What Medicare beneficiaries really want in AEP

Medicare beneficiaries’ priorities have clearly shifted. Factors beyond cost are significantly influencing consumer decision-making, presenting new challenges and opportunities for carriers and advisors.

Consumer confusion drives plan switching, while consumers place a high importance on prescription coverage and provider networks. Addressing these factors through proactive strategies, transparency and targeted education can improve retention, loyalty and consumer satisfaction.  

Here are the key consumer insights that should drive the industry to deliver better outcomes in the 2025 enrollment season.

Consumer confusion leads to switching

Consumer confusion is a major driver of plan switching, highlighting specific pain points that carriers and advisors must address to prevent dissatisfaction. About one-third of Medicare enrollees said they don’t fully understand their coverage, according to data that Centerfield Insurance obtained from more than 19,000 call center conversations and an in-depth survey of 1,000 Medicare consumers. Additionally, 17% of Medicare Advantage members said they lack confidence in their plan’s details, and 18% believe their plan includes benefits that don’t align with their needs.

These survey results show a significant opportunity for retaining existing customers by providing clear messages that explain current coverage options. For example, simple, educational answers to “Is my out-of-pocket cost for my medications changing?” or “Does my plan really provide coverage for dental care?” can help demystify complex plans.

Prescription coverage and provider networks play critical roles

Medicare enrollees often shop for new plans due to critical concerns with prescription coverage and provider networks. Prescription tiers are the No. 1 coverage concern among new enrollees and those who switch plans, but many struggle to understand how prescription tiers work. This highlights the need for simplified explanations more accessible to the average consumer. Determining the true cost of prescription drugs also can be confusing, as some drugs may be cheaper when paid out-of-pocket instead of through insurance. 

Provider networks are a major consideration, with 68% of enrollees prioritizing their networks when selecting a plan. However, many enrollees face difficulties finding in-network doctors and dentists who are accepting new patients and frequently become frustrated with inaccurate or outdated provider directories.

Consumers increasingly rely on digital research

With 98% of consumers saying they rely on online resources to research Medicare plans, the importance of clear, transparent and user-friendly digital interfaces has never been greater. However, 39% of users said they visit carrier websites and encounter challenges due to limited plan comparisons.

The need for ongoing engagement 

Although many Medicare Advantage members report satisfaction with their plans, knowledge gaps still contribute to plan switching. Among MA enrollees, 81% said they are satisfied with their provider network, and 88% report high satisfaction with their quality of care. However, 23% of those with chronic conditions said they are unaware of additional plan benefits available to them. Because one-third of Medicare Advantage enrollees said they do not fully understand their coverage, ongoing engagement can help enrollees use their benefits. Another enrollee concern is provider networks. Some enrollees worry about being able to keep their existing doctors, and maintaining their provider network is critical to ensure continuity of care.

AEP is overwhelming and time-consuming

Many enrollees find AEP challenging to say the least, leading to decision fatigue and inaction. In fact, 43% of Medicare consumers describe AEP as “overwhelming,” while 21% find it “frustrating.” Perhaps not surprisingly, consumers tend to trust physicians and financial advisors over traditional AEP advertisements. In addition, 14% of Medicare enrollees who consulted a trusted professional spent less time researching their plan options — three hours instead of the typical five hours.

Given these consumer insights, here are some strategies to improve engagement, satisfaction and retention.

1. Enhance digital transparency

Improve digital transparency by offering easy-to-understand side-by-side comparisons of available plans, including coverage, costs and benefits. Prioritize accurate, up-to-date provider directories to build trust and reduce frustration and ultimately boost retention rates. To enhance digital engagement, online platforms must provide easy-to-navigate, comprehensive and straightforward comparisons. 

2. Close knowledge gaps with education

Implement comprehensive nurture programs that provide ongoing education about plan options, benefits and changes through email campaigns, webinars and direct-mail initiatives that break down complex insurance terms into easily understandable messages. Partner with physicians and financial advisors in education efforts, as consumers are more likely to trust and act on information provided by health care professionals than that provided by traditional advertisements. Simplify prescription coverage explanations and focus on what is staying the same in the plan versus only on what is changing.

3. Optimize media for enrollment and retention

A strong media strategy can enhance consumer engagement and retention by delivering relevant, timely information across multiple channels. Use targeted digital campaigns to educate Medicare shoppers year-round, not just during AEP. By leveraging data analytics and AI-driven insights, carriers can identify key concerns within different consumer segments and tailor messaging to address specific needs.

4. Reduce AEP fatigue with year-round engagement, using AI

Proactive, year-round engagement is key to reducing AEP fatigue and helping consumers make informed decisions without the pressure of last-minute choices. AI-driven call center insights allow carriers to customize messaging, while nurture programs provide ongoing guidance to help consumers understand their plan benefits and switching implications.

As Medicare consumer expectations shift, carriers as well as advisors must focus on education and accessibility. Refining marketing strategies and addressing critical knowledge gaps can build trust, drive enrollment and improve long-term outcomes.

Kris Schneider is the Medicare leader of Centerfield Insurance, based in Los Angeles. Contact her at [email protected].