Digital Experience Transformation for Medicare Advantage: Bridging the Understanding Gap in Extra Benefits
Medicare Advantage (MA) plans have become a cornerstone of healthcare for millions of Americans, offering not only core medical coverage but also a suite of extra benefits—ranging from dental, vision, and hearing to fitness and transportation services. Yet, despite the promise of these additional offerings, a significant portion of MA members remain unclear about what their plans truly provide. According to recent survey data, 78% of MA members wish they understood their extra benefits better, and 33% specifically cite extra benefits as a main area of confusion. This knowledge gap represents a missed opportunity for both members and insurers: members may not fully utilize valuable services, while insurers risk lower satisfaction and engagement.
The Challenge: Complexity and Confusion in Extra Benefits
The complexity of MA plans is a well-documented barrier. Only 15% of surveyed members say they understand their plan "very well," while 22% admit to not understanding their plan well at all. The confusion is most acute around extra benefits—such as fitness, transportation, dental, vision, and hearing—where utilization rates lag behind core medical services. For example, while 68% use dental and 54% use vision benefits, only 28% use fitness and 12% use transportation benefits. This underutilization is not due to lack of interest, but rather a lack of clear, accessible information and support.
The Digital Imperative: Transforming Member Experience
To bridge this understanding gap, health insurers must move beyond transactional relationships and embrace digital experience transformation. Modern, patient-centric digital platforms—spanning web portals and mobile apps—are proving essential in making benefits transparent, accessible, and actionable for all members, especially those in high-need populations like Medicare.
Key Strategies for Digital Experience Transformation
- 1. Human-Centered Design for Clarity and Accessibility
Successful digital transformation starts with a deep understanding of member needs and behaviors. By engaging directly with plan participants, insurers can co-create digital journeys that are intuitive and empathetic. For Medicare populations, this means designing interfaces that are easy to navigate, with clear language and visual cues that demystify complex benefits.
- 2. Transparent, Personalized Benefit Explanations
Digital platforms can present benefit information in a way that is both comprehensive and easy to digest. Personalized dashboards, interactive FAQs, and scenario-based explanations help members see exactly what is covered, what their out-of-pocket costs might be, and how to access each benefit. For example, a reimagined online pharmacy experience can show members their medication coverage, available cost-saving programs, and step-by-step guidance for ordering or refilling prescriptions—all in one place.
- 3. Integrated Support and Proactive Engagement
Modern digital tools go beyond static information. Features like live chat, virtual assistants, and proactive notifications (e.g., reminders to use fitness or transportation benefits) encourage ongoing engagement. Integrated support services—such as care navigation, appointment scheduling, and direct access to care teams—empower members to make the most of their plans without confusion or frustration.
- 4. Omnichannel Consistency and Accessibility
Members interact with their health plans across multiple channels. Ensuring a seamless experience—whether on a website, mobile app, or through customer support—builds trust and reduces friction. For older adults or those with limited digital literacy, providing consistent information and support across channels is critical to driving adoption and satisfaction.
- 5. Data-Driven Personalization and Continuous Improvement
By leveraging data from claims, pharmacy, and digital interactions, insurers can tailor communications and recommendations to each member’s unique needs. This enables targeted outreach—such as highlighting underused benefits or sending reminders about expiring services—and supports continuous optimization of the digital experience based on real-world feedback.
Real-World Impact: From Confusion to Empowerment
A leading health insurer, in partnership with Publicis Sapient, undertook a comprehensive digital transformation to address these very challenges. Through a deep study of member needs, the insurer launched a new digital health platform featuring a reimagined online pharmacy and personalized benefit dashboards. The results were striking:
- Members found it easier to locate and understand their benefits, with no surprises in coverage or charges.
- Engagement increased, particularly among Medicare members 65 and older, who reported greater access to resources and support.
- Utilization of extra benefits rose as members became more aware of what was available and how to access it.
- Operational costs decreased as digital self-service tools reduced dependency on call centers.
Best Practices for Health Insurers
Drawing from successful transformations, several best practices emerge:
- Start with human-centered design: Involve members, caregivers, and providers in the design process to ensure solutions address real-world needs.
- Invest in modular, cloud-native architectures: Enable rapid deployment of new features and seamless integration with partners.
- Prioritize omnichannel integration: Ensure members can move effortlessly between digital and physical touchpoints.
- Automate and streamline workflows: Free up staff for higher-value interactions and ensure regulatory compliance.
- Be transparent and proactive: Clearly communicate benefit details and proactively engage members to maximize plan value.
The Path Forward: Unlocking the Full Value of Medicare Advantage
Digital experience transformation is not just a technology upgrade—it is a strategic imperative for health insurers seeking to bridge the understanding gap in extra benefits. By modernizing digital platforms, embracing personalization, and fostering transparent, supportive member journeys, insurers can empower Medicare Advantage members to fully realize the value of their plans. The result: higher satisfaction, improved health outcomes, and a stronger, more loyal member base.
Ready to reimagine your Medicare Advantage member experience? Publicis Sapient stands ready to help you put your members at the center of your digital journey—bridging the gap between benefit complexity and member empowerment.