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This is the third part of a three-part series on how AI and automation are transforming the Medicare Advantage experience. To read the previous part, Ensuring CMS Marketing Compliance with Conversational AI and Automation, click here.
Traditionally, Medicare Advantage (MA) enrollees are often considered to be sticky, tending to stay with same insurer once enrolled. However, a 2022 study published in The American Journal of Managed Care found that enrollees who join MA undergo significant turnover in the years following enrollment. Among new MA enrollees, 15.6% had changed insurance one or more times by the one-year mark after enrollment and 49.2% had changed insurance by five years. It also found that voluntary switching and disenrollment was the most common type of insurance change.
15.6%
of enrollees had changed insurance by the one-year mark after enrollement
49.2%
of enrollees had changed insurance by five years after enrollement
MA enrollment can be quite challenging as consumers are often inundated with choices. For 2023, enrollees had an average of 43 MA plans to choose from. In addition, prescription drug coverage under Part D requires choosing from 35 MA drug plans on average. In such a scenario, beneficiaries may get overwhelmed and select a plan that does not meet their needs or correspond to their preferences.
Phone interactions are one of the largest channels through which insurers and TPMOs acting on their behalf enroll new beneficiaries. Their agents are at the frontline of the enrollment experience and can become trusted advisors that help seniors navigate complexity and select a plan that best suits their needs and preferences.
To do this, agents need to:
- Better understand callers and their needs
- Better articulate the benefits of the plan(s) tailored to caller
- Provide easy access to tailored plan summaries and information
Fortunately, AI and automation can do much of the heavy lifting for MA agents. This enables agents to provide personalized, empathetic and knowledgeable responses that help seniors select the plan best suited to their needs and, consequently, reduce churn. Let’s take a closer look at how this transformative technology helps agents in these three key areas:
Better Understand Callers and Their Needs
According to a BCG study, there are four broad personas of seniors who enroll in MA plans:
Value Seekers
These enrollees often struggle financially and want health care that doesn't break their budget. They represent 30% of the Medicare market.
All the Extras
These enrollees want to maximize the benefits they get from a health plan. Their priorities include affordability and a wide range of supplemental benefits. They represent 10-15% of the Medicare market.
Experience seekers
These enrollees seek convenience and a positive experience with their insurer. They are not willing to pay extra for supplemental benefits that they don’t expect to use. This segment represents roughly 20% of the market.
Provider First
These enrollees prioritize continuity of providers over brand or experience. This is the largest segment and constitutes roughly 40% of the market.
Each of these personas has differing needs and preferences. Luckily, AI and automation can assist agents in real-time by monitoring the conversation, extracting caller needs and surfacing probing questions agents should ask to understand caller preferences and their persona. AI can also extract entities, like caller service area, and automatically surface the number of plans and details about the plans in a caller’s service area to ease the burden on the agent.
Better Articulate the Benefits of the Plan(s) Tailored to the Caller
MA beneficiaries need clear information to evaluate their coverage options. However, this need is often unmet for a number of reasons. Insurance terms, multiple plan options and generic plan information can overwhelm and confuse beneficiaries.
AI and automation can provide real-time personalized plan recommendations tailored to caller needs and preferences uncovered earlier in the conversation. It can provide agents with plan details in a language that is easy for beneficiaries to understand. Agents can then use this guidance to explain the plan features and benefits to beneficiaries, how the selected plans meet their requirements and preferences and any trade-offs.
For enrollees who are considering switching plans, agents can use this guidance to explain how their current coverage will be impacted and what it will mean to the caller. This gives callers a better understanding of what they are enrolling in and helps them select a plan they are likely to stick with.
Provide Easy Access to Tailored Plan Summaries and Information
Many callers do not enroll in the first call. Instead, they want time to understand their options and look at information before committing to enroll. Using multi-modal AI and automation, agents can provide easily accessible and easy-to-understand information regarding plan options and benefits to caller mobile devices. Callers can then go through these details at their convenience and use AI to explain specific features and benefits (such as asking about coverage for a specific benefit condition or a for a specific drug, etc.) This interactive experience allows beneficiaries to better comprehend their choices and take a well-informed decision.
Summary
MA enrollment is a complex process that can be overwhelming for beneficiaries. However, new technology is making things significantly easier—for MA enrollees and enrollment agents alike. Today, AI and automation are helping agents better understand their callers and provide tailored, personalized plan recommendations in an easy-to-understand language. This, in turn, elevates agents to trusted advisors and helps them guide beneficiaries toward plans that are more likely to meet their needs, preferences and goals. As a result, insurers and TPMOs can create a better enrollment experience and reduce churn—at every step of the enrollment journey.