Designing for clarity: The new standard for AEP performance

Health plans go into the Annual Enrollment Period (AEP) with clear goals: acquire new members, reduce churn, and grow market share. But despite sophisticated marketing campaigns, digital tools and trained agents, many plans fail to meet performance targets.

The root cause often isn’t poor campaign execution. It’s something more fundamental- member confusion.

Medicare Advantage plans are complex. Benefit tiers, formularies, network limitations and cost structures are difficult to understand, even for highly engaged members. And when people feel unsure or overwhelmed, they hesitate. They drop off. Or worse, they make decisions that lead to dissatisfaction and switching later on.

This isn’t just a communication issue. It’s a clarity issue. And unless health plans address it directly, they will continue losing members not because of what they offer, but because of how it’s presented.

What decision makers are really searching for before AEP

1. How do we reduce drop-off during the enrollment process

Member drop-off rarely comes from a lack of interest. Instead, it happens when the process creates friction, usually at moments where clarity is missing.

Some of the most common points of hesitation include:

• uncertainty about prescription drug coverage

• not knowing whether their current doctor is in-network

• confusion about out-of-pocket costs for specific services

These aren’t complex questions, but they are deeply personal. And when members can’t find clear answers quickly, they stall. And in the context of AEP, hesitation leads to churn.

Improving this part of the journey isn’t about adding more information. It’s about delivering the right clarity, at the right moment, through intuitive experiences.

2. How do we simplify benefit explanations without losing CMS compliance

CMS requires that plans provide accurate, accessible information but accessibility does not mean complexity. In fact, CMS CAHPS surveys specifically assess whether members feel they understood their coverage. Plans simply need to translate dense terms into everyday language.

For example:

• “Tier 3 coinsurances” becomes “you’ll pay 25 percent of the cost for this medication”

• “Non-preferred specialist” becomes “you may pay more to see this provider”

Clarity builds trust. And trust leads to higher satisfaction, fewer support calls, and stronger star ratings.

What does a high-performing, clarity-first enrolment journey look like

A well-designed AEP experience does not start with benefits. It starts with the member.

In a clarity-first journey, members can:

• understand the difference between plan options in under five minutes

• find out whether their doctors and prescriptions are covered

• navigate the enrolment process without needing to speak to an agent

• receive help in their preferred language, on their preferred device

This level of simplicity may sound ambitious but it’s achievable, especially when supported by tools like Mia, a voice-first, AI-powered assistant built specifically for Medicare Advantage plans.

Mia helps members:

• understand plan details using plain language

• get real-time answers to specific questions

• search for in-network providers near their home

• receive support in the language they understand

With Mia in place, clarity becomes consistent, scalable, and immediate without placing added strain on your agent network.

What CMS and member data tells us about the cost of poor clarity

CMS and industry data confirm what health plan leaders already suspect.

According to a recent Drips AEP report, many plans saw improvements in engagement when communications focused on plan understanding and support.

In another survey of Medicare Advantage enrollees:

• 17 percent said they do not feel confident in their understanding of plan benefits

• 18 percent said their plan did not meet their personal health or lifestyle needs (Insurancenewsnet.com)

And in 2025, plan disruption is adding more confusion. A rising number of members are experiencing involuntary terminations or changes to coverage, requiring them to re-evaluate their options during AEP, even if they didn’t plan to switch (Medi-Solutions Survey).

The conclusion is simple: confused members are less likely to convert, and far more likely to churn.

What health plans can do to deliver clarity during AEP

You don’t need to overhaul your entire enrolment system to improve clarity. The best-performing health plans are making targeted changes in a few high-leverage areas.

1. Give members instant help

PDFs and FAQ pages are rarely enough. What members want are instant answers to their personal questions.

Tools like Mia allow members to speak naturally- “Is my cardiologist covered under this plan? " and get clear, compliant answers in real time, without waiting on hold.  

2. Help members search providers by location and specialty

Provider search tools are a major source of drop-off. If members can’t easily verify that their doctor is in-network, they’ll assume the worst.

Give them tools like Mia, that let them ask questions the way they would speak to an agent:

• “Is Dr Patel covered?”

• “Show me primary care doctors in Brooklyn”

3. Explain coverage using relatable scenarios

Telling a member that “ambulance transportation is covered” is vague. Tell them what it means:

“If you need to take an ambulance to hospital, this plan pays for it.”

Narrative clarity builds confidence. And confidence drives enrollment completion.

4. Speak their language

Many members speak English as a second language or not at all. Give them clarity by offering support in their preferred language, helping them feel seen, heard and understood.

FAQs

How can we tell if our enrollment process is causing confusion?
Look for high abandonment rates, repeated member questions, increased support calls around basic plan details, and post-enrolment dissatisfaction. These patterns suggest gaps in clarity.

Can we improve clarity without breaching CMS regulations?
Yes. CMS encourages clarity and member understanding. As long as your communications are accurate and disclaimers are available, you can present plan information in plain, accessible language.

Can we deploy tools like Mia without rebuilding our systems
Absolutely. Mia can be integrated into your website, IVR, or mobile experience as an added layer of support. It complements your existing enrolment journey without requiring a full redesign.

What is the impact of clarity on star ratings
Clarity contributes to higher satisfaction and better CAHPS survey results. CMS measures how well members understand their plan and get the care they need. A clearer experience improves these scores.

Conclusion

Health plans that focus on clarity outperform those that rely solely on scale. In a Medicare Advantage market where members are comparing more plans, encountering more disruption, and receiving more marketing than ever before, your best advantage is simplicity.

If your enrollment journey is clear, supportive, and easy to navigate, you won’t just win new members. You’ll keep them.

And that’s the outcome AEP is about-not just enrollment, but long-term trust and retention.

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