Social Defaults and Plan Choice: The Case of Spousal Following

Tal Gross, Tim Layton, Daniel Prinz and Julia Yates

No 11207, Policy Research Working Paper Series from The World Bank

Abstract: This paper studies how couples in the Medicare Part D program choose an insurance plan. Over 70 percent of enrollees choose the same plan as their spouse. Even among those with differing health care needs, well over half do so. Discrete- choice models suggest that beneficiaries place a value of more than $1,000 per year on being on the same plan as their spouse. Using a regression-discontinuity design, the paper shows that younger spouses disproportionately follow their older spouse’s plan choice. Joint plan choice contributes modestly to overall overspending, but increases costs substantially for couples with different cost-minimizing plans.

Date: 2025-09-05
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