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Streamlining Medicare Advantage Enrollment is Key for Health Plans to Thrive During Surge


As soon as next year, enrollment in Medicare Advantage plans are expected to exceed 50% of the entire Medicare eligible population. For the first time ever, the majority of Medicare beneficiaries will receive health benefits delivered by a private health plan, rather than through traditional, fee-for-service Medicare.

As we wind down the 2022 open enrollment period, it’s clear that now more than ever, health insurers offering Medicare Advantage plans need to ensure they are delivering a great member experience.

As soon as next year, enrollment in Medicare Advantage plans are expected to exceed 50% of the entire Medicare eligible population. For the first time ever, the majority of Medicare beneficiaries will receive health benefits delivered by a private health plan, rather than through traditional, fee-for-service Medicare.

Just ten years ago, Medicare Advantage enrollment represented only 27% of the total Medicare population. Some of the key drivers of this significant growth in Medicare Advantage include more robust prescription drug coverage, supplemental health benefits such as vision, fitness and telehealth, and reduced premiums. In addition to these offerings, consumers increasingly have access to more choice in the marketplace, making it difficult to navigate how they want to best spend their healthcare benefits.

In 2023, the average beneficiary will be able to choose among 43 Medicare Advantage plans, which is more than twice the number of plans available in 2018, according to the Kaiser Family Foundation. In some U.S. counties, there are as many as 75 Medicare Advantage plans available. Health plans continue to aggressively expand their footprints to compete in as many geographical markets as possible, with Humana and UnitedHealthcare each offering plans in more than 80 % of U.S. counties.

Medicare Advantage beneficiaries shopping for the best plan to meet their needs, the amount of choice and information to consider may seem overwhelming. During the Medicare Oct. 15 to Dec. 7 annual election period, members can renew, join, switch or drop a plan. The Medicare Advantage open enrollment period, between Jan. 1 to March 31, allows enrollees to switch to a different Medicare Advantage plan or join traditional Medicare.

In this compressed time frame of eight weeks, tens of millions of Americans will be seeking answers to complex questions related to premiums, out-of-pocket costs, and prescription drug coverage, among many others. This will test health plans’ ability to maintain a frictionless member experience in communicating with potential members the competitive differentiators their plans offer in the marketplace

Many of those Americans will be signing up for an Advantage plan for the first time and will be seeking guidance from a qualified, knowledgeable licensed insurance agent. As many as 57% of Medicare enrollees don’t review or compare coverage options, and many struggle to understand the different plans available.

All of these factors combined – an exploding Medicare Advantage population that’s becoming more diverse, has higher social risk factors and higher rates of chronic conditions – create challenges as well as opportunities for health plans. People who are more satisfied with their member experience are more likely to renew with their same provider.

This makes it vital for health plans to make the enrollment experience as seamless and hassle-free as possible.

Here are three important steps health plans should take to improve members’ enrollment experience:

  • Identify and understand the root causes of member dissatisfaction. We’ve all seen how dissatisfied customers can air their complaints about poor experiences on their social channels and damage a brand’s reputation among some customers. More than ever, health plans need to remove friction points along the entire member journey, and that starts with the enrollment process. From the moment an insurance agent enrolls a new member or re-enrolls an existing member, ensure that communications are easy to understand, that members aren’t being asked repetitively for the same information, and that insurance agents are being fully transparent about costs and what’s covered, eliminating surprises down the road.
  • Ensure that agents take a consultative, empathetic approach to serving members’ needs.
    Insurance agents should be equipped to consult and guide members as much as possible. Rates of health insurance literacy vary among Medicare beneficiaries, who struggle to understand complex health plan terms and would rather speak to a helpful agent rather than seek out information sources online. If a member chooses a plan that provides suboptimal coverage, chances are they will blame their health plan and be less satisfied. Insurance agents should be prepared to understand each members’ health situation and help identify the coverage options that will keep them healthier and satisfied.

    Choosing a health plan isn’t aspirational, it’s essential to maintain good health, and making the right decision can be an emotionally charged experience. Agents should also listen carefully and be empathetic toward members’ concerns.
  • Provide culturally and linguistically appropriate resources.
    An insurance sales agent workforce, whether in-house or outsourced, should include agents who are multilingual or bilingual so that they can better serve the needs of individuals who have limited English proficiency. Don’t rely on members’ family or friends to translate, as this could lead to miscommunication. Additionally, health plans should take every opportunity to collect data from enrollees on race, ethnicity and preferred languages to help ensure their provider network is equipped to deliver culturally competent care.

Health plans have taken promising steps toward modernizing their member experience with digital technologies – mobile apps, chatbots, online tools – that streamline interactions and allow for more self-service options. But enrolling in a Medicare Advantage plan is a big, complicated decision that necessarily involves interactions with a human to get questions answered and alleviate any anxieties. This is especially true for people transitioning to Medicare from a private health plan. Simplifying communications, providing linguistically and culturally appropriate resources, and having consultative and caring agents is the surest way to keeping members satisfied from the beginning.

Dave Palmer is president of Everise.

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