Awareness, Stress, and Income as Contributors in Medicare Part B Late Enrollment

Awareness, Stress, and Income as Contributors in Medicare Part B Late Enrollment by Bishnu Hari Dhaurali MPA, American Military University, 2015 BS, University of Washington, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University February 2019 Abstract Medicare Part B is one of the federal health insurance programs available to senior citizens in the United States. Unlike Medicare Part A, Part B enrollment is not automatic, and those missing their initial enrollment period are assessed a 10% or more penalty in addition to their monthly premium rate for the rest of their lives. This problematic enrollment policy has impacted senior citizens who have missed Part B enrollment windows, creating for them an added financial burden when many are transitioning to fixed incomes. Guided by social construction theory and using a nonprobability, convenience sampling approach, the likelihood coefficient values associated with Medicare Part B enrollee awareness, stress, and income of 112 residents of a suburban city in a northeastern state who were 65 years and older were examined. Sequential Forward: LR methodology yielded a significant, negative (b = -1.21, Wald X(1) = 7.56, OR = . 298, p = . 006, CI [. 126, . 707]) and a significant, positive (b = 2.16, Wald X(1) = 6.29, OR = 8.678, p = . 012, CI [1.60, 46.99]) likelihood of predicting Medicare Part B late enrollment penalties for awareness and stress; income was not a significant model predictor. Participants who reported higher stress levels were 8.7 times more likely to be classified in the Medicare Part B late enrollment penalty than those reporting lower stress. Participants who were aware of enrollment needs were 3.4 times more likely to have no late enrollment penalties than those who were unaware. Positive social change centers on increasing Medicare Part B consumer awareness, reducing stress of enrollment deadlines, and providing information to federal policy makers to simplify enrollment policies to reduce or end late enrollment penalties.Medicare Part B is one of the federal health insurance programs available to senior citizens in the United States. Unlike Medicare Part A, Part B enrollment is not automatic, and those missing their initial enrollment period are assessed a 10% or more penalty in addition to their monthly premium rate for the rest of their lives. This problematic enrollment policy has impacted senior citizens who have missed Part B enrollment windows, creating for them an added financial burden when many are transitioning to fixed incomes. Guided by social construction theory and using a nonprobability, convenience sampling approach, the likelihood coefficient values associated with Medicare Part B enrollee awareness, stress, and income of 112 residents of a suburban city in a northeastern state who were 65 years and older were examined. Sequential Forward: LR methodology yielded a significant, negative (b = -1.21, Wald X(1) = 7.56, OR = . 298, p = . 006, CI [. 126, . 707]) and a significant, positive (b = 2.16, Wald X(1) = 6.29, OR = 8.678, p = . 012, CI [1.60, 46.99]) likelihood of predicting Medicare Part B late enrollment penalties for awareness and stress; income was not a significant model predictor. Participants who reported higher stress levels were 8.7 times more likely to be classified in the Medicare Part B late enrollment penalty than those reporting lower stress. Participants who were aware of enrollment needs were 3.4 times more likely to have no late enrollment penalties than those who were unaware. Positive social change centers on increasing Medicare Part B consumer awareness, reducing stress of enrollment deadlines, and providing information to federal policy makers to simplify enrollment policies to reduce or end late enrollment penalties. Awareness, Stress, and Income as Contributors in Medicare Part B Late Enrollment by Bishnu Hari Dhaurali MPA, American Military University, 2015 BS, University of Washington, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University February 2019 Dedication I dedicate my proposal to my late father, Lekh Bahadur Dhaurali, who always reminded me to work hard and become a medical doctor to serve my community. Twenty years ago he passed, and I was not able to accomplish what he had set out for me because of poverty and inability to afford materials. Today, I am here accomplishing that goal he set for me all those years ago. I am not becoming a medical doctor, like he said; however, he was a middle school teacher and a community leader, which inspired me to complete my Doctor of Philosophy in Public Policy and Administration to promote positive social change around the world. Thank you, Dad. Thank you to each of my daughters, Amishika Dhaurali (14) and Shubhecchha Dhaurali (16), for their unwavering encouragement, incredible moral support, unconditional love, and valuable technical assistance. Both daughters have been with me through this entire process: not just my proposal, but hardships in my life. Without their inspiration and motivation, I would not have had the encouragement and stability I needed to complete my Doctor of Philosophy in Public Policy and Administration. Thank you, Ami and Subu, for all that you do for me, even though I do not say it enough. Acknowledgments I would like to acknowledge my committee chair, Dr. Steven A. Matarelli. He has tirelessly helped me correct errors in my papers and encouraged me to keep working. He has given me recommendations, guidelines, and valuable advice throughout the entire dissertation process. Thank you, Dr. Matarelli, for all your help! I really appreciate your help and your hard work in being my dissertation chair. I would also like to acknowledge Dr. Miyoung Lee for being a member of my dissertation committee. Thank you for all your valuable comments, recommendations, advice, and help. I would like to thank the University Research Reviewer and the Walden University Institutional Review Board for their guidelines and approval regarding this dissertation. Finally, I would like to thank all faculty members, friends, and classmates from my residencies for their encouragement and moral support during my dissertation process. Thank to everyone who has helped me with this achievement.