Leveraging technology to compete and thrive in the Medicare Advantage dental and vision markets

Updated on October 6, 2023

The Medicare Advantage (MA) market has been on an upward trajectory in recent years. With the eldest members of the baby boomer generation now well into their 70s and an estimated 10,000 Americans turning 65 each day, MA plans are the fastest-growing segment of the health insurance market, according to the J.D. Power 2023 U.S. Medicare Advantage Study

As MA plans offer increasingly robust benefits like vision and dental care, insurers have an exceptional opportunity to launch a competitive MA plan or expand their current market share. To differentiate themselves, though, these insurers will need to innovate their plan designs and adopt digital tools to help ensure members are consistently enrolled in the right plan for their needs.

The current competitive MA landscape

Today, nearly all MA plans offer preventive dental coverage and access to some vision coverage. Currently, 88% of Medicare plans offer comprehensive dental coverage and 93% of MA enrollees have access to both eye exams and eyewear. Additionally, consumers are shopping both directly and through brokers. In this overcrowded market, only the most attractive plans and those with the best user experience will engage potential new members.

What’s more, with omnichannel customer experiences like Amazon and Google increasingly becoming the norm, consumers expect health care plans to offer some level of centricity by leveraging technology. Seniors in particular are increasingly using online sources to shop for and compare plans, including payer websites and self-service options on brokers’ websites. According to a recent survey, online search tools were the most important source of plan information during the latest annual enrollment period. In fact, the percentage of members who say they value information from payer websites has more than doubled, increasing from 14% in 2020 to 29% in 2022. 

Technology-powered solutions that shape better experiences  

Technology and digital tools are one vehicle to shape the future of Medicare Advantage benefits and administration. SKYGEN, a leading Software as a Service (SaaS) technology and third-party administration (TPA) services company, has developed several technology-powered solutions to help MA vision and dental benefits plans stand out in an increasingly competitive market. These tools can help insurers differentiate themselves by:

  • Simplifying the member experience. With seniors rapidly adopting digital tools like mobile apps and web portals, insurers have a prime opportunity to offer friendly and reliable service with distinctive senior-friendly offerings.

For instance, SKYGEN’s member web portal is built with features specific to seniors such as larger font sizes, sharper color contrast and responsive design for computer, tablet and mobile experiences. From the portal, members can easily and conveniently access claims, benefits and coverage information online, as well as prescriptions and online vendors that can fulfill and deliver prescriptions right to members’ homes. In addition, SKYGEN’s call center is available with multilingual 24/7 IVR and self-service capabilities to maximize the customer service experience.

  • Expanding access to quality, consistent care: Difficulty with hearing and vision is relatively common among Medicare beneficiaries leading to an increased need for access to stronger, more reliable plans. Through modern connectivity solutions, seniors can shop for and enroll in their dental or vision plan online, with some offering 24/7 access. Portals create enhanced experiences that enable members to choose their plan, enter enrollment information, select their billing frequency and more.

These technology solutions also allow insurers to reach more seniors and drive quality care. Insurers can build stronger plans using highly configurable, industry-specific payer portals that include benefits like access to national retailers, full lab integration and facilitating complete workflow interoperability. SKYGEN’s online self-service provider portals capture information to manage credentialing, contracts, member benefit verification, authorizations and claims, helping insurers stand out in the MA market by offering the best specialty benefits experience. 

  • Keeping costs low and driving profitability. Beyond preventive care and access to quality care, solutions that help insurers streamline and manage costs are incredibly important.Costs impact the success of MA plans at all levels, from product sustainability to market share, with cost-sensitive seniors on the look-out for competitive premiums and opportunities to save on out-of-pocket costs. Leveraging resources with technology helps insurers develop, manage and administer cost-effective MA dental and vision plans and keep administrative costs low.

For instance, technological advancements empower self-service that enables members to access benefit information and locate providers on their own terms, cutting payer costs by allowing members to manage their own care. With MA remaining the largest value pool for payers, this is an important and distinctive offering for payers to stay competitive. Other tools like SKYGEN’s Provider Select Suite help increase patient and provider satisfaction by not only offering enhanced find-a-provider tools, but identifying and driving high quality, appropriate care; recognizing and rewarding high-performance providers; and directing seniors to the right high-performing providers based on their specific needs.

Members satisfied with their Medicare Advantage experience will stay with their plan and are more likely to recommend it to their friends. That requires insurers, payers and providers alike to focus on opportunities that improve the member experience by continuing to add new portal features, self-service capabilities and tools as member needs evolve. 

Investment in digital tools like SKYGEN’s solutions present strong potential to attract and retain MA members while simultaneously reducing costs and likely improving outcomes by way of greater engagement, adherence and care coordination.

Klotz Kyle 0
Kyle Koltz

Kyle Koltz is chief operations officer for SKYGEN.