Medicare Plan Decisions: What Strategy Do Older Adults Use for e-Healthcare Decision-Making and What Intelligent Assistance Do They Need?

Medicare Plan Finder (MPF), an e-healthcare tool on Medicare.gov, is designed to support beneficiaries in selecting a Medicare plan. The large number of plans and complexity of plan attributes make decisions arduous for older adults, whose decisions can suffer from cognitive aging. No studies have explored the optimization of older adults’ decision strategies while making a plan decision. We applied decision strategies (LEX = plan selection based on a prime attribute; SAT = selecting an initial plan that satisfies minimum attribute cutoffs; MCD = comparing two plans at a time until a winner is selected; EBA = successively eliminating plans that do not meet attribute criteria; and WAD = comparing multiple plans for attribute trade-offs) from consumer theories to observational data from 29 participants (65+ years) selecting a plan using MPF with counselor assistance. Transcripts were analyzed to identify (1) participant strategies and (2) counselor intervened strategies. Before counselors’ first intervention, 7 participants used no strategy, while 19 used only one strategy, mainly SAT. Most often, counselors promoted LEX (f = 29), followed by MCD > SAT > EBA > WAD (fs = 26, 23, 19, & 12). With counselors’ intervention, participants came to use two (f = 17; most frequently, SAT then LEX [f = 7]) or more strategies. From 88 counselor interventions, participants adopted a strategy about 58%. Our findings highlight how older adults’ e-healthcare decision strategies are impacted by on-task interventions and inform the development of real-time artificial intelligence (AI) decision assistants for Medicare plan decisions.