This post is part of a series sponsored by AgentSync.
How to scale your insurance organization efficiently and effectively during AEP and beyond
‘Tis the season! The Medicare open enrollment season, that is. It’s time again for Medicare beneficiaries to find the Medicare Advantage plan best suited to their unique needs. As for insurance carriers, agencies, and MGA/MGUs, the annual enrollment period (AEP) is a time to flex your operational efficiency and prove your organization is agile enough to handle the increase in business without letting producer experience fall to the wayside.
The insurance industry faces higher pressure during Medicare open enrollment
Medicare Advantage enrollment grew by over two million beneficiaries from 2023 to 2024, with an estimated 32.8 million eligible individuals currently enrolled in some type of plan.
That’s a whole lot of people who’ll be looking to insurance agents over the next few months for help understanding Medicare plan specifics and navigating the ins and outs of enrollment. The pressure is on for insurance organizations to onboard and appoint enough producers during this time to handle the increased volume of business. Is your organization agile enough to sail smoothly through this temporary expansion, or will the influx in producer count leave you struggling to stay above water?
For the unprepared, Medicare open enrollment season means:
Ballooned administrative costs
Recruiting, onboarding, managing, and offboarding additional producers during Medicare open enrollment increases your existing staff’s workload tenfold. If your current operations aren’t set up to scale efficiently, you’re stuck either paying existing staff to work more hours or paying to hire more administrative staff to shoulder the extra work. Without the ability to scale operations quickly and efficiently, open enrollment can be a real lose-lose situation for an organization’s bottom line.
Higher compliance risks
More producers means more licenses to verify and keep track of. Traditionally, onboarding and offboarding producers (plus everything in between) comes with a whole slew of regulatory requirements for each state a producer sells in, and Medicare open enrollment is no exception.
In fact, agents and brokers tasked with enrolling individuals in Medicare Advantage plans are held to even stricter regulatory standards like those set by the Centers for Medicare & Medicaid Services (CMS). In April of 2024, CMS introduced changes to the rules it sets for Medicare Supplement, Medicare Advantage, and Part D insurance carriers and agencies. We’ve published a full breakdown of rule changes and their implications, but here are a just few of the changes insurance organizations can expect going into this year’s AEP:
- Changes to Medicare billing requirements: Medicare’s final rule for 2024 tightened several billing conditions. As a result, carriers can anticipate more aggressive coverage disclosure requirements. CMS also expanded its ability to recoup overpayments, meaning carriers and agencies will likely face more pushback on claims.
- Timely access and prior authorizations: While the new prior authorization rules won’t go into full effect until 2026, proactive carriers are already taking steps to introduce more uniformity and transparency into their operations. Changes include tighter turnaround times, more detailed explanations for consumers, and adopting APIs for a more automated and streamlined prior authorization process.
- Marketing protections: Stricter regulations surrounding advertising and marketing rollouts for Medicare Advantage and Part D plans mean carriers are tightening their advertising compliance reviews and requiring producers to submit more materials for review.
Unhappy producers
Even the smallest drop in system performance can cause significant delays in producer onboarding. Slow and inefficient onboarding means longer wait times before a producer’s able to sell. When the systems your organization relies on for distribution management are unable to scale without interruption, producers suffer.
Lest you forget, Medicare open enrollment is annual, meaning the experience you provide producers with this year will influence their decision to partner with you again the next time around. If overall producer experience at your organization is inefficient, time-consuming, and messy during this year’s AEP, there’s a high chance producers won’t return, and you’ll be stuck spending even more time, money, and resources on recruiting next year.
Without a proactive and agile distribution channel management strategy, these outcomes are pretty much a guarantee for insurance carriers, agencies, and MGA/MGUs navigating the annual Medicare enrollment season. But AEP isn’t the only instance in which it pays to be able to accommodate a change in producer headcount. Consider how well your current systems might handle:
- Onboarding hundreds of emergency adjusters in the wake of a natural disaster
- Being involved in a merger or acquisition
- Rapid market expansion or entry into new verticals
Best practices for a successful Medicare open enrollment season
With millions of seniors and individuals with disabilities looking for support, Medicare open enrollment season is no doubt a busy time for our industry. Done well, AEP allows your organization to showcase just how efficient and built-to-scale its operations are. But without the right preparations and tools in place, it can quickly become stressful and expensive. Set yourself up for success during Medicare open enrollment by following these best practices:
1. Prepare staff well in advance with ample training and resources
Medicare enrollment can be a confusing time for beneficiaries. Between researching different options, understanding changes and nuances, and navigating federal websites, it’s no surprise so many individuals don’t end up changing plans during this time.
Knowledgeable producers are mission-critical to a successful Medicare open enrollment season for your carrier. It’s a good idea to provide any educational materials and resources that can help producers familiarize themselves (and their beneficiaries) with the different Medicare plans and their benefits well in advance of AEP. And don’t forget to include the 2024 CMS rule changes and their impact on your distribution force in your training.
2. Dial in your onboarding process for a top-notch producer experience
Set yourself up for a successful AEP this year and every year after by establishing positive, delightful producer experiences and working relationships from the get go. If you still rely on individual producers to manage their own data during onboarding, you’re introducing inefficiencies and increased compliance risks into your business. These things slow down a producer’s ready to sell speed and foster frustrations.
Now consider the benefit of using an automated solution to capture and process producer data automatically, eliminating time-consuming manual work from your distribution partners’ plates, and ensuring data is always complete, accurate, and accessible. Building a more efficient and positive experience fosters loyalty and encourages producers to partner with you again year after year.
3. Prioritize flexible systems and automated solutions for easy scalability
If an increase in NPNs negatively impacts your system’s performance, then effectively navigating AEP is going to be a challenge to say the least. More flexible systems can turn that challenge into an opportunity by enabling you to quickly adapt to an influx in producers with little to no business disruption.
By investing in software that allows you to maintain operational integrity as you scale without adding more overhead costs, you optimize your distribution processes to handle not only seasonal cycles like Medicare open enrollment, but also other changes your organization might face in the future.
The most successful organizations stay ahead by investing in technology that integrates with their existing systems and is capable of scaling up (and down) to meet fluctuating market demands and conditions without losing its value.
Can your distribution channel strategy handle Medicare open enrollment?
Or, more importantly, can it handle open enrollment without dropping the ball on compliance, inflating administrative costs, and/or negatively impacting producer experience? If the answer is no, it’s time to consider updating your distribution channel management strategy to include more modern, scalable solutions.
Crush Medicare open enrollment season and turn your distribution network into an asset that drives growth, rather than a bottleneck that holds it back with AgentSync. Whether you’re looking to streamline your onboarding process, tighten your compliance efforts, or fortify your business operations to handle future growth, we’ve got you covered. Talk to an AgentSync expert and start transforming your distribution channel management strategy today.
