Medicare Part D, decision-making, pre-Medicare eligible, interview study, Theory of Planned Behavior


Objectives: The objective of this study was to elicit salient beliefs among pre-Medicare eligible individuals regarding (1) the outcomes associated with enrolling in the Medicare Part D program; (2) those referents who might influence participants' decisions about enrolling in the Part D program; and (3) the perceived barriers and facilitators facing those considering enrolling in the Part D program.

Methods: Focused interviews were used for collecting data. A sample of 10 persons between 62 and 64 years of age not otherwise enrolled in the Medicare program was recruited. Interviews were audio taped and field notes were taken concurrently. Audio recordings were reviewed to amend field notes until obtaining a thorough reflection of interviews. Field notes were analyzed to elicit a group of beliefs, which were coded into perceived outcomes, the relevant others who might influence Medicare Part D enrollment decisions and perceived facilitators and impediments. By extracting those most frequently mentioned beliefs, modal salient sets of behavioral beliefs, relevant referents, and control beliefs were identified.

Results: Analyses showed that (1) most pre-Medicare eligible believed that Medicare Part D could "provide drug coverage", "save money on medications", and "provide financial and health security in later life". However, "monthly premiums", "the formulary with limited drug coverage" and "the complexity of Medicare Part D" were perceived as major disadvantages; (2) immediate family members are most likely to influence pre-Medicare eligible's decisions about Medicare Part D enrollment; and (3) internet and mailing educational brochures are considered to be most useful resources for Medicare Part D enrollment. Major barriers to enrollment included the complexity and inadequacy of insurance plan information.

Conclusion: There are multiple factors related to decision-making surrounding the Medicare Part D enrollment. These factors include the advantages and disadvantages of enrolling in Part D, facilitators and barriers to enrolling in Medicare Part D, and significant individuals and groups for pre-Medicare eligible individuals.