Medicare is among the largest and fastest growing segments in healthcare. Market participants are aggressively investing to compete in this race for higher enrollment and grow their Medicare book of business.

In 2017, there were more than 57 million Medicare beneficiaries1 with an additional 11,000 people expected to turn 65 (age into Medicare) each day.2 Total Medicare spending is expected to grow at 7.1 percent annually to a whopping $1.4 trillion by 2027.3 Health insurers are looking to capitalize on this growth by offering Medicare Advantage (MA) and Medicare Supplement (MedSupp) plans. MA enrollment grew by 8 percent in 20174 and MedSupp grew by 6 percent in 2016.5 MA plans are particularly attractive for health insurers, as the revenue potential may range from $800 to $1,200 per member per month, more than five times that of MedSupp plans.6

Health plans must look beyond age-ins to compete in this market.

The switcher opportunity

Health plans traditionally focus efforts on attracting the new-to-Medicare population. However, health plans must look beyond age-ins to compete in this market. Accenture research indicates that 13 percent of existing Medicare beneficiaries leave their current plans each year, with 10 percent voluntarily switching and 7 percent switching carriers.7 Medicare switchers, therefore, represent 4.3 million (64 percent) of the ~6.7 million MA and MedSupp members up for grabs each year for health plans (See Figure 1).

Why are they switching?

Health plans can capture the switcher segment and develop relevant retention strategies to minimize churn within their existing membership by understanding the needs, expectations and shopping behaviors of existing Medicare beneficiaries.

Several factors are influencing switching behavior:

Value for money is crucial

Sixty-two percent of survey respondents who switched MA and MedSupp carriers in the past year did so because they did not believe they were offered good value for their money.

SEE FIGURE 2

Price and experience

More than 50 percent of MA and MedSupp switchers claimed they would not have switched if their current plan offered better pricing.8

SEE FIGURE 3

A growing opportunity

Medicare enrollment is expected to grow to 77 million by 2027.10 Accenture analysis shows that during this period, the addressable market for MA and MedSupp switchers will grow from 4.3 million in 2017 to 8.4 million in 2027 (assuming today’s 13 percent switching rate remains consistent).

While growth in overall Medicare enrollment will increase the number of beneficiaries eligible for switching each year, there is another important contributing factor that will drive the switcher segment to be even higher than the 8.4 million members currently estimated: voluntary switching.

How to win the race

To win in this competitive market, health plans must:

  1. Proactively identify and retain those at risk to switch. Predictive analytics that uses a 360-degree view of the member, inclusive of behavioral and call center data, can help identify at-risk-to-switch Medicare members.
  2. Simplify the shopping and renewal experience. Health plans must simplify shopping, enrollment and renewal by following service design principles and supplementing physical interaction points with digital front-end experiences.
  3. Reach for the STARs. Deepening collaboration with providers and incentivizing providers to collect member-level data is critically important to drive meaningful improvement to a plan’s STAR rating.
  4. Partner strategically. To boost acquisition of Medicare members, health plans must strategically partner with vendors that demonstrate meaningful evidence of three key attributes: lead conversion efficiency, ability to transfer leads to alternate sales channels and higher levels of compliance with regulatory requirements.
  5. Deliver consumer value. To deliver a compelling value proposition to seniors, health plans must proactively offer differentiation in the form of enhanced support for complex conditions, a higher quality network, integrated physician services, in-home care and other value-added services that enable improved clinical and financial outcomes.

1 Henry J Kaiser Family Foundation, Medicare Advantage 2017 Spotlight: Enrollment Market Update

2 Healthcare Leadership Council, “Aetna CEO: New Math for Medicare”

3 Congressional Budget Office, The Budget and Economic Outlook: 2017 to 2027

4 Henry J Kaiser Family Foundation, Medicare Advantage 2017 Spotlight: Enrollment Market Update

5 Mark Farrah Associates, Year-over-Year Growth for Medicare Supplement, April 27, 2017

6 LEK Consulting, “Why Medicare Advantage Is Marching Toward 70% Penetration”

7 Accenture 2018 Health Insurance Shopping and Enrollment Experience Survey

8 Accenture 2018 Health Insurance Shopping and Enrollment Experience Survey

9 Health Affairs, “Substantial Physician Turnover and Beneficiary ‘Churn’ in a Large Medicare Pioneer ACO,” April 2017, 36(4):640–48.)

10 Congressional Budget Office, Medicare – Congressional Budget Office’s January 2017 Baseline, January 24, 2017

Scott Brown

Managing Director – Accenture Health


Mehul Doshi

Strategy Senior Manager


Yvena Atkins

Senior Strategy Consultant

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