• Kathleen Kan, Andrew J Barnes, Yaniv Hanoch, and Alex D Federman.
• Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1087, New York, NY 10029. E-mail: alex.federman@mssm.edu.
• Am J Manag Care. 2015 Apr 1; 21 (4): e247-54.

ObjectivesThe aim was to understand older adults' self-efficacy with insurance decision making by examining their preferences for delegating insurance decisions to others.Study DesignCross-sectional analysis of data from an observational cohort study.MethodsEnglish- and Spanish-speaking adults aged ≥60 years were recruited and interviewed in residential and senior center locations in New York City neighborhoods with median annual household incomes<$50,000. The analyses included the subset of individuals 65 years and older and without Medicaid. Self-efficacy in insurance decision making was measured with a 7-item assessment of perceived understanding of Medicare, preferences for decision support, and decision-making anxiety. We used multivariable linear regression to examine the association of self-efficacy with subject characteristics, including sociodemographics, insurance coverage, and health and functional status.ResultsAmong the 250 subjects, 55% were aged ≥75 years, 29% were black, and 33% were Hispanic. Half (53%) reported difficulty understanding insurance information and concern (45%) about making wrong insurance choices, yet 89% preferred to make decisions themselves. In adjusted analysis, greater decision-making self-efficacy was associated with male gender (P=.02), higher educational attainment (P=.04), better health (P=.0003), greater Medicare knowledge (P=.0002), and lack of a spouse or partner (P=.04) or any person who they trust to assist with decision making (P<.0001).ConclusionsMost older adults preferred to make insurance decisions themselves while also wanting to receive advice, and those who preferred to delegate decisions had less Medicare knowledge. Programs that support insurance decisions among older adults should identify clients who prefer delegating decisions and have the right support available to them.

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