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Open enrollment is an important time of year for any payer’s calendar. For payers with an individual marketplace presence, connecting with members for their health plans is the most crucial during open enrollment period. The stakes for the 2023 Open Enrollment period are even higher with the end of the Public Health Emergency and resulting Medicaid redeterminations. Payers can look to recent datapoints to understand the individual marketplace landscape and gauge the member expectations for the premiums experience.

Every year, open enrollment is an annual period in the healthcare industry where consumers can enroll in a new health plan or make changes to an existing plan. This happens across all lines of payer business from employer-sponsored plans to the individual marketplace. The significance of Open Enrollment for payers cannot be understated.

During Open Enrollment, there are opportunities for payers to attract new enrollees, as well as a need to retain current members. Ultimately, a successful open enrollment period can increase membership enrollments, demonstrate how loyal members are, and potentially improve the financial stability of a payer’s bottom-line.

The largest opportunity for payers during Open Enrollment can be in the individual market where members can enroll in a health plan without an employer sponsor, even if they were not eligible for Medicare or Medicaid. In the year’s since it was first introduced, the individual marketplace, where consumers can shop for insurance coverage, has been going strong and growing year after year.

In this blog, payers can find 8 datapoints that demonstrate the potential of the open enrollment landscape and how premium experiences can play a pivotal role.

1. The uninsured rate was at an all-time low at 7.7% in 2023.1

The Affordable Care Act was passed in part to reduce the number of uninsured Americans. Since 2010 when the law went into effect, the number of uninsured Americans is at an all-time low. For payers, that means there are more consumers who enroll in health plans through this channel.

Initially, the individual marketplaces were supported by a mandate that penalized Americans who did not carry health plan coverage. This mandate has since been overturned but enrollment has not decreased as a result.

2. 32% of Medicaid members said they will look for coverage on the individual marketplaces if they are no longer deemed eligible.2

In early 2023, the Public Health Emergency (PHE) officially came to an end. Part of the PHE ending means that millions of Americans will no longer be eligible for Medicaid coverage. A portion of those Medicaid members look to the individual marketplace to get coverage as part of the Medicaid redeterminations.
For payers, this represents an opportunity to connect with new members during the Open Enrollment period for the individual marketplaces this year.

3. 71% of payers reported calls due to member confusion and payment questions as a top challenge.3

Payers have reported call volume due to member confusion and payment questions as a top challenge to their organizations. Call volume is a direct result of a payer’s existing tools and channels not meeting the needs of their members, and likely an indicator of a poor experience with a payer’s brand. For individual members, high amounts of friction can result in choosing a different plan in the individual marketplace the following Open Enrollment period.

4. 45% of payers reported missed and/or late premium payments from members as a top challenge.3

Nearly half of payers are having trouble collecting premiums from members in a timely manner. When premiums are a late or missed, members can lose their coverage. Members can be less likely to pay if payment channels are mail and paper-based such as having to remember to pay with a paper check every month.

5. 93% of individual members want to pay premiums electronically.3

Not only do mailed paper checks make it more difficult to pay, but individual members overwhelmingly prefer electronic payment methods to pay their premiums. Electronic payment methods can include payment cards such as a debit and credit card or electronic transfer from a bank account or an eCheck.
It is important to note that premium statements can often include a payment coupon which prompts the member to write down their payment information for an electronic payment. While this is technically considered an electronic payment, this payment practice is not secure and actually negates the benefits of paying electronically like eliminating the hassle of paper and mail.

6. 81% of individual members want to pay health plan premiums online.3

Electronic payment methods enable digital payment channels for individual members to pay their premiums. This includes online payments, which is how a majority of individual members prefer to pay their premiums. Online payments are a convenient way for individual members to make payments and can also help increase their likelihood to pay.

7. About half of individual members want to pay premiums on their health plan’s website.3

There is a significant portion of individual members who not only prefer to pay online, but also want to go directly to a health plan’s website for their premiums. This datapoint represents an opportunity for payer’s to drive individual members to their website through the payment experience. When members visit a payer’s website to pay, payers can digitally engage with members and create a positive brand touchpoint to help boost retention.

8. 68% of individual members want to schedule automatic deductions for recurring premiums.3

If an individual member does not pay their premium, their coverage may lapse. For many payers, premium collections are a challenge and potential issue for member retention. An answer to that challenge may be automated payments. When payers offer automated payments, members can securely set up payments for their premiums on a recurring basis. As the majority of individual members want automated payments for their premiums, payers can offer this payment option to further increase member satisfaction and loyalty.



3 InstaMed Consumer Healthcare Payments Survey

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