Date of Award
Summer 7-23-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Interdisciplinary
First Advisor
Kathryn Wagner
Second Advisor
Marianne Weiss
Third Advisor
Brian Miller
Abstract
Beneficiaries and policymakers face choices in Medicare. Annually, beneficiaries can exercise their right to review and compare among the two coverage options, Medicare Advantage (MA) and Fee-for-Service (FFS). Likewise, policymakers can exercise their right to enact change, typically favoring either MA or FFS. This dissertation examined how exercising the right to engage in certain activities may motivate beneficiaries and policymakers to favor either FFS or MA. Individual preferences likely play a role, and this dissertation includes three analyses to explore such preferences. Comparison of FFS and MA was enabled by 2019-2021 data from the Medicare Current Beneficiary Survey. The first analysis examined the impact of beneficiaries exercising their right to review cost and service information. Less than 30% of beneficiaries exercised their right to compare coverage, but review of cost and service information increased the probability of comparing coverage by 44.4 percentage points or 159%. Forty-seven percent of beneficiaries did not exercise their right to review cost nor service information. In analysis two, exercising the right to compare coverage increased the probability of a beneficiary switching plans (from FFS to MA or vice versa) by 1.8 percentage points or 69%. Further, an examination of the sticker population, found exercising the right to compare coverage increased the probability of sticking with MA, relative to FFS, by 18% (7.2 percentage points). In the third analysis, policymaker’s decision to exercise their right to enact change, as evidenced by investing capital in FFS telehealth during the COVID-19 pandemic, was associated with a 4.3 percentage point increase in access to FFS telehealth, relative to MA. Despite a lack of investment, MA plans closed the initial gap in telehealth access and provided near equal access by the end of the first year of the pandemic. Taken together, these findings suggest when beneficiaries and policymakers exercise their rights, they may become more aware of their preferences, which may motivate them to favor FFS or MA. Though not all beneficiaries and policymakers engaged in these actions, we can gain insights from those who did and disseminate the findings to increase engagement in fully exercising rights, in the future.