Data-Driven Insights for Medicare Health Plans and Brokers

The Medicare Advantage (MA) market is becoming increasingly competitive. Medicare health plans and brokers need to be armed with actionable insights to grow and retain their membership in the coming year. Let’s look at the most significant trends from the 2023 Annual Enrollment Period (AEP) and strategies for the road ahead.

2023 AEP Takeaways

1. Increasing competition

Competition is increasing as most Medicare beneficiaries now live in counties with greater than 50% MA penetration and more than 46 plans to choose from. Health plans are introducing new products and using innovative distribution strategies to grow and retain their market share.

2. Bigger and broader carriers

Seven national carriers enrolled nearly 75% of all individual Medicare Advantage (MA) beneficiaries. That only leaves leaving roughly 221,000 net enrollments for the other more than 4,800 plans. These carriers are growing by offering a broad range of products for all beneficiary segments.

3. Mixed performance for startup

Startup enrollment growth was mixed. Their simplified and highly competitive plan designs worked well—for a while. But now they must learn to take share from incumbent plans.

4. Local plans struggle to compete

Local plans are feeling pressure from tough competition. Plans with less than 60,000 MA lost 19% of their membership to national plans and startups. They must use their local market expertise and alternate growth strategies in the coming year to succeed.

5. MA enrollment accelerates

Dual Eligible Special Needs (D-SNP) and Chronic Condition Special Needs (C-SNP) plans are taking lead in MA enrollment growth. SNP enrollments increased 19%, outpacing all other MA plan types.

6. Medigap-to-MAPD conversion expands

Non-SNP PPO enrollments are increasing. Stand-alone Prescription Drug Plan (PDP) membership is decreasing. This indicates Medigap-to-MAPD PPO conversion continues and is expanding into additional states. This trend represents a significant risk to Medicare Supplement carriers. It is, however, an opportunity for PPO carriers.

As and competition increases, plans will need to innovate. Opportunity lies in localization strategies and the distribution channel of the future: technology-enabled field agents.

7. Distribution changes

Field agents are emerging as carriers’ and beneficiaries’ preferred channel. Telesales continues to struggle with high lead costs ($446 CPA in 2022) and low member persistency.

Field agents can scale and take advantage of the additional 20 million beneficiaries aging in and will be key to reaching Boomers who will be the majority of Medicare beneficiaries by 2030. Growing and retaining membership will hinge on modernizing field agent capabilities and aligning with Boomer shopping and enrollment preferences.

8. CMS oversight increasing

Carriers and their distribution partners should prepare for greater oversight from the Centers for Medicare and Medicaid Services (CMS). Three proposed rules governing MA marketing and distribution have the potential to significantly impact the upcoming AEP. An industry-wide response consisting of Medicare health plans, distribution partners, agencies, lead providers and related parties is required as the proposed rules touches everyone in the leads-to-enrollment supply chain.

• Prohibition of Medicare ads that do not mention a specific carrier by name
• 48 hours waiting period for scope of appointment (SOA)—no exceptions
• Requirement of MAOs and Part D sponsors to have an oversight plan that monitors agent and broker activities and reports agent and broker non-compliance to the CMS

Preparing for the future

Growth Strategies

• Understand the county-level market context. Design localized growth campaigns tailored to target segments.
• Modernize the field agent channel with true lead-to-enrollment capabilities.
• Develop new lead formats that better align with Boomers’ shopping and enrollment preferences. In-home and scheduled appointments are a good example.

Retention Strategies

• Profile and understand why members are leaving you and target them for retention campaigns.
• Prepare to defend against growing D-/C-SNP penetration and Medigap-to-MAPD conversion expanding nationally.
• Proactively identify your current members’ best-fit plan. Let them know whether they should stay, switch, or upgrade their plan.

Acting on Insights

Competition is growing. The distribution landscape is changing. And CMS oversight is increasing. But by acting on the trends and insights gained from the 2023 AEP, you can position yourself for success in the coming year.

Insights and data are available in the MyMedicareBot 2023 Retrospective Report.

This article was first published in Aspire Magazine.