Evolution Of The Medicare MarketplaceDocument Transcript
How to Come Out on Top in the Rapidly Evolving Medicare Marketplace.
If there’s one thing that has remained constant in the Medicare landscape in recent years, it’s
change. From the creation of the Medicare Advantage program to the addition of prescription drug
benefits, Medicare insurance companies have had their hands full just keeping pace with the
market. The biggest challenge? Adapting to evolving CMS advertising guidelines while still remaining
The latest regulations make this more difficult than ever. With serious restrictions placed on the
types of allowable marketing activities, private Medicare organizations have been placed in a game‐
changing situation. Many traditional sales methods will have to be severely curtailed or even
eliminated, while others will have to be retooled to meet the new requirements.
Add to those difficulties the challenges that all those marketing to seniors now face—namely, an
ever‐fragmenting audience and a new generation aging in that’s unlike any we’ve ever seen
before—and you have a conundrum that, at first glance, seems unsolvable.
However, there is a way around these problems. A sales model that not only helps to cope with
these changes, but actually gives marketers a better chance of growing—and thriving—in the
Medicare marketplace of the future.
All it requires is a change in focus. By switching the bulk of your enrollment efforts from in‐person
sales calls to Internet lead generation, you can both effectively combat the most stringent of CMS
requirements and place your organization in a leadership position in the hottest frontier of
Medicare advertising—the web.
This business model relies on a content‐rich website and Internet advertising to do most of the
heavy lifting, with phone sales consultants available to answer beneficiaries’ questions, and to help
This isn’t to say that a field sales force is no longer necessary. But instead of operating on a cold‐call
basis, these agents can be used to pursue leads first qualified through phone consultations—
ultimately increasing the conversion rate.
How does this circumvent tightening CMS regulations? By putting the consumer in the driver’s seat,
giving them control of the marketing process.
Unraveling the New CMS Guidelines.
When the last CMS rules for Medicare Advantage and Part D prescription drug advertising were
published in 2005, much was still unclear. Because the programs being regulated were so new,
officials were unsure how many insurers would participate—and how enrollees would be pursued.1
What resulted was an explosion of Medicare Advantage and Part D prescription plans. There are
now an average of 54 Medicare plan options in every state—up from just 15 in 2006.2 Because of
this, concerns have been raised that insurers are marketing too aggressively—and that seniors are
signing up for plans they don’t fully understand.3
Therefore, CMS decided it was time to both clarify existing rules and implement new ones in order
to do away with inappropriate sales activities. These new regulations put a serious dent in
marketers’ ability to approach potential beneficiaries, with rulings that eliminate:
• Door‐to‐door solicitations3
• Outbound cold calls—even to current members3
• Calls to former members3
• Follow‐up calls to people who attend sales events, unless they specifically request the
• Marketing efforts during educational events, like health fairs4
• Marketing materials in health care settings, including pharmacy counters and waiting
• Meals at sales events4
• Gifts and incentives, unless their retail value is less than $154
Even when a sales representative sets up an appointment, he or she is only allowed to discuss plans
confirmed in advance—in writing. So even if, after talking to the potential enrollee, the field agent
feels that another Medicare plan option would be a better fit, it can’t be discussed at that meeting.
Instead, another appointment has to be scheduled, and it has to occur at least 48 hours later.4
The purpose of all these restrictions is to make sure that seniors are the ones driving the enrollment
process, and that marketers aren’t pushing them to make inappropriate decisions. Sales consultants
can still contact them—both over the phone and in person—but not until the potential customer
A New Kind of Senior for a New Kind of Medicare Market.
This tightening of CMS guidelines comes just as marketers are confronting another challenge—the
dramatically changing face of the senior demographic. With the first of the Baby Boomers aging in,
it’s about to become a whole new ball game.
The Baby Boomers are the largest generation in modern history, and stand to double the total size
of the Medicare market by 2030.5 Their attitudes are also considerably different than those of older
seniors, and they are turned off by many of the tactics the majority of Medicare organizations have
come to rely on. Generally speaking, Boomers feel relatively young, healthy and take pride in
remaining as hip as possible.6
As a result, they’re far more comfortable with technology than their predecessors—and they make
full use of the web. Dissatisfied with most advertising today, this generation takes it upon
themselves to find the information they need. In fact, more than 60 percent of them currently
research health care decisions online,7 and that number is expected to continue to grow at an
Making the Internet Work for Medicare Insurers.
Since the Medicare audience is increasingly turning to the Internet for both entertainment and
research purposes, it makes sense to target them there. It also allows consumers to direct their own
search, helping to satisfy CMS’ new directives. But in order to make your sales efforts pay off in this
media, it’s crucial to have all the right tools available.
The key is to have a content‐rich website that provides a wealth of information about all your
available Medicare plan options, as well as advice on choosing the right plan and other articles that
make your site a valuable resource. Including blogs and newsletters by experts can also help boost
the amount of time your audience will spend on your site—and make it more likely that they will
ultimately enroll with your organization.
And when it comes to enrollment options, more is definitely better. While it is important to give
seniors the ability to sign up online, many people in this target market—perhaps even the
majority—still prefer to speak to a real live person before making a decision of this magnitude.
Therefore, having a qualified, knowledgeable team of sales consultants available to answer
questions and help people through the enrollment process is essential. In addition to having phone
numbers clearly indicated throughout their sites, many Medicare insurance marketers have begun
using a tool called “click‐to‐call,” which encourages customers to ask for a return call from a sales
representative by filling out a short form. By doing so, they are giving that company permission to
contact them—opening the door for ongoing outbound marketing efforts.
Other strategies for generating leads online include:
• Making PDFs of important articles and information available—but requiring seniors to give
out their contact information before gaining access
• Creating a forum that requires registration before posting can begin
• Generating a weekly or monthly email newsletter
• Requiring a name and phone number at the very beginning of all enrollment forms—
ensuring that if the enrollee doesn’t complete the process, your company can follow up
During the phone consultations that result from these leads, your sales staff can also generate
business for your field‐based consultants. Many seniors still feel more comfortable engaging in
business deals face‐to‐face, making an in‐home visit necessary. However, because these customers
will have already done a fair amount of research, chances are good that they will know which
options are the best fit for them—making it all the more likely that enrollment will be procured at
the first meeting.
Internet Lead Generation—The Key to Continued Success.
In an age of increasingly restrictive CMS guidelines, Medicare marketers have to seek creative ways
to reach their customers and continue to grow their businesses. Switching to an Internet‐based lead
generation model is both the most cost‐effective solution and the best route to take to ensure your
company remains competitive in these challenging times.
By providing consumers with the information they need to make their decision online, you’re
targeting them at a time when they’re most open to hearing what you have to say—while they’re
researching their options. You’re also giving them the power to direct the marketing process,
ensuring that when they reach out to you, you can fully engage with them in spite, or perhaps
because of, the most recent CMS regulations.
You’ll also ultimately make your sales staff—both in the call center and in the field—more
productive. That’s because the leads they receive are far more qualified than ones generated by
cold calling, and potential enrollees have already begun to establish a relationship with your
company—resulting in more completed enrollments.
There’s no doubt about it. An Internet‐based business model is the wave of the future. And the time
to get on board is now.
1. “Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Final
Marketing Provisions,” Centers for Medicare & Medicaid Services (CMS), HHS.
2. “The Growth of Private Plans in Medicare, 2006,” The Henry J. Kaiser Foundation, March
3. “What Every Producer Should Know About the Final CMS Regulations on Medicare Plan
Marketing,” InsuranceNewsNet, Inc., October 21, 2008.
4. “Medicare Issues New Rules to Enforce MIPPA Marketing Requirements this Fall,” California
Health Advocates, October 4, 2008.
5. Kim, Gary “Boomer Broadband: Boom!” IP Business News, November 19, 2008.
6. Tooker, Richard, “Capturing the Exploding Senior Market: 23 Rules for Targeting Seniors,”
7. “Online for Health: the Impact of Online Behavior on Healthcare Decisions Breakdown by
Age,” Harris Interactive, September, 2007.