Thinking about 2028 Medicare Advantage Plan Design? January May Be Too Late

Every fall, we see the same pattern. Health plans wrap up AEP, take a breath over the holidays, and then in January the calls start: “We need to test our 2028 Medicare Advantage plan design. How quickly can you turn this around?”

The honest answer is usually: faster than we’d like, and slower than you need.

CMS Medicare Advantage submission deadlines don’t move. And when plan design research is compressed into the months between January planning meetings and submission, there’s less time to make sure the research is focused on the right questions and enough time afterward to use the findings to evaluate and refine plan options.

Good plan design research starts before the study does

Research to inform Medicare Advantage plan design isn’t just about fielding a survey or running a conjoint.

Before the research begins, teams need to determine which plan attributes and levels should be tested across areas such as premium, MOOP, supplemental benefits, network breadth and Part D benefits. Those choices need to reflect what the health plan could realistically offer and the competitive decisions it is trying to make.

There also needs to be enough time to recruit the right Medicare audience, particularly when the research requires specific plan types, geographies or member segments.

And the end product should be something product and actuarial teams can actually use to evaluate different scenarios, not simply a set of research findings that gets reviewed once.

Rush those key decisions, and you risk getting a precise answer to a question that wasn’t quite the right one.

Start with the decision, not the methodology

The plans that get the most value from this type of research don’t start with, “Let’s run a conjoint.” They start with the decisions they need to make.

Where are we most exposed competitively? Which benefits may be costing more than the value members place on them? What combination of benefits and costs could make our plan more competitive in a particular market?

Those questions should drive the research design.

Starting earlier gives you time to decide what you really need to learn, design the right research around those questions, and put the findings to work before plan submissions are due.

In practice, that might mean:

• Agreeing on the two or three strategic questions the research needs to answer
• Developing an attribute list with input from the people responsible for pricing and administering the benefits
• Allowing time for qualitative work before launching the larger quantitative study

None of this requires starting with a fully developed research plan. It simply means bringing research into the discussion before the deadline begins driving the decisions.

Starting earlier gives you more options

One example comes from work we did with a major health plan to help redesign its Medicare Advantage plans using a build-your-own-plan survey approach. Consumers could make tradeoffs between benefits and costs in a way that more closely reflected the choices involved in selecting a health plan.

Just as important as having time to conduct the research was having time afterward to use the simulator TRC provided, explore different plan options and understand their potential impact before finalizing the plan design.

You can read more in our Guiding Consumers to Build Their Own Health Insurance Plan case study.

The 2028 window is open now

If your team is beginning to think about 2028 Medicare Advantage strategy, now is a good time to bring research into the discussion.

Not after the strategy has already been set and research is primarily being used to validate it. And not in January, when the calendar starts limiting which questions you have time to answer.

Starting earlier gives you more opportunity to decide what you really need to learn, design the right research around those questions, and put the findings to work before bids are due.