AEP Marketing and Sales Readiness — Do You Pass the Quiz?

The following are questions Gorman Health Group would ask when conducting an assessment on marketing and sales strategies and execution plans for our Medicare Advantage clients.  Take the quiz today and see if you are on track for a successful Annual Election Period (AEP).

If you have answered "no" to any of these questions and you feel you are behind the eight ball — contact us, and we can get you on the right track. AEP is just around the corner!


Resources

Understanding what's working and what's not within your sales and marketing plan is a must in the ever changing competitive Medicare market.Our seasoned veterans will work with your team to redefine sales and marketing strategies that will pay big dividends short and long-term at your plan. Visit our website to learn more >>

Gorman Health Group's Sales Sentinel™ is a flexible, module-based software solution with the ability to onboard agents, provide training, manage ongoing oversight activities and pay commissions.  Created by GHG, Sales Sentinel™ was designed to address the specific needs of government managed care organizations. Contact us today to set up a demo >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


How do health plans increase brand recognition and improve brand loyalty?

It is believed brands who engage on social media channels enjoy higher loyalty from their consumers.  So why should health plans and health professionals engage in social media?

Social media provides a key opportunity for health plans and health professionals to build relationships with Medicare beneficiaries through social media, develop trust, and collaborate to design future programs to support the needs of the ever-changing Medicare population.

Social media creates an environment where consumers feel comfortable sharing honest feedback and feel a sense of community.  Health plans can use this environment to communicate health and wellness tips, upcoming community events, and, as we enter into the Annual Election Period (AEP), these channels can help promote new products and services, help position products for growth, and provide a place to tell a story about your organization and the services you provide.

Are you still asking yourself if social media make sense for your particular audience, or is it a big waste of marketing dollars?  Here are a few additional reasons why social media can help drive engagement, satisfaction, and promotion:

Health Plan

  • Social media is not just a marketing tool — it is now a business and communication strategy
  • Provides innovative ways to communicate with both prospects and members and deliver key messages about your products and services in real time
  • Ability to use current members as advocates to share their positive experiences with your health plan
  • Influence consumers not easily reached though traditional or direct communication channels

Consumer

  • Consumers now play an active role in their healthcare, obtaining real-time data from their doctor and their health plan through their smartphone or tablet
  • Allows consumers additional outlets to receive information in the way they feel most comfortable
  • Capture the young adults helping their aging parents gain information and help navigate the complexity of our healthcare system

Is your 2017 social media plan in place?  Don't miss out on the opportunity to engage consumers with a communication tool to proactively engage, educate, and identify negativity outcomes with current and future members.

 

 Resources

Gorman Health Group an unparalleled track record working with clients in government programs to develop cost-effective strategies and tactics to help plans achieve maximum potential for their products. Visit our website to learn more >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


Are Your Members Giving Your Plan A Thumbs Up?

It's that time of year when health plans are designing their benefit packages for the upcoming selling season, setting goals for their sales team, and implementing strategies to achieve greater success than the year before. But have health plans lost sight of what really matters to membership growth? Are health plans thinking about their current members while planning for their future members? If not, you should know each retained member contributes an incremental amount annually. Do you know the impact of a single member?

Member retention is key to long-term success. Net growth does not happen with new sales alone but with a careful balance between new sales and the retention of members once they have enrolled. Plans can meet all sales goals and still end up significantly below membership and revenue targets if members disenrolll from the plan.

Members leave a health plan for a variety of reasons, including dissatisfaction with the health plan, the product, provider access, misinformation/marketing abuse, cost sharing too high, and service or quality of care, but the majority of disenrollments are within the plan's control.

Dissatisfied members may enroll into a competitor's Medicare Advantage or Part D plan, a Medicare Supplement, or return to Original Medicare coverage. Proactively addressing factors which lead to member disenrollment should be the focus of any member retention effort.

What is a member retention program? A member retention program encompasses member engagement, satisfaction, and performance measures. A successful program should be geared around the relationship between the member, the plan, and trusted advisors.

Careful design of retention initiatives and a commitment to communication will deliver a significant and positive impact on enrollment and revenue generation. The foundation of an effective member retention strategy is cross-functional alignment, placing the member at the center of the health plan's initiatives and core business functions.

Sales and Marketing typically are responsible for attracting new members and keeping them engaged during the onboarding process, but a true retention strategy contains efforts from all disciplines inside the health plan. No one department can be responsible for the full engagement of a member. Once a member is part of the health plan, they touch Customer Service, Communications, Risk Adjustment, Care Management, Compliance, and Operations. Their experience in all of these aspects of the health plan drives the retention of that member which in turn helps health plans increase Star Ratings and helps the health plan reinvest their performance bonuses in more and better member benefits.

Utilizing our cross-functional expertise, Gorman Health Group can work with your health plan to create a customized retention program focusing on strategies that address key factors driving your disenrollment and negatively impacting revenue.

For more information, please contact Carrie Barker-Settles at cbarkersettles@ghgadvisors.com.

 

Resources

Gorman Health Group's marketing experts have developed strategic plans for hundreds of Medicare Advantage Plans, Prescription Drug Plans, Special Needs Plans and Exchange participants. We will work with you to understand your market, mining demographic data for opportunity and finding the gaps in the competitive field into which your plan can fit.Visit our website to learn more about our services >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


Latest Sherlock Benchmarks Confirm Medicare Advantage is a Miserable Beast to Manage

The geniuses at Sherlock Company, whose benchmarks on health plan administrative standards are considered the gold standard, have released their 2016 findings and the numbers paint a clear picture: Medicare Advantage (MA) is a miserable beast of a product.  It's complicated and labor- and capital-intensive, requiring tremendous patience for executives and investors alike.

First: Sherlock's benchmarks confirm that MA requires nearly double the staff per 10,000 members as do commercial group products, and nearly triple that of Medicaid managed care.  Much of this staffing is driven by unique requirements in the "Account and Membership Administration Cluster" (Enrollment / Membership / Billing, Claim and Encounter Capture and Adjudication, Customer Services, and Information Systems.)

Second, successful MA management requires big investments and, above all, patience.  Sherlock found investments in Medical Management, Star Ratings and Sales/Marketing in Medicare takes at least a year, and often much longer, to show results.

Third, Sherlock demonstrates seniors are high utilizers of customer services relative to all other insured populations, and low costs are not optimal costs.  Plans that spend little on service typically suffer worse member retention, membership growth, and customer satisfaction.  MA members have longer service handle times, higher appeal rates, much higher rates of claims inquiries, and are less likely to utilize automated call systems.

The upshot? Once you master MA, all other lines of insurance business are a walk in the park in comparison. If this was an easy business, we'd be out of business.

 

Resources:

More than 200 health plan clients and an additional broad range of other industry participants each year trust Gorman Health Group's team of professionals to deliver expert counsel and tools to help them meet their goals. We pride ourselves on having both day-to-day alignment with the latest CMS guidance and the long-term strategic vision to keep it all in perspective. Contact us today >>

Under the provisions of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), physicians and other practitioners will face a Hobson's choice: live with a more aggressive risk-based adjustment to payments or join forces with an alternative delivery model, like an Accountable Care Organization (ACO), that is taking risk. Read the full article >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


What Is Driving Growth in Your Plan?

It's May, so if you have not formalized your sales and marketing strategy for this Annual Election Period (AEP), now is the time.  At our recent Gorman Health Group 2016 Forum, Carrie Barker-Settles and I had a very insightful discussion with Forum participants about what is driving growth in plans today.

First, membership data analysis.  It is critical to understand your data in order to understand the following about your members:

  • What are the geographic, demographic, and plan selection of new members in the last year, and which plan, marketing tactic, and sales distribution did they come from?
  • You need the same information about voluntarily termed members and any additional data gleaned from survey data.

Next, it is important to conduct a market analysis to review the following:

  • Medicare population and penetration
  • Product and plan trends
  • Benefit design analysis — looking for product and benefit innovation
  • Multicultural diversity
  • Competitive analysis and trends

With this information, you should have a strong idea of what your growth looks like — now you need to understand how to attract it going forward.

Whether or not you are currently attracting the aging in audience, you want it!  Having a young Medicare beneficiary helps drive down costs.  But Medicare beneficiaries are beginning to delay retirement, so developing strategies to capture these folks is probably the most cost-effective program you will have, and having a benefit design that is attractive to this market is critical.

When trying to attract the younger Medicare beneficiary, the Affordable Care Act (ACA) enrollees aging into Medicare will be a strong market — if you are in the ACA market segment.  Plus, you have the opportunity to target enrollees with "like" plans and just enroll them without having them test the outside waters, if you do it correctly.  In addition, this audience is much more attuned to social and online media.  We have found there are online media tactics now entrenched in most media plans, but testing should be continuous since more members will begin to enroll online who have purchased their ACA healthcare online and will expect the same experience with Medicare.

"For continued growth in your plan, make sure you're leveraging a multi-channel strategy to achieve your sales goals," said Carrie Barker-Settles, Gorman Health Group's Director of Sales & Marketing Services. "Placing too much emphasis on one channel may result in unsavory consequence.  Utilizing the right channel for the opportunity will enable you to reach prospects that don't respond to the standard marketing outlets and help achieve the stretch goal that the sales team is always faced with year after year."

When looking at the sales channel, this segment continues to diversify.

First, there are the Transition Managers or "Navigators" − Distribution of direct-to-consumer Medicare products to support commercial companies transitioning their members from group plans to defined contribution individual plans.  We have seen this segment grow substantially in the last few years.

In addition, we are beginning to see some transition among plans regarding their sales distribution of contracted agents, captive agents, and employed agents, and mixtures of all of the above with telesales and online sales. Another segment we see gaining popularity is storefronts.  Have you reviewed your strategies among those discussed here today?  If not, make sure you understand from where your opportunity for growth for 2017 will come.  Believe it or not, 2016 is coming to a close quicker than we think.

If you need help in evaluating your marketing and sales strategies, let us know — we are here to help!

 

Resources

Gorman Health Group's marketing experts have developed strategic plans for hundreds of Medicare Advantage Plans, Prescription Drug Plans, Special Needs Plans and Exchange participants. We will work with you to understand your market, mining demographic data for opportunity and finding the gaps in the competitive field into which your plan can fit. Visit our website to learn more about our services >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


The ABCs of Member Satisfaction

Member satisfaction. Customer centricity. Member retention. Consumer experience. Regardless of the term used, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey measures continue to be the common denominator by which the Centers for Medicare & Medicaid Services (CMS) measures a health plan's success, creating a positive member experience. CAHPS® survey responses now represent 16% of a Medicare Advantage (MA) plan's overall Star Rating, and an additional 33% is comprised of member-reported health outcomes and administrative measurements of member access and experience. With approximately 50% of the overall Star Rating now driven by some element of the member's experience, many health plan leaders now better appreciate the value of consistently providing members with excellent service and a positive experience.

I recently had the pleasure of listening to a group of members from a variety of MA plans share their health plan experiences with industry leaders. Though health plan discussions regarding member experience are often abstract and very general in nature, listening to the experiences of actual members is always a refreshing way to remind ourselves not only what a privilege it is to service the healthcare needs of Medicare beneficiaries but also how emotionally our "routine hiccups" impact members. Not surprisingly, this group of MA members shared stories that illustrate we've still got room for improvement in our quest to create a 5-star customer experience. The experiences of these members spotlight some of the ABCs for a successful member experience:

Access — When members discover providers with closed panels, struggle to make timely appointments with physicians, experience arduous referral or service authorization requirements, or are unable (even if only temporarily) to obtain medications at the retail pharmacy, we reduce the likelihood of the member reporting positive experiences with our plan on their CAHPS® survey.  Because many problems have multiple and/or multi-layered root causes, use of a technique such as the "5 Whys" can efficiently and effectively support root cause analysis of issues so impactful improvements can be rapidly deployed.

Better Communication — Many plans struggle to effectively communicate with members and often compensate by over-communicating to members, particularly via low-cost channels such as mail and IVR. By carefully crafting outreach strategies, letters, mailings, and scripts and using each member's preferred communication channel(s), plans can improve the effectiveness of their communications and demonstrate customer-centricity to members.

Coordination and Clinical Context — During the early years of Star Ratings, many plans deployed measure-specific tactics and interventions which were often conducted by disparate teams. In many cases, such tactics were implemented without anyone "connecting the dots" to ensure such strategies passed the "common sense" test from the member's perspective or that such tactics were appropriate within the clinical context of the member's overall health status. By strategically planning and developing outreach scripts and workflows, leveraging Health Risk Assessment (HRA) and claims data, and developing effective business rules through which to identify member interventions, plans can identify the right intervention for the right member at the right time.

Determination and Decision-making — Organizations with a sustained, strong customer experience are intensely focused on consistently making decisions that deliver value to their customers and meet customer expectations. This requires persistent determination, particularly as problems arise which necessitate process improvements or additional resources to resolve. Transforming a health plan into a consumer-focused organization with strong CAHPS® measure performance often requires a new or refreshed consumer focus within each operational area (from benefit design to care management to customer service to sales/marketing) supported by an effective customer experience leader and customer experience governance structure.

The member experience will continue to be a necessary core competency as the industry evolves over the next few years. Gorman Health Group (GHG) understands this can be challenging, both logistically and politically.

Whether your plan needs help establishing an effective member experience or member communication strategy, cataloging and evaluating existing member communications, or identifying opportunities to streamline and strengthen the return on investment from existing materials, tactics, or interventions, we can help. For additional questions and inquiries about how GHG can support your organization's member experience efforts, please contact me directly at msmith@ghgadvisors.com.

 

Resources

Today you need to identify opportunities to increase your score for next year, implement an enterprise-level strategy, and carefully monitor your progress over the next plan year.  We can help you every step of the way with our full portfolio of GHG practices, products and services.Visit our website to learn more >>

Our distinguished team of experts collaborated to provide our interpretation of this announcement and the key features that will have the greatest impact on the industry, emphasizing core business functions in Risk Adjustment, Provider Network, Quality, Compliance, Pharmacy, and Data Integrity. Download our full Summary & Analysis of the Final Rate Announcement & Final Call Letter >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


Takeaways from the Gorman Health Group 2016 Client Forum

The Gorman Health Group 2016 Forum concluded last week with over 200 of our closest clients and partners. There was great news and rough news, so here are a few takeaways:

  • The playing field of government programs continues to expand rapidly, with improving revenue outlook across the board:
  • We're sticking by our projections of over 29 million Medicare Advantage (MA) enrollees by 2023, driven by more positive rate trends and a plan-friendly baby boomer tsunami underway.
  • Six to eight more states expand Medicaid — once President Obama leaves office.
  • Significant enrollment gains for dual eligibles as home and community-based services (HCBS) waivers and managed long-term services and supports (MLTSS) initiatives become the new normal. We expect dual eligible special needs plan (D-SNP) enrollment to double and exceed 4 million by 2019.
  • Rising ObamaCare enrollment, albeit slowing and below projections, as more difficult-to-reach populations remain outside coverage.
  • During the Forum, United announced its departures from most ObamaCare Marketplaces. We characterized the news as a nothingburger in terms of enrollment or market impact but huge symbolically and politically. We expect another two to three messy years sorting out the pricing and finances of the Marketplace business, with membership reconciliation and cleanup of membership discrepancies front of mind for issuers.
  • Risk Adjustment Data Validation (RADV) audits will begin to be conducted in MA — 2016-2018 will be the first time we see plans prosecuted under the False Claims Act and hundreds of millions clawed back by the Centers for Medicare & Medicaid Services (CMS) for unsubstantiated codes submitted for higher payments.
  • Clinical and pharmacy data integration and strong provider partnerships around person-centered care were clear priorities in medical management, Star Ratings improvement, and Pharmacy Benefit Manager (PBM) oversight.
  • The Star Ratings system of performance-based payment drives the payer and provider markets. This year will be the first year where plans below 3 stars are terminated. It's also when another 180+ MA plans will be scored for the first time, diluting ratings for existing plans, especially those at 4+ stars and denying many their bonuses and rebates in what promises to be an ugly "October Surprise."
  • The turbulent Presidential elections will likely be won by Hillary Clinton, promising continued gridlock with a likely weakened and more polarized Congress. This means CMS will increasingly fight out policy changes "below the waterline" in subregulatory guidance and enforcement, where politicians are less likely to intervene. That means more surprises for plans not paying attention.
  • Appeals and grievances and pharmacy benefit management vendor performance remain the #1, 2, and 3 regulatory infractions in MA and integration of long-term care and supports and services the leading challenge facing Medicaid health plans.
  • CMS is on pace for its most aggressive enforcement year ever, with over a dozen actions taken against plans this year already.

As we've said since the passage of the Affordable Care Act, we are now in the Golden Age of government-sponsored health programs, and the opportunities and challenges that come with this shift have never been greater. Our clients went home with a clear grasp of both, and we are thrilled so many joined us this year.

 

Resources

Our distinguished team of experts collaborated to provide our interpretation of this announcement and the key features that will have the greatest impact on the industry, emphasizing core business functions in Risk Adjustment, Provider Network, Quality, Compliance, Pharmacy, and Data Integrity. Download our full Summary & Analysis of the Final Rate Announcement & Final Call Letter >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


To Everything There Is a Season: Marketing Materials

There is a season for every activity within your organization: one for bids, one for applications, one for data validation.  We are soon to come upon marketing material season, when a flurry of activity usually gets underway in Marketing Communications and Compliance Departments nationwide.  Here are three reasons to ramp up:

  1. Now more than ever, we have seen a growing trend towards high-quality service and retention.  How does this affect marketing materials?  In our estimation, submitting the bare minimum, core materials is no longer good enough if an organization wants to be leader of the pack.  Sponsors are getting creative with benefits, maintaining robust networks, doing their best to keep premiums low — and while those factors are key in member retention, so is service.  If an organization wants to work on maintaining relationships (through retention) rather than establishing only (through the sale), we expect to see additional, more personalized materials coming through Compliance Departments.  While each piece may not require CMS submission, all member- and beneficiary-facing materials must be reviewed by Compliance.
  2. CMS clarified in their draft guidance that while designations of "approved" or "accepted" do not have an expiration date, the status remains valid so long as the material is still compliant with the most current version of the marketing material guidelines.  Therefore, if this was not occurring in the past, organizations should be reconciling their past approved and accepted materials to ensure they are still compliant.  We anticipate a flurry of questions to roll into Compliance Departments about whether or not an update needs to be submitted (because, remember, some changes do not require resubmission!)
  3. The reach of the Duals Demonstration continues to stretch across the nation, and with that comes a significant amount of required coordination.  This also includes the review of materials.  Timing is everything, and unless one agency (CMS or the state) chooses to defer to the other for the review and approval of materials, an additional party is added to the process.  This should certainly light a fire under every business owner responsible for updating their materials.  The sooner the process begins, the better it will be for the review, printing, and distribution processes.

Compliance might feel the pinch this year of business owners asking for more assistance and guidance in the wake of sub-regulatory changes. Consider that beneficiaries, too, are asking health plans to be something more than a claims processor.  We find in all aspects of a successful organization, the bare minimum is not enough.  Therefore, instead waiting until someone starts asking for more, think about proactive ways you can deliver more before they even ask.

Resources

Let's face it: the marketing staff is at a disadvantage with the shortened period between bid submission and the start of the annual enrollment period. We can develop or review your sales collateral and creative by product type to help ensure your high-impact messaging is both targeted and compliant. Visit our website to learn more >>

We are proud to announce a new session at the Gorman Health Group 2016 Forum  featuring David Sayen, a former Centers for Medicare & Medicaid Services (CMS) Regional Administrator, who will provide a CMS update on "The March to Value-Based Payment." Register now  to reserve your seat!

 
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>


2016 Annual Election Period (AEP) Medicare Advantage (MA) Enrollment Growth Slows Compared to 2015

The number and share of Medicare beneficiaries enrolling in MA plans continue to increase, but the pace of growth is beginning to decline. Currently, there are nearly 18 million Medicare beneficiaries enrolled in MA health plans across the country. This includes all individual and group plan enrollment.

Approximately 32% of Medicare beneficiaries are now in MA plans, but we are starting to see the MA penetration begin to flatten out (Figure 1).

Figure 1 — Total Medicare Private Health Plan Enrollment, 2012-Feb 2016

The following chart shows the dramatic growth of Medicare beneficiaries enrolled in MA plans as of February 2016 (Figure 2), but the percentage growth of enrollment is declining. Since 2012, MA enrollment has grown 32% to nearly 18 million.

Figure 2 Total Medicare Private Health Plan Enrollment, 2012-Feb 2016

Note: Includes Medicare Medical Savings Account (MSA) plans, Cost plans, demonstration plans, and Special Needs Plans (SNPs), as well as other MA plans (individual and group).

Gorman Health Group (GHG) analyzed the 2016 AEP and saw the following when analyzing national and state-level enrollment trends:

  • MA enrollment has continued to grow and increase in virtually all states in the 2016 AEP.
  • MA enrollment is highly concentrated among large organizations.
  • Most enrollees continue to be in Health Maintenance Organizations (HMOs). (Enrollees in HMOs typically pay lower premiums and have lower limits on out-of-pocket expenses.)

But we also saw a real decrease in the MA percentage of growth from the 2015 AEP to the 2016 AEP. The following tables show the total enrollment from December to February of each year.*

2015 AEP VS. 2016 AEP

While the 2015 AEP saw an overall growth of nearly 650,000 beneficiaries enrolled in MA health plans, the 2016 AEP saw an overall growth of 445,245 beneficiaries enrolled in MA health plans — this is nearly a 31% decrease in enrollment from 2015 AEP to 2016 AEP. This is attributable to the lack of growth in the Medicare-Medicaid Plan (MMP) product, which had an almost 160,000 increase in growth last AEP but only increased approximately 15,000 in the 2016 AEP. In addition there were losses in enrollment in the HMO-SNP enrollment as well as in Preferred Provider Organization (PPO) plans. The enrollment in HMOs continues to see growth, although the growth was not enough to compensate for the other losses or decreased gains from last year.

*AEP is measured by looking at February MA enrollment since the total AEP enrollment is not captured in January enrollment numbers.

For more information on enrollment trends or other Sales, Marketing, and Strategy consulting services through GHG, email ghg@ghgadvisors.com or contact me directly at dhollie@ghgadvisors.com.

Also, read about "MA Plans' Must-Fix: The Member Experience" in a blog by John Gorman.

 

Resources

For actionable advice and best practices, join us at our annual Gorman Health Group 2016 Forum, April 19-20, at the Worthington Renaissance Fort Worth Hotel in Fort Worth, Texas. During this year's information-packed two days, our elite team of experts, operators, clients, and partners will help you figure out what matters and what doesn't. We will share proven tactics to cut costs, increase member satisfaction, and manage and drive sustainable growth. The hotel room block expires on March 28 so register now  to reserve your seat!

The Medicare Advantage marketplace is evolving — are you prepared? Gorman Health Group's marketing experts have developed strategic plans for hundreds of Medicare Advantage Plans, Prescription Drug Plans, Special Needs Plans and Exchange participants. We will work with you to understand your market, mining demographic data for opportunity and finding the gaps in the competitive field into which your plan can fit. Visit our website to learn more >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>

 


Another Health Plan Cuts Commissions — Is there a trend developing?

Is there a trend developing with health plans and their offerings under the Affordable Care Act (ACA)?

Raising rates, high-risk members, and cutting agent commissions continue to be challenges for all health insurance companies offering plans under the ACA.  Some of the big plans still in the game say it's too early to bail out, and they see the ACA as a big opportunity.  But late last year, one of the largest health plans announced they would be pulling out of the ACA business. Following this news, multiple non-profit Co-Ops announced their closure, and, most recently, another large health plan providing ACA products is following suit, announcing late February they would be cutting commission on sales of individual health plans.  We can all agree changes in the structure of the individual market need to happen, but how fast can these changes be made and still accomplish profitable enrollment goals? 

With fewer options, will agents still be a necessary resource for the prospect?

In the last year, we have seen several health plans pulling back on their marketing and reducing the number of  choices for the consumer.  It appears health plans are still trying to figure out how to price the products and if they should pay commission to agents or have the prospects use online tools to navigate their health care options.  Meanwhile, agents are left with less in their pockets and wondering if there is still an opportunity for them in the ACA.

If agents generally sell plans within the Marketplace, and these continue to dwindle, where will that leave the agent?  With the uncertainty of how big plans will navigate the complexity of the ACA, it is anticipated that agents will redirect focus to Medicare for 2016:

Reason #1 — No doubt the Medicare space offers unprecedented opportunity!  With the growing number of Baby Boomers, health plans and agents continue to see limitless earning potential (nearly 10,000 people turn 65 every day).

Reason #2Commissions for Medicare Advantage (MA) are typically paid on application submission for some of the large plans and include lifetime renewals, which means agents and agencies get paid as soon as an application is submitted, and, after 13 months of enrollment, the agent and agency receive a prorated monthly commission for the life of the policy.

Reason #3 — Year-round selling opportunities.  These days, it's not just about the open enrollment period — many agents find a great deal of opportunity with the dual-eligible (Medicare and Medicaid) population, as these individuals can enroll year-round.

Don't get distracted by the ACA crisis, focus your time and energy on building a sustainable business in Medicare.  For more information about Medicare, Field Marketing Organizations (FMOs), and year-round selling opportunities, please contact:

Carrie Barker-Settles
Director, Sales & Marketing Services
Gorman Health Group
cbarkersettles@ghgadvisors.com

 

Resources

For actionable advice and best practices, join us at our annual Gorman Health Group 2016 Forum, April 19-20, at the Worthington Renaissance Fort Worth Hotel in Fort Worth, Texas. During this year's information-packed two days, our elite team of experts, operators, clients, and partners will help you figure out what matters and what doesn't. We will share proven tactics to cut costs, increase member satisfaction, and manage and drive sustainable growth. Register now >>

Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG's weekly newsletter. Subscribe >>

Gorman Health Group's Sales Sentinel™ provides a platform for organizations to onboard their agents, adapt to any oversight program, as well as generate commission payments. To learn more about Sales Sentinel™ or to request a demo, visit our website >>