The 2023 open enrollment period began on November 1, 2022 and ends January 15, 2023 in most states. For the next 10 weeks, employees can shop, adjust, cancel, or sign up for a health plan to begin coverage on January 1. Unfortunately, we all know that this is far easier said than done. Think about your own experience with your health insurer. Do you consider health insurance information straightforward? Is finding the right information seamless and intuitive? For most Americans, with or without a PhD in health economics, the answer is likely a hard “no.” Health insurance is a complicated financial product, and it’s constantly changing. People want trusted guidance and advice to inform their plan selections and a less painful process overall. Even just providing a few simple guidelines would simplify the customer journey. As we plunge into open enrollment and Medicaid redetermination, health insurers must address the knowledge barrier to win members and improve the customer experience.

Today, the majority of the US population has some form of coverage provided by a private health insurer. The health insurance industry is evolving well beyond payers by providing medical care, wellness services, chronic care management, and more. Insurers are bringing new benefits, digital experiences, and extended healthcare services to the table each year. But health insurers are still grappling with getting health information to members when and where they need it. Members struggle to understand their benefits, find the right information, and choose what plan is best for them and their loved ones. Empowering and engaging members with helpful information will be paramount in 2023 as the plight of current market conditions — inflation, the tightening of salaries, and a potential recession — elicit continued uncertainty. The trust imperative is front and center in healthcare, and employees are unsure about who to turn to if they have questions about their health or their health plans. As a result of feeling defeated and disappointed, many fall back on selecting the same plan every year, potentially undercutting employers’ efforts to improve the enrollment experience by adding new plans or offering coverage at new price points. Here is the breakdown of the current situation:

  • Despite digital investment, member usage remains low. Our own Forrester Analytics Consumer Technographics® data tells us that, despite investment in new digital experiences such as website and mobile app experiences, fewer than half of consumers have logged into their health insurer’s website portal or mobile app. When asked why, 25% said they did not know it existed. Health insurers must double down on member education and engagement, yet websites and member portals are failing.
  • Members don’t understand their plan options and struggle to find the right information. Members are not being navigated to the health information they need at the right time or channel. The result: Members are left in the dark, feeling bewildered and unsupported. They lack the self-confidence to choose the best plan for themselves or their loved ones. According to Consumer Technographics data, 41% of consumers wish that their health insurer would do more to help them understand their health insurance benefits, and 32% say their health insurer’s website is difficult to navigate (it is hard to find the information they want). Inexperience and incomprehension about health benefits can lead to apprehension and worry during open enrollment. In fact, according to a study done by Justworks, 62% of respondents say they don’t usually change their health insurance selections from year to year because it’s too stressful.
  • Confusion over health insurance terminology creates barriers to plan accessibility. A recent Forbes Advisor survey of 2,000 Americans who have health coverage revealed an ignorance of health insurance terms, with over three-quarters of respondents unable to identify the term “co-insurance” and nearly half incorrectly defining “co-payment” and “deductible.” Additionally, Consumer Technographics data finds that 63% of consumers expect definitions of basic health terms from their health insurer. Individuals with less education and income are at the highest risk for choosing the wrong plan. Health insurers must zero in on content accessibility for their broad member population — including furnishing content in different languages for maximum reach and impact.
  • Health insurers are failing to provide personalized recommendations. We are seeing a s seismic shift to providing more personalized, proactive care across healthcare and continued disruption. This is especially important when it comes to health plan enrollment. According to Consumer Technographics data, 47% of consumers expect their health insurer to suggest which health plan they should choose based on their personal situation. They crave real-time support and a smooth and seamless experience.

Health Insurers Should Use These Three Steps To Close The Knowledge Gap Now

If health insurers fail to tighten the knowledge gap, the cost will be poor member experience, high costs for members that choose the wrong plan, and, in the case of Medicaid, loss of coverage altogether. Health insurers should immediately spring into action:

  • Increase member engagement nudges. Using precision nudging, health insurers can encourage members to take “next best” actions. Implementing nudging to provide information on open enrollment and to remind members to sign up for their plan can boost member engagement and support them with helpful information in their moment of need. An added bonus: Nudging can improve member trust and provide members assurance at every touchpoint of their experience. Oscar Health launched a new messaging framework that simplifies member communications with the aim of increasing engagement and personalization. Other insurers should be paying attention to these differentiators and following suit to be competitive.
  • Invest in digital tools to support customer service. Digital tools such as conversational AI and chatbots can transform the member experience with 24/7 availability to interact with members, enabling them to get personalized information in real time across every channel. These tools and their functionalities augment the work of customer service employees, lowering the burden of work for quick/simple questions and allowing them to focus on more complex issues. They can answer FAQs, suggest plans, answer questions about coverage, help with onboarding, and assist with filing medical claims. Anthem is using chatbots during annual open enrollment to make it easier for employees to ask questions and select the health benefits that are right for them in their moment of need. With the rise of innovation and consumerization, we expect to see this trend continue.
  • Partner with employers, community leaders, and local health clinics to inform members. Raising member advocacy takes a village, and insurers should not go this path alone. Some health insurers are partnering with key stakeholders to educate their member population on upcoming open enrollment and Medicaid redetermination. Educational content, training courses, and other support materials can prompt employers, community leaders, and local health clinics to speak with their employees, citizens, and customers and ultimately nudge them to action. Partnering with these key stakeholders ensures access to a larger member population and a more meaningful impact.

This message is timely and clear: Resuscitate member engagement and the customer experience by eliminating the knowledge gap. Aided by digital tools and targeted communication strategies, health insurers must do the work now to win and retain members, allow members to reach optimal health and wellness, and reduce the number of the uninsured. To learn more, stand by for our data snapshot that dives into consumer attitudes toward their health insurer and for our health insurer trends 2022 report, coming soon. If you have questions about how to boost member engagement, please schedule a call with us — we would love to speak with you!