This post is part of a series sponsored by AgentSync.
How to effectively and efficiently scale your insurance organization during AEP and beyond
‘Tis the season! Medicare’s open enrollment season, that is. It’s time again for Medicare beneficiaries to find the Medicare Advantage plan that best fits their unique needs. For insurers, 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 the manufacturer’s experience fall by the wayside .
The insurance industry faces increased pressure under Medicare open enrollment
Medicare Advantage enrollment grew by over two million beneficiaries from 2023 to 2024, with an estimated 32.8 million eligible people currently enrolled in some type of plan.
That’s a whole lot of people who will be looking to insurance agents over the next few months for help understanding Medicare plan specifications and navigating the ins and outs of enrollment. The pressure is on for insurance organizations to get on board and appoint enough producers during this time to handle the increased business volume. Is your organization agile enough to sail smoothly through this temporary expansion, or will the influx in producer numbers leave you struggling to stay afloat?
For the unprepared, Medicare open enrollment season means:
Increased administrative costs
Recruiting, onboarding, managing and offboarding additional manufacturers during Medicare open enrollment increases the workload of your existing staff 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 take on 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 manufacturers means more licenses to verify and keep track of. Traditionally, onboarding and offboarding manufacturers (plus everything in between) come with a whole host of regulatory requirements for each state a manufacturer sells in, and Medicare open enrollment is no exception.
In fact, agents and brokers tasked with enrolling people in Medicare Advantage plans are held to even stricter regulatory standards such as those set by the Centers for Medicare & Medicaid Services (CMS). In April 2024, CMS introduced changes to the rules it sets for Medicare Supplement, Medicare Advantage, and Part D insurers and agencies. We’ve published a full overview of rule changes and their implications, but here are a few of the changes insurance organizations can expect as they enter this year’s AEP:
- Changes to Medicare billing requirements: Medicare’s 2024 final rule tightened several billing conditions. As a result, carriers can anticipate more aggressive disclosure requirements for coverage. CMS also expanded its ability to recover overpayments, meaning carriers and agencies are likely to face more pushback on claims.
- Timely access and pre-approvals: While the new pre-clearance rules will not take full effect until 2026, proactive airlines are already taking steps to introduce more uniformity and transparency into their operations. Changes include tighter turnaround times, more detailed explanations to consumers, and adoption of APIs for a more automated and streamlined prior approval process.
- Marketing Protection: Tighter rules surrounding the rollout of ads and marketing for Medicare Advantage and Part D plans mean carriers are tightening their reviews of advertising and requiring manufacturers to submit more materials for review.
Unhappy producers
Even the slightest drop in system performance can cause significant delays in manufacturer onboarding. Slow and inefficient onboarding means longer waiting times before a manufacturer can sell. When the systems your organization relies on for distribution management are unable to scale without disruption, manufacturers suffer.
Not to forget, Medicare is open enrollment annually, which means the experience you provide manufacturers this year will influence their decision to work with you again next time. If the overall producer experience in your organization is inefficient, time-consuming and messy during this year’s AEP, there’s a good chance producers won’t return and you’ll be stuck spending even more time, money and resources recruiting the next year.
Without a proactive and agile distribution channel management strategy, these results are pretty much a guarantee for insurers, agencies and MGA/MGUs navigating the annual Medicare enrollment season. But AEP is not the only case where it pays to be able to accommodate a change in producer numbers. Consider how well your current systems can handle:
- Onboarding hundreds of emergency adjustments 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 people with disabilities looking for support, Medicare open enrollment season is undoubtedly a busy time for our industry. Done well, AEP allows your organization to demonstrate how efficient and scalable its operations are. But without the right preparations and tools in place, it can quickly become stressful and expensive. Prepare 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 that many individuals don’t end up changing plans during this time.
Experienced producers are mission critical to a successful Medicare open enrollment season for your provider. It is a good idea to provide all educational materials and resources that can help producers familiarize themselves (and their beneficiaries) with the various Medicare plans and their benefits well in advance of the AEP. And don’t forget to include the 2024 CMS rule changes and their impact on your distribution force in your training.
2. Enter your onboarding process for a premium 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 start. If you still rely on individual manufacturers to manage their own data during onboarding, you introduce inefficiencies and increased compliance risks to your business. These things slow down a manufacturer’s ready-to-sell momentum and foster frustration.
Now consider the benefit of using an automated solution to automatically capture and process manufacturer data, eliminating time-consuming manual work from your distribution partners’ plates and ensuring that data is always complete, accurate and accessible. Building a more effective and positive experience fosters loyalty and encourages manufacturers to work with you again year after year.
3. Prioritize flexible systems and automated solutions for easy scalability
If an increase in NPNs negatively affects your system’s performance, navigating the AEP effectively will be challenging to say the least. More flexible systems can turn this challenge into an opportunity by enabling you to quickly adapt to an influx of manufacturers with little or no business disruption.
By investing in software that allows you to maintain operational integrity as you scale without adding more overhead costs optimizes your distribution processes to not only handle seasonal cycles like Medicare open enrollment, but also other changes your organization may face in the future.
The most successful organizations are ahead of the curve by investing in technology that integrates with their existing systems and is able to scale 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, increasing administrative costs, and/or negatively impacting the 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’s 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 want to streamline your onboarding process, tighten your compliance efforts, or strengthen 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.
