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The Gap
The Star Ratings
What Your CFO Wants
Year-round Deployment
The Ramp Advantage
The Question
Here is the member lifecycle event that most health plan operations teams don’t formally track, because it doesn’t appear on any dashboard as a discrete moment of failure: The day your licensed agents offboard at the end of Annual/Open Enrollment Period is the day your member experience capability drops by several orders of magnitude – and stays there for ten months.
The members your agents just enrolled are now in the hands of a care team that doesn’t know your products with the same depth, can’t navigate a benefits question with the same authority, and isn’t equipped to identify a retention risk early enough to intervene. The knowledge that your agents spent a season building walks out with them when the season ends.
This is not a staffing problem. It’s a structural decision about how you deploy a critical asset. And the plans that are rethinking it are gaining measurable advantages in Star Ratings, member retention, and, when AEP/OEP arrives again, in the cost and speed of their seasonal ramp.
What a licensed agent actually knows that your member care team doesn't
Your licensed agents passed a state licensure examination. They understand the regulatory framework that governs what can and cannot be said on a sales call. They have been trained, to understand the specific anxieties, language patterns, and decision-making processes of the member population they’re serving. A Medicare Advantage beneficiary approaching their first coverage decision is not the same conversation as a Medicaid enrollee navigating a formulary change. A trained licensed advocate knows the difference in their bones.
Your general-member care team is excellent at what they do. But when a newly enrolled member calls in January with a coverage question that they half-understood during enrollment, the resolution path is entirely different depending on whether the person answering has plan-level depth or call-handling depth.
First-contact resolution (FCR) is the operational signal here. Plans that redeploy licensed agents into member care see FCR rates improve materially – because the agent can resolve at the level of understanding the member’s actual situation, not just log the call and escalate. Escalations drop. Call handle time drops. Member satisfaction scores move. And the member who got their question answered by someone who clearly understood their plan is meaningfully less likely to churn at renewal.
None of that happens if your licensed agents are gone.
The Star Ratings connection that operations leaders are increasingly paying attention to
Member experience is not a soft metric in Medicare Advantage. It is one of the most heavily weighted dimensions of CMS Star Ratings – a rating system that directly affects your plan’s revenue through quality bonus payments and its competitive positioning in the next AEP.
The CAHPS measures that feed into Star Ratings – how well your plan’s customer service responds, how often members get needed care, how easy it is to get information – are surveys of member perception, taken across the full plan year. Not just during enrollment. Not just during peak claim events.
Plans that invest in the quality of every member interaction, not just enrollment interactions, build a structural advantage in their Star Ratings trajectory. The member who calls in March with a PCP network question and gets a confident, empathetic resolution from someone who clearly knows their plan is a different survey respondent in Q3 than the member who called and got a confused transfer.
Licensed agents deployed year-round on member care and benefits navigation programs are not just a retention play. They are a Star Ratings investment.
The operational efficiency argument — which your CFO will want to see
The cost-per-enrollment metric that your finance team watches most closely during AEP is substantially shaped by decisions made in the off-season. Specifically, by whether your licensed agent vendor has maintained a ready, tenured, returning cohort or whether they are onboarding the majority of their seasonal headcount from scratch.
A first-season licensed agent is slower to ramp, more variable in quality, more likely to generate a QA scoring flag in the early weeks of the season, and more likely to require remediation coaching that pulls your operational team’s attention. A returning agent – pre-licensed, familiar with your products, already through the compliance learning curve – hits effective performance measurably faster.
This translates directly into your AEP/OEP economics. Faster effective ramp means more productive calls earlier in the season, when member acquisition momentum is highest. Lower early-season error rates mean fewer compliance events to manage. Higher conversion rates from experienced agents mean your cost-per-enrollment comes down – not because the vendor discounted their rate, but because the program infrastructure is producing better outputs per call.
The plans that are seeing the strongest CPE performance in our data are the ones running year-round models. Not because year-round deployment is cheap – it isn’t, necessarily. But because the agents who have been active, trained, and embedded in your plan’s programs for 10 months before AEP starts are categorically different performers than agents who were licensed in July and started calls in October.
What the year-round deployment actually looks like in practice
For operations executives who manage these programs, the question isn’t whether year-round deployment makes conceptual sense. It’s whether the workload exists to justify it, and whether the economics hold.
The workload exists – and it is often sitting in your current program portfolio, underserved.
Effectuation follow-up is the clearest example. Newly enrolled members who don’t activate their benefits are your highest near-term churn risk and your most visible revenue recognition gap. A licensed agent who can call a new enrollee, walk them through their first-use experience, answer their coverage questions with real depth, and confirm their first appointment or prescription fill is not doing generalized member services work. They’re doing the work that only a plan-literate advocate can do – and the effectuation lift is measurable.
Benefits navigation is another. The complexity of Medicare Advantage benefits – dental, vision, flex cards, OTC allowances, transportation – generates member confusion that your standard care team handles reactively. A licensed advocate who understands the full benefit structure handles it proactively, correctly, and in a way that leaves the member feeling more confident in their plan decision.
Proactive retention outreach is the third. Identifying at-risk members before the disenrollment window opens – and reaching out with someone who has genuine plan literacy and is trained in empathetic, resolution-oriented conversation – changes the retention outcome. This isn’t a script-reading exercise. It’s the kind of conversation that only works when the agent actually understands what they’re talking about.
The ramp advantage that compounds over time
There is a compounding effect to a year-round licensed agent model that takes a full cycle to fully appreciate, but is worth naming here.
The agents who stay active year-round become more deeply knowledgeable about your plan, your member population, and your quality standards with each month. When your next AEP arrives, you are not restarting. You are accelerating from a higher baseline. Your QA scores don’t dip in the first four weeks of the season. Your compliance events don’t spike as the headcount grows. Your conversion rates are stronger from day one, because the people handling your most high-value calls are not in their first month on your product.
That compounding effect is real, and it is one of the structural reasons why plans that have made the shift to year-round models consistently outperform plans that haven’t – not just in member retention metrics, but in AEP/OEP outcomes.
The question worth bringing to your next planning cycle
Your next Annual Enrollment Period will be better or worse based significantly on decisions made in the months before it begins. Not just vendor selection – but how you choose to use the agents you have between now and then.
The operational case for year-round deployment is no longer a theoretical one. It shows up in FCR data. It shows up in Star Ratings trends. It shows up in CPE performance and effectuation rates. And it shows up in the difference between a seasonal ramp that hits the ground running and one that spends its first three weeks finding its footing.
If your current model has your licensed agents arriving in September and leaving in December, it may be worth asking what the ten months in between are actually costing you.
The ResultsCX’s Elite Licensed Agents Program is purpose-built for health plans that want to drive new member acquisition during AEP/OEP and build the member loyalty, Star Ratings performance, and retention outcomes that compound over time. We have exceeded enrollment goals on 9 of 12 client lines of business in the 2024 season and ranked #1 by 6 of 7 health plan clients.
Build lasting member outcomes.