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The Behavioral Foundations of Default Effects: Theory and Evidence from Medicare Part D

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  • Zarek Brot-Goldberg
  • Timothy Layton
  • Boris Vabson
  • Adelina Yanyue Wang

Abstract

We show in two natural experiments that default rules in Medicare Part D have large, persistent effects on enrollment and drug utilization of low-income beneficiaries. The implications of this phenomenon for welfare and optimal policy depend on the sensitivity of passivity to the value of the default option. Using random assignment to default options, we show that beneficiary passivity is extremely insensitive, even when enrolling in the default option would result in substantial drug consumption losses. A third natural experiment suggests that variation in active choice is driven by random transitory shocks rather than the inherent attentiveness of some beneficiaries.

Suggested Citation

  • Zarek Brot-Goldberg & Timothy Layton & Boris Vabson & Adelina Yanyue Wang, 2023. "The Behavioral Foundations of Default Effects: Theory and Evidence from Medicare Part D," American Economic Review, American Economic Association, vol. 113(10), pages 2718-2758, October.
    • Handle: RePEc:aea:aecrev:v:113:y:2023:i:10:p:2718-58
    DOI: 10.1257/aer.20210013
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    Cited by:

    1. Paul Heidhues & Mats Köster & Botond Kőszegi & Botond Köszegi, 2024. "A Theory of Digital Ecosystems," CESifo Working Paper Series 11332, CESifo.
    2. Abe Dunn & Joshua D Gottlieb & Adam Hale Shapiro & Daniel J Sonnenstuhl & Pietro Tebaldi, 2024. "A Denial a Day Keeps the Doctor Away," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(1), pages 187-233.
    3. Drake, Coleman & Ryan, Conor & Dowd, Bryan, 2022. "Sources of inertia in the individual health insurance market," Journal of Public Economics, Elsevier, vol. 208(C).
    4. Paul Heidhues & Mats Köster & Botond Kőszegi, 2024. "A Theory of Digital Ecosystems," ECONtribute Discussion Papers Series 329, University of Bonn and University of Cologne, Germany.
    5. Tal Gross & Timothy Layton & Daniel Prinz & Julia Yates, 2025. "Social Defaults and Plan Choice: The Case of Spousal Following," NBER Working Papers 34137, National Bureau of Economic Research, Inc.
    6. Christina Gravert, 2024. "From Intent to Inertia: Experimental Evidence from the Retail Electricity Market," CESifo Working Paper Series 11139, CESifo.
    7. Bernheim, B. Douglas & Mueller-Gastell, Jonas, 2024. "Optimal default options," Journal of Public Economics, Elsevier, vol. 237(C).
    8. Müller, Tobias & Shaikh, Mujaheed & Kauer, Lukas, 2025. "Retirement and health plan choice," Social Science & Medicine, Elsevier, vol. 370(C).
    9. Steffen Altmann & Andreas Grunewald & Jonas Radbruch, 2024. "The Double Dividend of Attention-Releasing Policies," CESifo Working Paper Series 11069, CESifo.
    10. Chlond, Bettina & Goeschl, Timo & Kesternich, Martin & Werthschulte, Madeline, 2024. "Transporting behavioral insights to low-income households: A field experiment on energy efficiency investments," Working Papers 0755, University of Heidelberg, Department of Economics.
    11. Chlond, Bettina & Goeschl, Timo & Kesternich, Martin & Werthschulte, Madeline, 2024. "Transporting behavioral insights to low-income household: A field experiment on energy efficiency investmen," ZEW Discussion Papers 24-079, ZEW - Leibniz Centre for European Economic Research.
    12. Henrik Yde Andersen & Camilla Skovbo Christensen & Claus Thustrup Kreiner & Soeren Leth-Petersen, 2025. "Are People Systematically Inactive Across Financial Decisions? Linking Evidence from Mortgage and Retirement Saving Decisions," CEBI working paper series 25-11, University of Copenhagen. Department of Economics. The Center for Economic Behavior and Inequality (CEBI).
    13. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    14. Drake, Coleman & Anderson, David & Cai, Sih-Ting & Sacks, Daniel W., 2023. "Financial transaction costs reduce benefit take-up evidence from zero-premium health insurance plans in Colorado," Journal of Health Economics, Elsevier, vol. 89(C).
    15. Steffen Altmann & Andreas Grunewald & Jonas Radbruch, 2024. "The Double Dividend of Nudges," Rationality and Competition Discussion Paper Series 503, CRC TRR 190 Rationality and Competition.
    16. Lynn Conell‐Price & Carolyn Kousky & Howard Kunreuther, 2022. "Encouraging resiliency through autoenrollment in supplemental flood insurance coverage," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(4), pages 1109-1137, December.

    More about this item

    JEL classification:

    • D91 - Microeconomics - - Micro-Based Behavioral Economics - - - Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • L65 - Industrial Organization - - Industry Studies: Manufacturing - - - Chemicals; Rubber; Drugs; Biotechnology; Plastics

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