Customer Contact Centers are Critical for Second Open Enrollment

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September 05, 2014

This post was originally written by Ilene Baylinson for Healthcare Reform Magazine, discussing the challenges the second open enrollment period will bring. To view the entire post, click here.

With the second wave of open enrollment for the Affordable Care Act (ACA) set to begin on November 15th, we can anticipate a high volume of newly eligible and returning consumers applying for health insurance, many of whom will be eligible for Medicaid coverage. While health insurance exchanges (“marketplaces”) and Medicaid Directors have been working to solve some issues from the first open enrollment, the second open enrollment poses new challenges.

This Open Enrollment Will Be Different

When the first open enrollment period began on October 1st, 2013, many pundits assumed that consumers would gladly go to marketplace websites and apply, select and enroll for health insurance without much need for assistance. Unfortunately, technology glitches, an overwhelming response and consumers experiencing difficulties with understanding an unfamiliar process caused an unprecedented high volume of calls, emails and web chats into the customer contact centers. These customer contact centers became a linchpin in getting consumers through the eligibility and enrollment process. Both federal and state marketplaces, as well as some Medicaid programs, immediately ramped up staffing to accommodate the increasing volumes.

For the second time around it would be easy to assume that, with many of the technology issues resolved and some valuable lessons learned, this open enrollment would be more predictable and easier to manage, but new factors will make it even more difficult to set expectations. The second enrollment period is heavily focused on bringing in harder to reach populations, which most likely will require more assistance than those from the previous enrollment period. Many of these consumers speak a primary language other than English, have little to no familiarity with health insurance, and their family members often have mixed eligibility for the different health insurance programs.

During the first open enrollment period, some consumers lost eligibility for failing to pay premiums or provide required verification of key information; others were caught in the technology and processing quagmire and never managed to enroll. If you couple both of the above states issues with a shorter enrollment period and an inconsistent and confusing renewal process, you can no longer depend on last years’ experience. In addition, a new dynamic is being introduced during and after this open enrollment: reconciling advanced premium tax credits with 2015 tax filings. Two key areas can help with getting the most out of the contact center staffing: enhanced training and contingency planning for technology glitches.

To read Ilene’s other recommendations, head over to Healthcare Reform magazine.