,673) and $271, respectively. We found that 254 (57.0%) beneficiaries with potential savings switched plans during their clinic visit. Factors that significantly differed between those who switched plans included current plan type (PDP vs. MA-PD) and self-confidence in selecting a plan.

conclusions: Annual plan reexamination can lower out-of-pocket costs for most beneficiaries. Sociodemographic characteristics may be unimportant in explaining which beneficiaries switch plans. Despite potential out-of-pocket cost saving, beneficiaries with MA-PDs may be less inclined to switch plans due to the importance of other factors (e.g., physician network).