Because elderly patients frequently ask for their doctors' help when choosing a Medicare prescription drug plan, researchers decided to examine the difficulties involved in selecting the lowest cost plan. What did they find? Residents and medical school students found it equally difficult as their patients.

“Our results add further evidence that simplifications to the Medicare Part D decision environment are needed,” the authors wrote in their study, published last week in PLoS One.

How Does It Work?

To understand the study, it is important to know just a little bit about the health care choices that senior citizens face. At age 65, a senior is automatically enrolled in Medicare Part A (hospital service) and Part B (medical service). Medicare Part D, though, is an optional prescription drug plan that adds coverage to a senior’s core health care plan. Unlike Parts A and B, private insurance companies provide Part D plans in each state during an open enrollment period.

In most states, seniors choose from 30 or more prescription drug benefit plans.

And this is one of the major criticisms of Medicare Part D "voiced by beneficiaries, pharmacists, and physicians," wrote the authors. To investigate the difficulty involved in choosing a plan, the researchers designed a study where 70 medical students and internal medicine residents were asked to choose a plan for a senior friend named "Bill." After reading a short scenario, participants were instructed to choose the prescription drug plan that suits Bill’s needs. They performed this task using Mouselab, a computer program that permits examination of how they go about making their choice of the cheapest drug plan — as price is usually the most important factor to Medicare beneficiaries.

Essentially, the researchers could “watch” how the medical students and residents went about making their decision, including the strategies they used to pick the cheapest drug plan from either a set of three or nine drug plans. Though shocking, what they discovered probably would not surprise seniors.

Even Doctors Failed To Make Correct Choice

When facing only three plans versus nine plans, the participants were significantly more likely to identify the lowest cost plan (roughly two-thirds vs. one-third) and to pay less in excess premiums ($60.00 vs. $128.51). When facing nine plan choices, the participants also seemed to spend a lot less time learning fully about each plan. Instead, they were more likely to focus on comparing alternate plans across a single plan attribute.

In a nutshell, the doctors-in-training may have used more efficient search strategies, but they still found Medicare Part D as confusing as their senior citizen patients. And, their odds at making the correct choice plummeted when facing nine choices versus just three. In fact, when nine plans were involved, the odds that they would correctly choose the least expensive plan decreased by a factor of 10.

“Many patients expect their doctor to help them choose a Medicare prescription drug plan,” wrote the authors in their study. “Whether the size of the choice set affects clinicians’ decision processes… and the quality of their choice, as it does their older patients, is an important question with serious financial consequences.”

Source: Barnes AJ, Hanoch Y, Martynenko M, et al. Physician Trainees’ Decision Making and Information Processing: Choice Size and Medicare Part D. PLoS ONE. 2013.