To paraphrase Green Day, summer has come and passed. When September ends, it is time to jump into Medicare’s Annual Enrollment Period (AEP), which starts on October 15th, so waking up then is a bad plan—and maybe even a little American Idiot. There are a couple of important changes that will make this a particularly challenging season and one that plans need to be preparing for now.
New Medicare Scope of Appointment Rules Put Call Center Speed to the Test
The first change is that agents no longer need to wait 48 hours after collecting a Scope of Appointment (SOA) before holding a one-on-one plan discussion with a beneficiary. The intent is to reduce friction and make it easier for beneficiaries who know what they want to get their enrollment done.
The implication for plans is that it is critically important to improve call center operations to operate in close to real time. Plans that are slow to connect with members will find themselves missing opportunities to more nimble rivals.
Why Real-Time Medicare Call Center Operations Matter
At Engagys, we have helped health plans and their vendors improve call center performance by examining the full operating system—staffing, dialing strategy, routing logic, agent capacity, and the member experience—rather than optimizing any one variable in isolation. For example,
We worked closely with a vendor who set up in-home appointments to close healthcare quality gaps. As we dug into their operations, we learned that they were missing out on a large number of member conversations because staffing and call throttling were not optimized to reach members when they wanted to be reached. Changing these constraints immediately increased scheduling by 50%. However, like squeezing a balloon, a new bottleneck appeared: the number of abandoned calls crept up as more members were engaged and agents spent more time talking to prospects; hold times grew. Therefore, we helped the plan to dynamically throttle calls and slow them based on answer rates and real-time agent availability. Over time, we ultimately reduced abandonment by over 20%.
The point is that call center operations require a blend of people, process, and technology. All of these factors need to be monitored carefully to maintain balance.
Scheduling an Appointment Is Only Half the Job
Speed matters, but conversion does not end when an appointment is booked. Related work has helped plans and vendors increase appointments kept once set. In many office-based settings, no-shows can reach as high as 20%, causing havoc with staffing and throughput.
- In collaboration with one plan, we established a multi-channel outreach that delivered reminders to patients after inpatient behavioral health stays. These patients were connected to local resources in their communities and offered additional services, like transportation. As a result, kept appointments increased by nearly 10%.
Supplemental Benefit Reductions Are Reshaping Medicare Member Expectations
The second major challenge this season relates to supplemental benefits and coverage. While increases in medical costs are slowing, small rate increases from CMS are putting pressure on plans to find ways to manage costs. Many are cutting transportation, dental, and other supplemental benefits. Others are leaving specific geographic areas entirely. Last year, UnitedHealthcare shed Medicare members. This year Humana is planning to do the same.
Changing service areas and cutting benefits increases the odds of members being termed or leaving a plan. Those who experience either of these are far more likely to leave their next plan. The sense of loyalty and trust is broken. This means that plans bringing in new members from retreating plans need to be proactive in communicating how to use benefits and how different systems work.
Use the Annual Notice of Change to Reduce Medicare Member Churn
The Annual Notice of Change (ANOC) is often the first time a member hears of changes – if they read it. Research from large plans and Deft Research suggests that they often go overlooked. Deft Research’s 2026 Medicare Member Experience Study found that fewer than 60% of seniors recalled receiving their 2025 ANOC, and many misunderstood benefit changes even after reviewing plan documents or speaking with agents. Data shows that those who claim to have read their ANOC and interpreted it negatively are four times more likely to churn than those who interpret the changes positively.
At Engagys, we look at this as an opportunity. Framing information so that it is helpful, relevant, and positive improves engagement, increases satisfaction, and reduces churn.
- We recently worked with a national plan on welcome-back materials. Like many plans, they were cutting back on benefits. The communications focused on delighters, like the OTC benefit, and on a plan-within-contract basis, specific benefits that had at least held steady or increased. As a result, we cut grievances to the call center by 50%.
- Furthermore, by proactively delivering bite-sized bits of information when members needed them, we reduced inbound calls by nearly 10% overall. Focusing on pharmacy changes is a good example. Odds are the first interaction a member will have with a plan in the new year will be a pharmacy fill. Reducing surprises and friction is critical. We are also working with a different national plan to “reimagine” their EOB. This historically dry and confusing document is another example of a frequently overlooked opportunity to communicate with members. By using plain English, clear graphics, and positive framing, the new documents make it much clearer how the plan will save members money. We’re very excited to see these launch in 2027.
Every required communication, from the ANOC to the EOB to a pharmacy notice, is a chance to influence whether a member feels informed, supported, and confident enough to stay.
AEP is Closer Than You Think: Don’t Get Caught at the Fork Stuck in the Road
Simply put, your father’s time has come to pass. For Medicare AEP 2027, health plan leaders should focus on three priorities:
- Build speed without losing control. Use real-time routing, dynamic call throttling, and flexible staffing to respond quickly while protecting service levels.
- Communicate change before members experience it. Explain benefits, pharmacy updates, network changes, and next steps early, clearly, and in manageable pieces.
- Treat every touchpoint as a retention opportunity. Mandatory documents, call center conversations, reminders, and onboarding messages should all reinforce value and trust.
There is no reason for plans to enter AEP trembling or alone. With this season of change, Medicare plans have reached another turning point—a fork stuck in the road. The choice is clear: follow the well-worn route of reactive communication or take the path toward faster service, stronger engagement, and lasting member trust.
