The major advantage of this prospective cohort study is the ability to evaluate how Medicare beneficiaries’ enrollment status, plan satisfaction, and plan decisions change over time. By following beneficiaries from pre-enrollment (age 64) through the processes of initial enrollment, change-of-plan decisions, and, if applicable, disenrollment, we can identify the preferences, information, information sources, and experiences that drive those decisions.
Key research questions for evaluating the NMEP will include the following:
1. How do beneficiary preferences (such as plan cost, physician access and selection, specialist access, and continuity of primary care doctor) change over time? How do these values influence plan decisions?
2. How does participant access to and reliance on NMEP information sources (such as the Medicare & You handbook, www.Medicare.gov, 1-800-MEDICARE, and SHIPs) change over time? To what extent are these sources perceived as important in helping beneficiaries make decisions?
3. How does participant access to outside, non-NMEP information sources (such as employer human resources departments, private health insurance companies, and nonprofit groups like AARP) change over time? To what extent are these sources perceived as important in helping beneficiaries make decisions?
4. What do beneficiaries know about health insurance options and the Medicare program before enrollment? What experience do they have with selecting benefits and options? What experience do they have with the benefits and options offered by Medicare?
5. How does reliance on spouses, adult children, and other proxy decision makers change over time? What is the nature and extent of these individuals’ participation in making plan decisions?
6. How does satisfaction with access to information and the Medicare plan decision-making process change over time? Does satisfaction diminish over time following a plan decision? If so, when and how do beneficiaries act on this diminishing satisfaction?
Ultimately, we can use the study to identify which factors such as specific NMEP resourcesare catalysts for enrollment change and which are catalysts for staying enrolled in one’s current plan. More importantly, the study can help us understand beneficiary decision making about Medicare and how values, NMEP resources, and outside information influence those decisions, including fit between expressed preferences and actual choices.