4 Tips to Expand and Grow Your Enrollment in a Fiscally Responsible Way

In the Medicare Advantage (MA) space, we are continually searching for opportunities to grow enrollment, either by adding new products or expanding our service areas. While both are certainly viable methods, it is important to approach the expansion process in a fiscally responsible way. Conducting a feasibility study can help make this process clearer and more achievable.

To help evaluate your potential growth opportunity, consider the following tips from GHG.

When examining service areas, benchmarks (and factors that play into the maximization of benchmarks) are critical.

  • How are benchmark rates trending from year to year?
  • Does the pre-Affordable Care Act (ACA) rate limit growth, or the amount of bonus for new plans and plans that achieve the 5% quality bonus?
  • Do any areas qualify for the double bonus?
  • Is there any upcoming legislation that may impact payment rates?

To evaluate membership potential, conduct a thorough study of the markets under consideration.

  • How many health plans and products are available?
  • What is the growth in the number of beneficiaries joining Medicare Advantage (MA) plans?
  • How much of the population is aging in?
  • What types of plans are growing membership?
  • Do I have existing populations through individual commercial or group pIans to whom I can market?
  • Can I co-brand with a provider group or hospital system?

Existing operations and performance can have a tremendous impact.

  • What kind of “lift” will it take to build my network?
  • Are there any risk arrangements?
  • Will I need a new Centers for Medicare & Medicaid Services (CMS) contract?
  • What amount of effort will it take with my existing systems to add a new service area or product?
  • How is medical management on my current population?
  • Will my Star Ratings positively or negatively impact the benchmarks used?
  • If I’m not already in MA, what kind of lift will it take, and what will it cost? 

Completing a feasibility study and conducting a sensitivity analyses can help plans make these decisions. 

  • For new plans: It is important to know just how sensitive certain factors can be. These factors include provider contracting and expected improvement in contracting rates, utilization management relative to Fee-for-Service and how much improvement there will be from year to year, risk adjustment trends, Star Ratings, administrative costs and trends, and membership. CMS expects plans to have a positive margin by the fifth year of business. 
  • For existing plans: Plans must understand the cost for expansion/growth and any revenue implications that may change. Plans need to be aware and prepare to face revenue adjustments to avoid being surprised during the next bid season.

At GHG, we have provided expertise to government-sponsored plans in conducting feasibility studies. We have extensive experience in the bid process as well as forecasting. Feel free to reach out and discuss how we can assist you in developing a feasibility study for any markets and products in which you may be interested.

2021 Chapter 2 Enrollment Changes

With the Centers for Medicare and Medicaid Services' (CMS) recent release of the 2021 chapter 2 enrollment changes, Medicare Advantage (MA) plans now have insight into the many proposals made earlier this year. GHG's Vice President of Sales, Marketing & Strategy, Diane Hollie, summarizes the key changes.

Medicare Advantage Plan Options for End-Stage Renal Disease (ESRD) Beneficiaries

Effective January 1, 2021, ESRD Medicare beneficiaries will now be able to enroll in MA Plans. Previously, ESRD patients could only enroll in a Medicare Supplement plan, MA Prescription Drug plan, or Medicare only.  This upcoming Annual Enrollment Period (AEP) is the first time ESRD beneficiaries can enroll in an MA Plan, even after diagnosis. Although this is a major change, plans have known about this for several years.  

Special Election Periods (SEPs) for Exceptional Conditions

In addition to codifying SEPs previously adopted and implemented, CMS established two new SEPs for exceptional circumstances:

  • SEP for Individuals Enrolled in a Plan Placed in Receivership. 
    • CMS established new SEPs for members enrolled in plans that are experiencing financial difficulties to such an extent that a state or territorial regulatory authority has placed the organization in receivership. 
    • The SEP begins the month the receivership is effective and continues until it is no longer in effect, or until the enrollee makes an election. The MA plan must notify its members, in the form and manner directed by CMS, of the enrollees’ eligibility for this SEP and how to use the SEP.
  • SEP for Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer. 
    • CMS established new SEPs, for individuals who are enrolled in plans identified with the low performing icon (LPI). This SEP exists while the individual is enrolled in the low performing MA plan.

Medicare Advantage and Prescription Drug Plan Model Enrollment Forms

CMS revised and improved the standard model form used for MA and Prescription Drug Plan (PDP) enrollment into a new streamlined form. The new model enrollment form requires a minimal amount of information in order to process the enrollment, and other limited information that the MA Plan is required or chooses to provide to the prospective member.

The new model form consists of the following parts:

  • Cover Page - The cover page includes information for the prospective member on Medicare enrollment and instructions to complete the enrollment form.
  • Model Enrollment Request Form - The model enrollment form includes two sections. Section 1 includes data elements required to process the beneficiary’s enrollment. Section 2 includes mandatory data elements that the plan is required to include on the application and optional data elements, which the plan is not required to include. All data elements in Section 2 are optional for the beneficiary to complete. Plan enrollment will not be affected if the beneficiary does not complete this additional information.

The new enrollment form is considered a “model” for purposes of CMS review and approval of plan marketing materials, and plans can choose to customize the form as needed.

Additional Updates

  • Model Notice Update – CMS removed information from Chapter 2 Exhibit 22 regarding the option to use an SEP to disenroll from the plan due to the loss of optional supplemental benefits because of nonpayment of optional supplemental premiums. An individual would be able to disenroll only if s/he is eligible for one of the existing SEPs.
  • Electronic Signatures - As part of the Electronic Enrollment process, CMS added language that allows plan sponsors to obtain an electronic signature as an alternative to the “Enroll Now” or “I Agree” button or tool used in completing an Electronic Enrollment request. This change only applies to the Electronic Enrollment mechanism. The affirmation requirements for the Telephonic and Paper Enrollment mechanisms remain the same.
    • An electronic signature is considered to have the same legal effect and validity as a pen-and-ink signature. An organization utilizing electronic signatures must at a minimum, comply with the CMS security policies.

Where Do We Go from Here?

GHG has been assisting our clients with both development and review of required materials for over a decade. We have a long, successful history of supporting these efforts. Our team undergoes re-training every year prior to deployment of any engagement, and we have a standardized process in place that is adaptable to any of your particular needs.

If you need assistance navigating these new changes or developing sales and marketing materials for the PY2021, contact Diane Hollie today to start the conversation.

For more information on the enrollment changes, you can view the full 2021 Medicare Advantage Enrollment and Disenrollment Manual here.

Elderly woman and man sitting on couch with computer.

Why the OEP is So Important This Year

With the overwhelming uncertainty due to a global pandemic and a Presidential election year, the entire industry is looking for a crystal ball to shed some light on this year’s Annual Enrollment Period (AEP). Despite this uncertainty, there are a few things we do know for certain:

  • There will be NO large gatherings for member town halls in the fall to review 2021 benefits.
  • With town halls, seminars, and one-on-one meetings transitioning to virtual, health plans and agents will face a learning curve this AEP.
  • This AEP could mark a real change in how business is conducted within the Medicare market going forward.
  • The consensus is that this year's AEP will be challenging, but that there will also be huge opportunity during the Open Enrollment Period (OEP) for enrollment gains or, conversely, more losses.

Large Field Marketing Organizations (FMOs) and National Marketing Offices (NMOs) are learning how to skirt the Medicare Communication and Marketing Guidelines (MCMGs) by generically advertising Medicare all year long – but especially during the AEP and OEP. The sheer prevalence of ads featuring Joe Namath during the last OEP is evidence enough of plans' desire to find creative ways to advertise.

Why the Open Enrollment Period is Critical for 2021

This year, health plans should be prepared with an intentional OEP strategy that specifically focuses on gaining membership. If you aren’t prepared, you may be the only Medicare Advantage (MA) plan not advertising. So, how can plans advertise while staying compliant? There are several strategies that your team can incorporate:

  • Utilize your New-to-Medicare Programs to actively market during this time, and apply other tactics not currently in play.
  • Rely on your brand advertising to gain awareness.
  • If you have Medicare Supplement, use that advertising to gather leads and see how many prospects actually need an MA plan.
  • Research the current NMOs/FMOs and see if it is worthwhile to be a part of their programs.
  • Talk to your best agents and brokers to find out what they are doing for you—or what you can do for them.

In addition, remember member retention! Of course, it is important to gain new members, but it is equally as important to hold onto existing members. Ensuring that your new members understand their benefits, and how to utilize them, is critical for member retention. Make sure your plan's existing members know what is happening to their 2021 benefits—and don’t surprise them. Overcommunication is key, and there are specific actions your plan can take to ensure your members are receiving proper communication.


These are just a small handful of ideas to help you build your OEP strategy. If you have questions, or want more information about how you can improve performance this year's OEP, contact Diane Hollie today. It is not too late to get this done before 2021!

As the Bid Submission Timeline Approaches, So Does the Release of PY2021 Model Documents

It’s that time again… the frantic whirl of both bid submission and material development in anticipation of the upcoming plan year and sales/enrollment activities.

If you are a health plan with multiple contracts and/or plan benefit packages (PBPs), you know how daunting material development and review can be.

If not delayed, the Centers for Medicare and Medicaid Services (CMS) will publish the plan year (PY) 2021 model materials by the end of May. Major changes to the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) are not anticipated, since they have been approved by the Office of Management and Budget (OMB) through December 2021. Regardless, ensuring accuracy of materials is critical as errors can lead to enforcement actions by CMS. Things to consider when developing PY2021 materials:

  • CMS model use
  • Following instructions found both in models and separate Health Plan Management System (HPMS) memo(s)
  • Applying the correct benefits to all of the documents
  • Submission and distribution timelines
  • Including fulfillment activities
  • Technology requirements (website changes)

How We Can Help

GHG has been assisting our clients with both development and review of required materials for over a decade. We have a long, successful history of supporting these efforts. Our team undergoes re-training every year prior to deployment of any engagement, and we have a standardized process in place that is adaptable to any of your particular needs. In addition, we have HPMS access and can submit materials on your behalf. Contact us today to discuss how we can best support you.

Medicare Sales in the Age of COVID-19

There’s no doubt about it: COVID-19 will change the way we sell Medicare products.

In previous years, health plans relied on agents for seminars, town halls and “kitchen table” sales. This year, plans cannot depend on face-to-face interactions with Medicare beneficiaries to be successful in the upcoming Annual Enrollment Period (AEP). Medicare beneficiaries are one of the most vulnerable groups for this virus. Meeting with people one-on-one and/or in larger groups is unsafe in this environment.

Plans will need to adjust and get creative in order to make sales goals this year.

Over the last few months, GHG has been working with several health plans on pivoting strategies to navigate the new norms of COVID-19 and a Presidential election year upon us. Here are some tips to consider.


This year, Medicare sales will be defined by those who enable an effective virtual selling environment. Health plans should be in close contact with top brokers, helping to build tools to be utilized during new-to-Medicare/Initial Enrollment Period (IEP), Special Enrollment Period (SEP) and AEP. Most, if not all, one-to-one discussions and seminars will be conducted online; having access to audio and/or video conferencing tools will be critical. This also includes an online enrollment tool for agents/brokers, so if your plan does not currently offer it, now is the time to get one! Agents/brokers will want to walk prospects through the online enrollment process over the phone or via video conference (e.g., Zoom).

In addition, having the right tools is one aspect, but this type of selling is different from the usual one-to-one, in-person discussion. Even if you enable video for both parties, it’s difficult to read and understand body language during a conference call. Agents will need to adapt selling styles to take this into consideration.

Still, the path back to “normal” is unknown. Even when social distancing restrictions and stay-at-home orders are lifted, it’s questionable when “the most vulnerable” for COVID-19 risk will feel comfortable again. Plans will need to hold agents/brokers accountable for the health of prospects when entering homes, as well as how to safely approach a “kitchen table” sales environment—clean hands, disinfecting wipes, masks, etc.

This means that call centers will be very important for the future of sales.

Call Centers

Many plans utilize call centers as a way to answer questions and move prospects to the next step, such as fulfilling information requests or sending to an agent/broker. It may be time to rethink that strategy. Considering the impacts of COVID-19, plus Presidential election season, telesales will play a much bigger role in hitting sales targets for 2021.

GHG recommends using licensed agents who can sell over the phone and have the opportunity to set up an online conference call to take the prospect through the process, if that’s needed to close the sale. Having trained several internal call centers, we’ve found that many don’t know how to sell or close a sales opportunity. We cannot stress enough the importance of having a thoughtful call center strategy this year (and don’t wait until AEP to test new approaches—start with your new-to-Medicare program). Selling approaches and monitoring will be key to success.

Online Sales

Online sales have been increasing over the last several years, and COVID-19 will undoubtedly precipitate moving this to the next level. New-to-Medicare beneficiaries especially are gravitating towards digital platforms, and online/social media channels are now a viable and profitable form of advertising for most Medicare plans.

Plans today need a solid online presence that serves as a “real” sales channel, not just a website with CMS information and an online enrollment process. When a prospect visits your website, can they easily travel through a well-organized sales process? Is your market differential front and center? The sales experience should be easy and user-friendly for prospective members, with access to customer service via phone or chat to get answers to their questions quickly.

What's Next?

The next few months are certainly going to be interesting. Given the unpredictability of the current environment, be sure to cover your bases now to be prepared for this AEP—including establishing a backup plan if needed. With COVID-19 and the Presidential election, AEP will be a difficult endeavor, but plans can utilize the OEP, agents/brokers and new-to-Medicare advertising to drive sales during AEP.

GHG is available to answer any questions you have and help evolve sales strategies for this unprecedented environment. Contact us to start the conversation.

New Benefits & Special Enrollment Period (SEP) During a National Emergency

Since President Trump declared COVID-19 a national emergency in all 50 states and the District of Columbia, a Special Enrollment Period (SEP) for Medicare beneficiaries is allowed. The SEP runs from March 1st to June 30th.

What is a Special Enrollment Period?

The SEP exists for Medicare beneficiaries who were unable to make an election during the Open Enrollment Period (OEP), including both enrollment and disenrollment decisions. If an enrollee did make an election decision during OEP, they are not eligible for the SEP.

SEPs present a unique opportunity for Medicare Advantage (MA) plans to capture new enrollees. However, this effort may be best left to the sales team. The number of Medicare beneficiaries taking part in this new SEP is most likely lower than the OEP, so it would be difficult to achieve a high return on any new marketing investment.

New Benefits During a National Emergency

In addition to the SEP, MA plans may offer additional benefits during a federal or public health emergency. There are a variety of benefits that can be offered, but they must be offered uniformly to all plan members. Here are a few examples:

  • Introduce an OTC benefit or increase an existing OTC benefit allowance. (Must be health related, unless part of Supplemental Benefits for Chronically Ill Enrollees [SSBCI].)
  • Waive the plan premium
  • Offer new mandatory supplemental benefits, such as meals or transportation
  • Provide a cell phone and/or tablet. (Again, this must be for health-related services only, unless part of SSBCI and there is a reasonable expectation of improving or managing the health or overall function of the chronically ill member.)
  • Decrease and/or eliminate copays/coinsurance of any benefits

What Should Medicare Advantage Plans Do?

With the current COVID-19 environment, the upcoming deadline for bid submissions, constant communications with members, and navigating the new normal for AEP, it may be difficult for MA plans to consider a change at this time. However, introducing new benefits during this unprecedented time demonstrates your plan is committed to going above and beyond for its members. Just remember—if you decide to make changes and believe they are worthwhile, advertise them! You’re in an SEP, after all.

If you need help navigating this SEP or anything related to marketing through COVID-19 and a Presidential election year, contact us to start the conversation.

AEP Marketing During COVID-19 ...AND a Presidential Election

Developing a marketing strategy during a Presidential election year is difficult enough. But adding in the current, and eventually, post-COVID-19 environment, which is unprecedented, makes it even more challenging.

As we mentioned in a recent webinar, Medicare Advantage (MA) plans will need to “think outside of the box” when developing and executing a go-to-market strategy for the 2021 Annual Enrollment Period (AEP). Making slight modifications to last year’s plan will not cut it in this “new” environment.

The Medicare Advantage 2021 AEP Will Be Here Before We Know It

Now is the time to dissect your marketing and sales channels; waiting any longer will put you at a disadvantage. Below are a few ideas to consider when rethinking a 2021 go-to-market strategy.

Branding and Creative

Hopefully, you have already been communicating to members and the community about COVID-19 and how to stay safe. Those visuals and brand components, as well as the tone, should extend into AEP communications, especially for localized plans. The messaging should focus on ensuring both prospects and members know you were there for them during COVID-19 and will continue to be there every step into the future. Fear of change is difficult for this population, and particularly for the switcher market, plans must alleviate that feeling of fear through messaging.

Marketing Channels

Advertising during an election year is challenging. The tried-and-true tactics aren’t viable; everything else is more expensive than normal; and it’s even more difficult to capture beneficiary attention. What can MA plans do?

  • TV: Purchasing TV spots is typically a nightmare. When developing your media plan, take into account other ways you may want to utilize TV commercials. Incorporating them into social media, landing pages or websites warrants consideration.
  • Social Media: For the last several years, we have seen plans implement strong, cost effective social media campaigns. This AEP is the perfect opportunity allocate more marketing spend to social media. Recent survey results from Deft Research indicate a continued increase in the effectiveness of online media and websites for growing enrollment. Test different social media and digital channels to find the best strategies to capture Medicare beneficiaries shopping online.
  • Direct Mail: Medicare beneficiaries receive a lot of mail during election season. Postcards may get lost in the clutter. Instead, try direct mail “kits” that are designed and written to stand out. Timing and targeted are also critical. Front-loading your marketing with a strong finish will help you during the heat of the election. Also, developing strong direct mail response models is important for this AEP. This is the perfect opportunity to send more direct mail, but only mail to those who are most likely to respond and cut out the least responsive segments.

Backup Plan

We are in uncharted territory with this pandemic, and no one has a crystal ball to understand how, or if, the market will respond this year. That’s why we recommend having a backup plan. If TV is a non-starter, what will take its place? If results are not what you need them to be, is there an opportunity to send one more direct mail campaign? Is it worthwhile to invest more in social media? Are newspaper ads, Free Standing Inserts (FSIs) or radio ads ways to help increase overall marketing results? Having alternate or additional materials ready, if needed, could be the difference between exceeding lead and sales goals, and falling short.


This AEP, it will be critical for enrolled beneficiaries to feel comfortable about their decision—both during the sales process and long after. Plans must have a strong onboarding process to prevent buyer’s remorse, including materials that clearly explain what to expect during the enrollment process, as well as multiple communications touch points (e.g., delivery of their ID card). Capturing communication preferences early and honoring those decisions sets the tone for the entire member experience. Also, set up multiple ways to communicate benefits, such as virtual town halls and phone calls, to ensure members get acclimated to your plan.


Marketing/advertising strategy is one focus area that plans need to assess and rethink in the context of the COVID-19 pandemic and an election year. There are also sales channels. How will your sales strategies and goals need to change for the upcoming AEP? Stay tuned for additional recommendations on the GHG blog over the next few months!

If you have any questions or need assistance with your AEP marketing strategy, contact Diane Hollie.

On Demand Webinar: Four Lessons Learned from the 2020 AEP Results

On April 14th, Diane Hollie of Gorman Health Group was joined by George Dippel from Deft Research for a thoughtful, data-driven discussion about the enrollment outcomes of the 2020 Medicare Advantage (MA) Annual Enrollment Period (AEP).

With support from a recent analysis on the AEP data by Pareto Intelligence, the webinar presentation explored the many variables affecting product and benefit design in MA, as well as how MA organization (MAO) decisions about those variables impacted 2020 enrollment.

If you did not get a chance to attend the webinar, click here to view the recording.

Some of the key takeaways from this discussion an analysis include:

  • Lesson #1 – Explosive Growth in MA Continues: With a projected 80 million Medicare-eligible Americans by 2035 and 41% of age-ins enrolling in MA each month, the MA market is ripe with opportunity. Where are we seeing the most growth by geography? By MA plan? In which products?
  • Lesson #2 – $0 PPOs Are Changing the Game: When looking at 2020 enrollment data, the movement to $0 PPOs is still in the early stages, but these plans are growing rapidly. Data from Deft Research's 2020 Medicare Shopping and Switching Study gives us critical insights to consider while building your own MA products.
  • Lesson #3 – Market Movements Introduce New Options for Consumers: New market entrants and exits change the competitive landscape for MA every year. In 2020, Medicare beneficiaries had more plans to choose from, more types of plans (such as Special Needs Plans) to evaluate, and more benefits to consider (especially when taking supplemental benefits into account). What does this mean for MA plans going into 2021?
  • Lesson #4 – Changing Consumer Behavior is Creating New Trends: Additional research from Deft on shopping and switching behaviors for seniors provide insight on how to market your MA plan during an election year. What strategies and tactics can you deploy to break through the clutter?
  • BONUS – Taking COVID-19 into Account: At the end of the webinar, our Medicare experts discuss how to communicate with and market to MA beneficiaries in the aftermath of COVID-19, while also navigating an election year.

Watch the Webinar On Demand!

These lessons are discussed at length in GHG’s April 14th webinar titled, “Lessons Learned from the 2020 AEP Results.” Use the form below to receive access to a recording of the webinar and explore the various insights from Gorman Health Group, Pareto Intelligence and Deft Research.

Where Do We Go from Here?

Now more than ever, MA plans must be prepared to adjust and pivot sales and marketing strategies to address a post-COVID-19 world and this busy election year.

For help building a data-driven strategy, get in touch with GHG's Sales and Marketing experts.

On Demand Webinar: Four Trends in Supplemental Benefits for 2021 Success

Supplemental benefits have been a valuable differentiator for Medicare Advantage (MA) plans since the Centers for Medicare and Medicaid Services (CMS) expanded the scope of coverage to certain non-medical supplemental benefits in 2018. Since then, we have seen continued expansion in supplemental benefit adoption and prevalence, which has required MA organizations (MAOs) to become even more creative in plan design to stay competitive.

So, how can you capture and maintain a competitive position in your market? Insights found by a Pareto Intelligence analysis after the MA Annual Enrollment Period (AEP) tell an important story that can influence product pricing and benefit design strategies for 2021. In a recent webinar, Gorman Health Group (GHG) Vice President of Sales and Marketing, Diane Hollie, shared the critical trends in supplemental benefits from the AEP results data that health plans need to know going into 2021 bids. Below is a summary of the key takeaways.

If you did not get a chance to attend the webinar, click here to view the recording.

Trend #1: Supplemental Benefits are Becoming Table Stakes

With the number of $0 HMOs, PPOs, and even HMO-POS plans available in the market—and with many supplemental benefits becoming homogenous across plans—consumers have new expectations about the “standard” offering when sitting at the kitchen table with a Broker.

This is apparent when comparing overall supplemental benefit prevalence between 2019 and 2020. In 2020, only 17% of MA Plans (in the Individual market, including SNP plans) did not offer any supplemental benefits versus 27% in 2019.

Trend #2: The Nationals are Offering Supplemental Benefits at a Higher Rate than Other Plan Types

When reviewing the enrollment data by type of MA plan (e.g., National Plans, Blues Plans, Provider-Sponsored Plans, Regional Plans), it was apparent, in most cases, that the Nationals offered major supplemental benefits, such as the over-the-counter (OTC) and meal benefits, more than other plan types.

One interesting benefit to note is “Transportation Services.” Regional plans, start-ups, and smaller MA plans in the “other” category were on par with the Nationals as far as providing the benefit. This could be attributed to D-SNP plans in this category, but it is certainly a trend to watch going forward.

Trend #3: Supplemental Benefits Can Impact your Member Experience

Given the increase in supplemental benefits offered, health plans should focus even more on member experience. As an example, in the recent Medicare Shopping and Switching Study from Deft Research, inadequate dental coverage was the most prevalent coverage issue mentioned by MA members, followed distantly by poor vision coverage. Therefore, if a plan doesn’t have sufficient dental coverage, member satisfaction may suffer as a result.

But simply offering the benefit is generally not enough to satisfy consumers. When a plan offers supplemental benefits, especially comprehensive dental benefits, communication is critical to managing members’ expectations. This includes:

  • Properly explaining the details of the benefit to ensure that the Medicare consumer doesn’t select the plan with a different understanding of the offering and end up disappointed the first time they attempt to use the benefit.
  • Outlining how to access the benefit once becoming a member or receive the benefit once it becomes available. Typically, supplemental benefits are implemented by outside vendors, which may require members to understand how to use up 6, 7, 8+ different companies to access benefits. This may cause confusion and poor member experience if member education and infrastructure are not properly aligned.

Trend #4 The Availability of Supplemental Benefits Correlates to Higher Enrollment Growth Rates

With data now available from multiple years of plans offering expanded supplemental benefits, we wondered: Does the availability of supplemental benefits impact enrollment? Preliminary results say yes.

For example, plans that offered comprehensive dental, transportation services, and/or meal benefits grew an average of 5% from 2019 to 2020, versus only 2-3% growth for plans that did not offer these benefits. The same goes for the OTC benefit… Plans that offered an OTC benefit grew 7% on average and plans that did not offer OTC actually decreased enrollment by 2%.

In diving further into OTC, Pareto’s analysis shows that the annualized benefit amount correlates to the amount of enrollment growth for a plan. MA plans with over $300 in annual OTC benefit grew 11%, whereas plans with an annual OTC benefit of up to $200 grew only 3% on average. This demonstrates that certain benefits are more influential for plan choice than others, which can help determine where to place the supplemental benefit dollars.

Watch the Webinar On Demand!

All of these trends are discussed in much deeper detail in GHG’s March 4th webinar titled, “Supplemental Benefits Trends to Address in 2021.” Use the form below to receive access to a recording of the webinar and explore the various data points discussed in this article.

Where Do We Go from Here?

In five years, MA plans will look very different than they do now. The new mindset of the baby boomer who is aging into Medicare will force change; they expect more from a plan and will demand it. Plans will need to improve member experience and address the social determinants of health (SDOH) specific to their population with various supplemental benefits.

This is also the time to reimagine the benefit/plan development process. Waiting to see what other plans are offering and following the leader is no longer sufficient in the long term. Plans must understand what members want/need and how to offer it effectively. There is also an opportunity to introduce benefits into the market that will help lower costs, increase Star ratings, and retain members over time, but this means effective change using strong data analysis with a clinical and quality lens in product and benefit strategy today.

For help with plan development, product strategy and benefit design, and more, get in touch with GHG’s Sales & Marketing team.

Dramatic Changes to the Telehealth Benefit Due to COVID-19

Over the last week, the Centers for Medicare and Medicaid Services (CMS) has released several documents providing guidance and relief to healthcare organizations amidst the COVID-19 pandemic. First, CMS broadened access and greatly relaxed regulations around telehealth services for Medicare beneficiaries. Through this expansion, Medicare can temporarily pay providers for telehealth visits for Medicare beneficiaries across the entire country.

Shortly after this announcement, CMS released two telehealth toolkits to help healthcare organizations navigate the expanded benefit: the General Provider Telehealth Tool Kit and the End Stage Renal Disease (ESRD) Provider Telehealth Tool Kit. According to CMS, “each toolkit contains electronic links to reliable sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. Many of these links will help providers learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.”

What Does Expanded Telehealth
Benefits Mean for Medicare Advantage Plans?

With the government and CMS directing
healthcare providers to deliver only essential and emergency care to patients,
those looking for non-essential services are suddenly unable to access the care
they need.

With the expansion of telemedicine, Medicare
beneficiaries are now able to receive various services through telehealth,
including common office visits, mental health counseling, and preventive health

Since Medicare beneficiaries are at a higher risk for COVID-19 (i.e., coronavirus disease), telehealth allows them to visit their doctor from the comfort of their home, instead of going to a doctor’s office or hospital and putting themselves or someone else at risk. Patients will now be able to visit with providers using a wider range of communication tools, including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect without a face-to-face encounter.

This change also broadens telehealth flexibility without regard to the diagnosis of the beneficiary or the coverage they have. The expansion is effective for all Medicare beneficiaries, not just those with Medicare Advantage (MA) that may already have a telehealth benefit within their plan. It is available to all Medicare beneficiaries whether they have no coverage in addition to Medicare, a Prescription Drug plan, a Medicare Supplement plan, or an MA plan. Note that CMS has requested that MA plans communicate the specific policies and procedures on how to manage the flexibilities with relaxed telehealth regulations to both members and providers.

What Does Expanded Telehealth
Benefits Mean for Providers?

Beyond the benefit to members, an
increased emphasis on telehealth for non-essential visits will reduce the
strain on the healthcare system overall, ensuring that doctor offices, urgent
care centers, and Emergency Departments are available to treat the most urgent
cases while reducing the risk of healthy beneficiaries contracting coronavirus
disease by unnecessarily visiting a healthcare facility in person.

The expansion of the telehealth benefit
will allow providers the opportunity to see more Medicare patients for non-essential—but
still important—services, such as diabetes control, a patient not feeling well
and is not sure what to do, prescription refill, and depression or anxiety
brought on by isolation.


Although telehealth has many benefits,
it is not without its complications. Providers were generally not prepared for
the onboarding of a telehealth platform, the expense, the change to the
structure of current practice operations, and the rapid timeline in which telehealth
needs to be implement in order to effectively manage the most vulnerable
members. Many of the specifics will require providers to quickly adapt (e.g., the
requirement that telehealth calls be initiated by the Medicare patient; the different
CPT and HCPCS codes).

As we look to the future beyond current COVID-19 flexibilities, in a recent proposed rule, CMS has also included the ability for plans to use telehealth services for certain specialties in order to expand their footprint into counties where they may not otherwise have been able to meet the network adequacy requirements. The success plans demonstrate in their ability to effectively care for and manage members remotely during this crisis may further support the expansion of relaxed adequacy requirements beyond those in the current proposed rule.

If you still have questions on how to navigate the expanded telehealth benefit, consider attending our upcoming virtual open forum on Thursday, March 26th, where the healthcare experts at GHG and analytics leaders at Pareto Intelligence will answer all of your specific questions across a variety of topics, including Marketing, Star Ratings, Risk Adjustment, Compliance, Network Adequacy and Development, Telehealth and Analytics.