AI-Based Cyber Agent Tools Allow Medicare Shoppers to Enroll their Way

By Dave Rich

Between the four Medicare parts (A – D) and various supplemental coverage options, Medicare is a complex but customizable system. Medicare shoppers can pick and choose from a wide variety of plans and coverage options which, while convenient, the sheer number and complexity of these options can make the shopping process more difficult. To reduce these difficulties and keep up with online shopping trends, the insurance industry is exploring Artificial Intelligence (AI) and how it can help simplify the process of shopping for Medicare products.  

What Makes Buying Medicare Complicated?

According to a 2019 study by the Kaiser Family Foundation, more than 30% of Medicare beneficiaries reported difficulty comparing their plan options. According to another study by Kelton Global, nearly one out of four seniors studied said they found reviewing their Medicare plan to be one of the most unpleasant tasks they do—even worse than getting a colonoscopy or going to the dentist. So, what is it that makes shoppers so apprehensive about shopping for Medicare? 

Medicare offers a variety of plan options for beneficiaries to choose from therefore making the right plan choice requires a great deal of health cognizance. Beneficiaries must have a strong understanding of their individual health needs to ensure sure a plan’s formulary and network meets their needs. They must know the names and doses of all their prescription drugs as well as the pharmacy where they fill them and the names of their preferred physicians and hospitals. They must also be able to understand the product benefits and features they are most comfortable with, like if they are willing to pay higher out-of-pocket costs for lower premiums or if they require travel benefits or additional coverage like vision or dental.

To further complicate the process, the period in which a consumer can enroll into these plans is limited. New enrollees are only given seven months to shop for and enroll into a Medicare plan when they turn 65. Delaying enrollment until after this time can result in life-time penalties, while enrolling into the wrong coverage can leave them paying too much or receiving less coverage than they need. Furthermore, once enrolled, beneficiaries are typically given only one opportunity each year to make changes to their coverage if they discover it does not adequately meet their needs.

In addition to the aforementioned challenges, many Medicare shoppers also find themselves overwhelmed by the volume of marketing messages from insurance carriers, brokers and agents as they approach 65 and again during the annual enrollment period. Understanding who to trust, what product to choose, and which carrier or plan to select from can be confusing, leaving many beneficiaries with the wrong coverage for their personal needs. 

The Current Shopping Experience – Driven by Telesales

So, how are shoppers currently navigating this complicated shopping experience? Traditionally, seniors bought their Medicare products at home across the kitchen table from a local agent or through in-person seminars. More recently, consumers have begun to favor enrolling into plans over the phone with the help from a licensed insurance agent.

Shopping over the phone with an agent has benefits. Agents take a lot of the burden off of the shopper by providing proper needs analyses. Acting as the beneficiary’s advocate, an agent can help guide them into a plan and shoppers can complete this process in the comfort of their own homes. 

On the flip side, there are several limitations to this agent distribution model. Some agents, especially if they are employed by private insurance companies, may be limited in the plans they offer or have unintentional biases towards particular plans. Consumers are also limited to shopping only during business hours when agents are available and can experience longer-than-usual hold times during busy annual enrollment periods.

No matter how they choose to enroll, many seniors today rely on online tools to aid in the top-of-funnel shopping process that takes place before enrollment. This includes online educational content and tools like quoting apps that enable consumers to compare rates for plans. Seniors use these types of tools to get a base knowledge of product selection to better understand how the various options may meet their needs. Many shoppers tend to be more confident about discussing their options with an agent over the phone when armed with this knowledge first.

AI Provides Shoppers the Power to Enroll Their Way, Including Online

While there are many top-of-funnel online shopping tools in existence, there are very few tools available today that provide a 100% online multi-product, multi-carrier enrollment experience capable of replacing teleshopping. Using AI and machine learning, we can use logic-based experiences to complete the needs analysis and decision-making processes of enrollment, replacing a shopper’s need to physically speak with an insurance agent to select and enroll into a coverage plan. 

Using data from live agent activity recordings, AI-powered tools can also be trained to interact with a consumer according to a person’s needs, building knowledge and providing an experience personalized to that specific person. As these AI-powered tools continue to advance, they will be taught to make decisions based off morbidity projections, formulary coverage, network restrictions and more.

Technology like this will give seniors the ability and the confidence to enroll their way on their own time when and where it is most convenient for them. And, while the need for agent intervention isn’t expected to disappear completely any time soon, we believe seniors will appreciate the opportunity to enroll in whichever way suits them. 

About The Author

Dave Rich is the Founder and CEO of Ensurem. Headquartered in Clearwater, FL, Ensurem is a leading technology and product distribution company serving carriers and consumers within the massive U.S. senior market. The company provides end-to-end solutions for carriers, including product development, digital marketing, and consumer-centric front ends and back end. For more information, please visit Ensurem.com

About the Company

Ensurem, headquartered in Clearwater, FL, is a leading technology and product distribution company serving carriers and consumers within the massive U.S. senior market. The company provides end-to-end solutions for carriers, including product development, digital marketing, and consumer-centric front ends and back end. For more information, visit www.ensurem.com.