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Winning strategies for election-year and regulatory disruption

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Navigating 2025 AEP/OEP: Winning Strategies for Election-Year and Regulatory Disruption

Heading into the 2025 Annual Enrollment Period (AEP) and Open Enrollment Period (OEP), health plans face a significant season of uncertainty : the twists and turns of an election year coupled with growing competition and material regulatory changes. These factors are stirring up a maelstrom, making it increasingly challenging for plans to not only attract new members but prevent current members from switching plans.

Empathy-Driven-Support

Health plans are gearing up for their toughest AEP/OEP season yet

Medicare Advantage (MA) plans are under pressure from nominal payment rate and regulatory changes

With 11K baby boomers entering Medicare each day, CMS projects enrollment to grow exponentially to 76M by 2031. MA plans, however, face intensified competition amidst shifting payment rates and increasing regulatory pressures. CMS payment rates for 2025 are expected to increase by just 3.7%. Moreover, the proposed CY 2025 rule introduces regulations aimed at enhancing beneficiary protection and equity.

Meanwhile, the commercial insurance landscape continues to shift.

Between 2018 to 2022, government programs like the Affordable Care Act (ACA) surged ahead, outpacing employer-sponsored insurance. Self-funded plans saw a significant increase, signaling a shift from fully insured options, increasing competition, and creating margin pressure.

In response, plans are adjusting benefit designs by either reducing coverage or raising premiums to manage costs.

This change is expected to prompt MA beneficiaries and members to reassess their current plans, resulting in higher churn rates during the 2025 AEP/OEP. Last AEP saw a notable increase in plan switching–with 13% opting for new coverage, the highest rate since 2015–a trend that is expected to continue.

Scaling up for AEP/OEP is never as simple as flipping a switch, and this year the election disruption adds an extra layer of uncertainty.

To stay ahead, health plans must swiftly reassess their member engagement strategies and keep a close eye on regulatory updates and market dynamics.

Strategies for AEP/OEP success in a volatile environment

With the heightened landscape expected to spur more aggressive marketing and sales strategies, relying on last year’s playbook may not be enough. Proactive development and meticulous execution of innovative strategies will be key to enhancing member loyalty and ultimately growth. Expect high inquiry volumes and devise a game plan–plus a contingency plan. Build an agile team of seasoned leaders to drive results-focused operations. Ensure your ground team comprises well-trained, licensed agents who can adapt and connect with beneficiaries personally.

Amidst the ongoing disruption, prioritizing strategic measures to retain existing members will be as crucial as attracting new ones to achieve optimal growth. Here are three tried-and-true methods to accomplish this.

Establish a dedicated ‘member retention’ unit

  • Utilize AI-driven recruitment and training to rapidly scale licensed candidate resources and accelerate their time-to-proficiency. For instance, ResultsCX’s proprietary AI chatbot Olivia, serves as an invaluable assistant and a second set of hands for our talent acquisition team by automating and accelerating time-consuming hiring tasks and promoting a candidate-friendly experience.
  • Develop retention-specific training. Ensure member calls are more than routine sales pitches. Empower licensed agents through targeted training, helping them communicate your plan’s value proposition effectively and empathetically, thereby driving market differentiation and boosting member retention.

Target frequent "Switchers"

  • Innovate marketing strategies. Identify at-risk members through data-driven outreach campaigns. Enable proactive engagement using low-cost omnichannel campaigns–phone, email, text, and IVR–to highlight plan benefits and communicate changes early.
  • Use low-volume days for effective member outreach. Agent calls during these times reduce missed calls and outreach costs, ultimately improving overall member experience.

Enroll on first contact

  • Match members to the right plan. To grow your member base, ensure seamless member enrollment right in the initial interaction. Leverage data and analytics to promptly match members with the right plans, reducing the need for further comparisons and increasing efficiency in conversions.
  • Implement Intelligent Automation (IA) solutions to monitor calls, alert supervisors, and provide real-time support to agents. ResultsCX Agent AI solution integrates AI-driven workflows to ensure timely service, accurate information delivery, and enhanced compliance, especially for vulnerable populations such as the hearing impaired.

Advancing healthcare outcomes, together

There is a lot to achieve and very little time. Collaborating with a Customer Experience Management (CXM) leader can enable you to leverage digital-first engagement systems and quickly scale your agent resources. ResultsCX specialists collaborate closely with leading health plan clients, ensuring a licensed and trained agent workforce through rigorous forecasting and efficient workforce management.

Delivering high-impact results for AEP/OEP success

Leading managed care provider of government-sponsored healthcare

At Risk campaign – Feb to Oct 2023

  • Deployed a blended Outbound/Inbound campaign
  • Contacted members likely to disenroll from their MA plan, identifying reasons such as gaps in plan understanding or broker influence.
  • Swiftly scaled agent support to meet client needs, providing ongoing empowerment through weekly feedback and recognition.
  • Insights from disenrollment reasons enabled proactive member retention and ROI generation.

Outcomes Delivered: Conversion rates above 65% and a 10% save rate.

Just Checking In–Ongoing campaign launched in March 2024

  • Initiate calls from text messages to address health plan benefits
  • Provide personalized assistance, including finding new PCPs, managing Spendable Cards, and utilizing Dental and Vision benefits

Outcomes Delivered: Conversion rate currently trending at 93.3% with a 92.17% save rate

Large not-for-profit health insurance

  • Implemented dedicated outbound skilling initiatives paired with robust incentive programs.

Outcomes Delivered: Significantly boosted conversions, surpassing AEP goals by 110% and OEP goals by 118%.

Top 5 health insurance provider

  • Transitioned 23,000 members to a more suitable plan by identifying and targeting at-risk members with a better available option than their current plan.

Outcomes Delivered: Conversion rate 35%

It’s time for a new AEP game plan

Clearly, success this year will demand more than ever before. But with the right approach you can adeptly navigate the 2025 AEP/OEP, driving excellence and growth.

Partner with ResultsCX : Turn disruption into opportunity

Supported by state-of-the-art technology, our licensed agents and seasoned supervisors strategically flex with your evolving needs, enhancing member acquisition, retention, and overall experiences.

To learn more about how ResultsCX can help you stay ahead during a challenging 2025 AEP/OEP season, reach out to us today.

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