Force Multiplier: OBBBA x Medicare Advantage Member Communications

By Chris Shiffert

The impending policy shifts from the “One Big Beautiful Bill Act” (OBBBA or H.R.1) put Medicare Advantage (MA) plans in a unique and enviable position when it comes to member communications.

Not what you expected, right? But don’t stop reading.

By implementing a multifaceted communication strategy, MA plans, particularly those serving dual-eligible and low-income populations, have the opportunity to move beyond standard, one-way messaging and communication to adopt a high-touch, member-centric approach.

The new rules in OBBBA present a great chance to connect with MA members where they are—whether online through a member portal, on their phones via text, voice calls, or apps, or through Agentic AI supported by human agents on a plan website.

OBBBA provides an opportunity to improve member communications that can be implemented with MA members now and extended to commercial members in the future.

New Policies Need New Communications

With OVER 34 million Americans enrolled in Medicare Advantage, OBBBA changes affect many health plan members. And the ongoing modifications could influence long-term member health and payer financial results. (H.R.1 mainly targets Medicare and Medicaid, with substantial attrition of Medicaid beneficiaries. Medicaid and Children’s Health Insurance Program benefits will be cut by $1.02 trillion, mostly by eliminating at least 10.5 million people from the programs. Of the more than 10 million people losing Medicaid coverage, 1.3 million would remain eligible for Medicare while losing Medicaid coverage.)

For the new eligibility restrictions, communications must focus on providing clear, accessible information.

New communication methodologies can impact these challenges:

• Elevated out-of-pocket costs for members are a threat to care utilization. When members face higher out-of-pocket costs, they are less likely to seek care. This leads to a rise in avoidable hospitalizations and ED visits, which affect member health and Star Ratings scores.
• Churn from frequent redeterminations destabilizes the MA member base. The increased frequency of eligibility checks for dual-eligible members creates a significant administrative burden. This can cause breaks in coverage, disrupting care plans and undermining the ability to meet quality and health metrics.
• AI-powered audits introduce new operational and compliance risks. As sophisticated AI audits come into play, MA plan administrative teams face a new level of scrutiny. This can lead to increased audit volume and require significant investment in internal compliance systems.

Scaling Personalized MA Engagement

As humans, we are masters at personalized engagement. But high-touch human support is not easily scalable for MA plans. To create a sound strategy, MA plans must understand not only an individual’s personal needs but also ways to counteract OBBBA changes at scale.

Despite vast repositories of data, payer databases have been traditionally siloed. Companies often rely on standard reporting and ad hoc analytical processes that fail to fully leverage member-level data across departments and functions, resulting in missed opportunities to better understand and support members.

By contrast, AI-enabled predictive capabilities can create a comprehensive whole-person view of each member’s healthcare goals and objectives, consumer behaviors, communication likes and dislikes, as well as other factors. With these insights at an MA plan’s figurative “fingertips,” it becomes much easier and more efficient to communicate with members not as ID numbers but as real people with complex, often contradictory, expectations.

An MA plan using these concepts will become the trusted source of truth on how OBBBA impacts individuals. Use H.R.1 as a foothold to strengthen a health plan’s MA brand as a compassionate and reliable partner in navigating a complex and changing system.

The Force Multiplier

The force multiplier is uniting OBBBA changes, technology like AI, MA plans, and MA members in such a way that the combination creates an experience greater than any single event or entity could on its own.

Here are a few ideas to help MA plans get the most out of the new environment by leveling up member relationships:

Get to Know Each Member

To provide a high-touch experience, you need to understand each member’s unique story. A digitally supported strategy, powered by data, allows the creation of a personalized experience. By using data on who members are, why they joined, and what their expectations are, you can drive more meaningful interactions that reinforce your brand as a trusted partner. Use multi-lingual agents or live translation services to ensure every member feels welcome.

Cultivate Trust

Trust is essential for retention. Using advanced analytics, MA plans can identify and mitigate negative experiences that could undermine trust, such as unanswered questions or poor service, before they lead to disenrollment or social media confrontations.

Prioritize Star Ratings

Star Ratings can be a driver of enrollment and financial success, with strong ratings potentially boosting enrollment. Because retention directly impacts an MA plan’s score, a data-driven, personalized communications strategy can improve ratings by tracking and addressing a member’s experience throughout their journey.

Hopefully, I’ve convinced you that OBBBA is an opportunity rather than an obstacle to overcome. Not only is H.R.1 the new normal, it’s a new way to look at interacting with MA plan members using innovative technologies to create operational advancements that can reinvigorate MA plans, making them more efficient and effective today and in the future.

Looking for deeper insights?
Download our companion white papers to explore actionable strategies for both payers and providers:

[Download] The One Big Beautiful Bill Act: A Strategic Guide for Payers

[Download] The One Big Beautiful Bill Act: A Strategic Guide for Providers