Seamless Customer Experience Begins with Enhanced Direct Enrollment



September 30, 2020

This year’s open enrollment period takes place from November 1 through December 15, when consumers can select or renew an individual exchange plan either on or off marketplace. For the millions who purchase these plans, the experience can be cumbersome and frustrating as they struggle to make complex decisions based on balancing competing interests of cost, quality, and access.

Because creating a frictionless shopping experience for customers (and especially repeat customers) should be a critical objective for health plans, the federal government has enabled a key technical enhancement to the marketplaces called enhanced direct enrollment (EDE). EDE changes the game for how consumers purchase insurance, and smart companies will optimize the upside available from EDE for their customers.

What is enhanced direct enrollment (EDE)?

When the healthcare exchanges first launched, individuals shopping for plans on a health plan’s website were unable to complete a transaction for coverage without being redirected to to first verify their eligibility. This led to confusion as customers were suddenly presented with new slates of options after having initially made a buying decision. In many cases, shoppers had to start over, or they closed out of the process in frustration. Many either never went back or went straight to when they felt ready to shop again.

EDE enables health plans and web brokers to connect directly to the Federally Facilitated Marketplace (FFM). Individual customers can complete the entire purchase process and experience without ever having to leave a health plan’s web environment. Plan research, eligibility determinations, subsidy applications, pricing, and enrollment initiation can all be completed in one unified shopping experience. In addition, once enrolled, individuals will also be able to access all CMS notices within the same application.

How does EDE improve the customer experience?

For someone looking to buy an individual health insurance plan for the first time, confusion is likely to be the defining emotional state. A research and purchase experience that includes multiple handoffs or disconnects will compound the frustration and anxiety. Plus, the underlying products—which everyone needs but hopes to never use—provide little inherent excitement or satisfaction.

Health plans spend a great deal of money in customer acquisition every year before the open enrollment period. If they don’t leverage EDE, these health plans risk “leakage” every time a hard-found potential customer is redirected to a federal site that is also prominently displaying competing products. Instead of finishing a purchase on the health plan’s website, they may start clicking around the government website and find dozens of additional options to entice them. In many cases, they may end up purchasing from another plan. This is marketing and advertising spend wasted. By leveraging EDE, the individual stays on the health plan website without having to go elsewhere to finish the process.

For health plans, the EDE functionality is not just another widget or fancy add-on; it’s a key component that offers seamless integration into existing enrollment products and workflows designed to improve the customer experience for both current and prospective members. The Centers for Medicare & Medicaid Services (CMS) has designated a small number of firms as licensed EDE entities, and health plan providers must choose a partner that has done the legwork, development, and testing to ensure their products and processes meet CMS standards.