Managing the Medicare Maze for Retirees

Four women working in cubicles in a brightly lit office

As a Co-Founder of RetireeFirst, I remember our earliest days when we were not only working intensely to obtain healthcare plans for Labor union retirees (members), but we were also acting as their “voice”, helping to advocate on their behalf when issues arose with prescriptions or providers. 

Back then, we had just one employee handling member advocacy. She would proactively contact pharmacies, providers, carriers, and other entities to resolve issues on members’ behalf. Whether the challenge was members being told that their drug wasn’t covered, that their provider wasn’t in their plan, or any number of other issues that arose, she wouldn’t stop working for our members until everything was resolved successfully. 

This type of compassionate, empathetic care was a model for all our early Advocates and, therefore, she and many others are now RetireeFirst Executives leading our growing Client and Member Account Management teams. 

Fast-forward 10+ years, and this Advocate’s work has formed the foundation for our Retiree Advocacy Services. Medicare plans are extremely complex for members to navigate, and members can easily get confused and frustrated on where to seek help with their questions and problems. Hear from members themselves about these common frustrations in this video below.

Given the confusion, the need for human-centric member advocacy is critical and, as a result, we now have over 100 employees (and counting) dedicated to ensuring that every member receives live, compassionate support in working through their multitude of issues and challenges. 

“Above and Beyond” Member Advocacy 

As our team grows, we diligently train our Advocates to focus on going to the greatest lengths possible in serving our members. This type of empathic care is indicative of the value that we provide not only to members, but also to clients, carriers, consultants, and other partners. 

This proactive, “above and beyond” approach taken by our Advocates is reflected in many ways. Here is just a sampling: 

  • Calling pharmacies, providers, carriers, and other entities to resolve issues on members’ behalf 
  • Phoning members to ensure they received their medications from a mail-order pharmacy 
  • Contacting members to confirm that their provider appointment went as planned 
  • Reaching out to transportation services to source lowest-cost transportation options for members without access to transportation 

Closing Gaps in Care to Enhance Member Health and Wellness 

Beyond member issue resolution, a key initiative of ours is ensuring long-term member health and wellness. Through our Gaps In Care program, Advocates on our Wellness Team connect members to programs covered by their carrier that can improve their health and wellbeing by closing gaps in care.

Examples of how our Advocates proactively engage members to take ownership of their health include: 

  • Scheduling an in-home provider visit to assess members’ physical, nutritional, and mental health, organize medications, conduct a safety assessment to identify hazards, and much more 
  • Scheduling yearly well visits and immunizations 
  • Scheduling preventative colorectal and breast cancer screenings 
  • Educating members on additional wellness initiatives that included in their plan 

More engaged members means happier and healthier members—driving value for the plan sponsor and carrier. We’re extremely proud of the Gaps In Care initiative – it’s full-service retiree healthcare advocacy unlike anything else in the industry.

Breaking Through the Noise: With Members, Communications Are Key 

In addition to phone outreach for advocacy and educational purposes, my team and I have found that high-touch communications through various mediums help members to better understand their plan benefits. 

Following are various of modes of communication that are highly effective in engaging members: 

  • In-person meetings with printed handouts written in 12-point font or larger 
  • Educational webinars with one-click access to video conferencing platforms 
  • Videos 
  • Letters and documents that emphasize timelines of deliverables 
  • Simple retiree webpages 

Additional Resources for Your Benefit 

I was honored to speak at the State and Local Government Benefits Association (SALGBA) Conference last month and at a webinar that RetireeFirst hosted last week. In addition to covering the topics above, I provided an overview of the complex Medicare landscape, Medicare plan design and implementation best practices, and the most common retiree questions about their benefits and Medicare.

Lastly, part of our webinar featured a discussion of a successful Medicare migration for the City of Lynn and City of Fall River, two mid-sized Massachusetts municipalities. It’s a terrific example of how we can help plan sponsors in providing enhanced Medicare benefits to their members, generating significant cost savings, and reducing their administrative burden in plan implementation and member advocacy/engagement. You can view the full case study here

Please contact us with any questions you have – we’d love to hear from you! 

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