Unlock Your Medicare Strategy with Segmenting and Mapping

Segmenting & Mapping Your MA Book Might Be the Smartest Move You Make This AEP

In the insurance world, the Annual Enrollment Period is an agent’s Super Bowl, an energized season where preparation and performance matter. Just like football players, you don’t start the game without a solid strategy.

You may be gearing up for AEP, running drills through the agent’s playbook of contracting, carriers, technology, and marketing plans. But, if you run your season the same way you always have—in the same order, same script, and same plans—you’re going to fumble.

Sure, you need to follow the playbook to get contracted, earn certifications, and master your technology, but don’t run the same tired plays. Even the most talented agents can fumble or miss their goal. The agents who will sweep this year’s AEP will analyze and prioritize.

A new strategy for your playbook may be segmentation and mapping. It’s not more work but a better strategy for serving clients in a meaningful way. It could completely change the way you experience AEP.  Let’s talk about the best play you can run this season.

Segmenting and mapping a playbook for success

Segmenting and mapping your Medicare book of business means managing your existing clients differently. Your clients may all qualify for Medicare, but their needs, priorities, and circumstances can vary widely.

Treating your entire Medicare book the same just because everyone is eligible is like grouping apples and oranges. Sure, they’re both fruit—but that’s where the similarities end. Segmentation is a marketing strategy that allows you to streamline your outreach.

Mapping is the action that helps you organize and schedule your communication and appointment strategy based on the new segments you’ve created. This strategy is ideally suited for agents to work their book at scale with clarity and a sharper focus.

Step #1: Export your Medicare Advantage book of business

Your goal is to create a clean client list. Export your MA clients from your Customer Relationship Manager (CRM) and anywhere else you may house a list. This process may take some time, but as you review the list, fill in any missing information, update records, and merge duplicates.

Step #2: Label or tag your categories for your segmentation needs

When you export your client data, all of the fields are labeled. However, you are creating a new list, and because you’ll have some new fields, tag them for easy sorting. If you’re tasking someone else with this job, select the fields you’ll ultimately need for sorting. 

Make segmenting and mapping your strategy. Here are typical ways to segment by category, but ultimately, it’s up to your needs. As AEP approaches, this is one way to be strategic with your outreach and target your audience more precisely.

Here are examples of how you may tag and group your clients 

• Plan Type
  • Medicare Advantage (MAPD)
  • Medicare Supplement (Med Supp)
  • Prescription Drug Plan (PDP) only
  • ACA/Marketplace
  • Dual Special Needs Plan (DSNP)
  • Not currently enrolled
  • HMO
  • PPO
  • DSNP (Dual Eligible Special Needs Plan)
  • CSNP (Chronic Condition SNP)
• Carrier or Network
  • Carrier name
  • Broad or national network
  • Narrow or local network
  • Big changes with their carrier or network
  • Plan with major change or plan discontinued
• Life Stage or Age
  • Turning 65  
  • Age 75+ (may need ancillary services)
  • Age 80+ (may need caregiving support)
  • Under 65 (disabled Medicare)
  • Approaching retirement but still working (even part-time)
• Health Status and Risk
  • Changing medical needs
  • Monitored medical needs (cancer survivor, diabetic, etc.)
  • Risk of losing LIS
  • Needs annual review of drug formulary
• Financial Eligibility
  • Low-Income Subsidy (LIS), also known as “Extra Help”
  • Medicaid/DNSP eligible
  • Under 150% Federal Poverty Level
  • Eligible for special savings, but not enrolled
• Upsell Potential
  • No ancillaries such as Dental, Vision, Hearing, Cancer, Hospital Indemnity
  • Previously declined ancillary options
• Client Engagement
  • High contact: annual reviews, frequent questions, and follow-up
  • Medium contact: annual reviews, may engage 1 - 2 times a year
  • Low contact: doesn’t always make annual reviews, engages only if needed
• Location
  • For plan availability (county, state, or ZIP code)

If you serve clients in different regions or states, know the plans for each area.

• Enrollment History
  • New clients (less than 3 years)
  • Long-term clients

MA clients typically are high retention, but only when they have a solid comfort level with their agent. Maintain contact at least twice a year with new clients.

• Communication Preference and/or Style
  • Phone
  • Text
  • Email
  • Mail
  • Digital-friendly
  • Prefers in-person

Ensure that all of your communication is permission-based according to the method and CMS requirements for compliance. When communication is within compliance, reach them by the methods they prefer, if possible.

• Ancillary Benefits Interest/Usage
  • Dental
  • Vision
  • Hearing
  • OTC card
  • Grocery card
  • Fitness program (ex. SilverSneakers)
  • Transportation

Enables agents to see who values their plan’s extra benefits and may be open to plan upgrades.

• Prescription Drug Usage
  • High-cost prescriptions
  • On formulary 
  • May be impacted by changes in Part D (ie. insulin)
• MA Benefits Usage
  • Used Annual Wellness Visits in past 12 months
  • Frequent visits to medical facilities and specialty providers
  • Rarely uses benefits
• Retention Risk
  • First-year MA client
  • Multi-year same plan client 
  • Plan switcher client (jumps plan to plan)

More than 10% of first-year MA clients change plans, which means they can change agents. Clients who stay with a plan too long, or switch every year, might be looking elsewhere because their plan doesn’t meet their changing needs. Annual reviews are imperative to this dynamic and to strengthening the agent-client relationship.

• Red Flags
  • Client missed annual review
  • Client confused about coverage
  • Client’s plan no longer offered
  • Copays changed significantly
  • Client’s physician left network
  • Carrier’s CMS star rating dropped
  • Client is on a Do Not Contact (DNC) list
  • Last contact date 6+ months

You may not need to create every one of these segmented lists. Customize the lists to your specific needs. Once you review each opportunity for segmentation, group your clients in a way that aligns with your goals.

If your goal is to catch clients before they fall between the cracks, segment for Retention Risk and Red Flags. Suppose you have a large number of clients who use prescription drugs. You can segment for Prescription Drug Usage. Make your segments make sense for you.

Step #3: Triage your lists based on risk level and needs

Now, it’s time to rate your clients in order of their risk level. Think of this step like a hospital emergency room where you are presented with all risk levels. Triage your client segments in order of risk level or engagement.

Consider setting your priorities as High Risk, Medium Risk, and Low Risk. Your goal is to prioritize your clients who need your help the most. Customize your formula for what you feel is High, Medium, and Low Risk. 

• High Risk Clients
  • Chronic medical condition or change in that status
  • Risk losing coverage, plan discontinued, or a change in financial eligibility
  • Called with major concerns, complaints, or confusion
  • Low satisfaction
• Medium Risk Clients
  • Changes with new medical needs
  • Losing their in-network physician or specialist
  • Missed their annual review
  • Haven’t been in contact for a year or more
• Low Risk Clients
  • Had an annual review
  • Happy and satisfied with their plan
  • Return calls and reach out if they have questions 

Time to set your priorities. For this example, the priorities are Urgent Care, At-Risk, Retention Focus, and High Opportunity. Choose your priorities to only segment the data lists you’ll need for mapping.

Priority Order (for AEP):

• Urgent Care: Clients with significant changes, discontinued plans, etc.
• At-Risk: Clients who need a plan that aligns with their physician and drug formularies, and are unhappy with their plan
• Retention Focus: Clients are researching and need education to make good decisions for plans that fit their needs. 
• High Opportunity: Clients want vision coverage and dental work, so ancillary services are a strong need

Step #4: Mapping your clients for meaningful and lucrative outcomes

Your goal is to map your segments into action items. This triage of your MA book will provide you with a clearer visual of how vital your outreach is at specific intervals. It’s only effective when you target the right audience through the drill-down approach.

Timeframe Goal Mapping

August through September, AEP Prep

• Send a letter, email, or call your High Priority clients

October 1 through 14, Preview Time

• Send plan previews to clients who need new plans

October 15 through December 7, Review & Switch

• Assist High-Risk clients first to get them covered

December through January, Retention

• LIS/DSNP check-in, send Thank You cards, and conduct surveys

February through June, Mid-Year Review

• Clients who use their benefits and want education

Once you begin this process and incorporate it into your annual planning for AEP, the benefits of resegmenting and remapping will become evident through increased growth, improved retention, and a higher level of client satisfaction. 

Segmenting and mapping could be your edge this selling season. This AEP, there is no room for missed opportunities or playing without a strategy. At Messer, we help agents make every move count and turn every opportunity into a win.

We understand that even the most talented players can lose the game if they don’t play strategically. That’s why we’ve been serving independent agents for more than 20 years, providing resources, education, training, and technology. 

Partner with Messer for the best play you can run this season!