Insurance Industry Must Step Up to Improve Cumbersome Medicare Process Worsened by Pandemic

By Dave Rich

In an effort to limit visits to doctors’ offices and thus possible exposure to COVID-19, the Trump administration announced on March 16 that Medicare will cover telehealth services. This move was one of the first of many proposed deregulatory decisions to cut costly rules and significantly trim healthcare, telecommunications and financial regulations.

There’s no doubt these efforts have helped provide a vulnerable population with life-saving healthcare resources vital during a global pandemic; however, they do little to help improve a complex Medicare process that has become overburdened by COVID-19.

A cumbersome Medicare system worsened by a pandemic

We’ve known for a while that the Medicare system is a cumbersome one—even without a pandemic looming over it. Medicare is highly regulated, and its associated processes can be incredibly slow. Together, these two things lead to major consumer confusion.That confusion is just one more entry barrier for a population that’s more likely to experience health concerns, and it prevents that population from finding the healthcare packages they need.

According to a 2019 study by the Kaiser Family Foundation (KFF), more than 30% of Medicare beneficiaries reported difficulty comparing plan options while nearly half said they rarely or never review their choices. According to another study by Kelton Global, nearly one out of four seniors studied said they found reviewing their Medicare plan to be one of the most unpleasant tasks they do—even worse than getting a colonoscopy or going to the dentist.

All of this confusion and frustration surrounding Medicare coverage is intensified even further by the pandemic. Job loss resulting in a loss of group coverage is pushing more Medicare-eligible people to attempt to enroll into Medicare, flooding a highly regulated, slow-moving system. At the same time, these people are facing added anxiety because of delays stemming from things like the closure of Social Security offices.

With a Contact Center specializing in Medicare solutions, we’re fielding hundreds of calls a day, many of which are from worried beneficiaries and Medicare-eligibles experiencing the same thing. They are concerned about their health during these uncertain times and are looking for guidance.

Temporary deregulation is a commendable step, but it’s not enough

There are nearly 60 million Americans enrolled in Medicare. When we talk Medicare, we’re talking about providing healthcare services to a population that makes up over 18% of the country. A population that is more likely to be prone to mobility limitations and immunocompromising ailments. A population that deserves to have convenient and safe access to healthcare services.

The coronavirus crisis put pressure on the federal government to bring telehealth services to senior and disabled people. This effort allows healthcare providers to offer more than 80 different health services over phone and video conferencing within a patient’s home.

Changes that provide for more covered healthcare services and less regulatory red-tape are creditable moves in the right direction. However, deregulatory efforts are temporary and will likely expire as soon as concerns over the virus subside. Regulators need to consider making changes like these permanent. While the telehealth change has helped countless people stay safe, it should have happened pre-pandemic, and we hope that it will stay in effect after COVID-19.

The insurance industry must do its part

While we can hope for further deregulation by the Center of Medicare and Medicaid Services (CMS) to help make the best use of available resources, we need to start thinking about how the insurance industry as a whole can help ease the burden placed on Medicare beneficiaries during and after this pandemic.

It’s time for the insurance industry to focus on providing consumers with the transparency they need to make educated decisions about their Medicare. This transparency goes beyond offering educational materials and comparison tools. Providing just access to these aids isn’t enough.

For example, evidence shows that comparison friction drives a wedge between the availability of comparative information and consumers’ use of it. Despite consumers having convenient access to comparative tools, this means they are less likely to use those tools when there is no intervention from outside sources, like insurance providers. Furthermore, those who don’t use those comparative tools save less money on their premiums than the ones who do.

That isn’t to say premium savings should be the only concern, though. Any friction that hinders a Medicare enrollee from learning about or comparing their options is a threat to their healthcare. If enrolled in a plan that is less than optimal for their needs, Medicare beneficiaries can fall into sizeable benefit gaps or even experience enrollment penalties. Both of these outcomes can be detrimental to a person’s health or financial status during a drastic health scare, like a pandemic.

So, what causes this friction, and how do insurance providers help intervene? As discussed above, there are several barriers that make shopping for Medicare abrasive. Of which include its complexity and the confusion resulting from it as well as bloated regulatory standards. To combat these issues, insurance providers must make tools like online quoting comparison, AI-based needs analysis and automatic underwriting a part of people’s everyday lives.

Soon it will be possible to remove the need for an agent in the buying process by using web-based tools, predictive analytics and direct access to the data needed to match a person to a product. The faster we can get there, the more prepared we will be for the next global catastrophe – despite any regulatory constraints.


Dave Rich, CEO of Ensurem, has held various positions over his 35-year career in the insurance industry. Experienced in both the home office environment and independent distribution companies, Dave has a unique understanding of home-office decision-making as well as agent and consumer preferences. For the last 10 years, Dave has held the positions of chief operating officer (COO) and chief marketing officer (CMO) of Amerilife Group LLC., one of the largest insurance marketing companies in the country. As CMO, Dave helped acquire distribution and design unique products in the life, health and annuity marketplace. As COO, Dave helped facilitate the reduction of expenses while increasing data security by consolidating servers, instituting security protocols and firewall systems. For more information on Ensurem, visit