From Confusion to Confident Transitions
The Challenge
About 10% of Client Company’s population was Medicare‑aged yet still enrolled in the group plan, creating uncertainty around eligibility, HSA use, and enrollment timing. This dynamic elevated the plan’s risk profile and medical spend. HR and Finance lacked a streamlined, disruption‑free way to guide employees toward the right coverage at the right time. Employees, meanwhile, were unsure how to compare Medicare to the group plan and feared making a costly mistake.
The IMPACT
During last fall’s open enrollment, the majority of Medicare‑eligible employees chose to transition to Medicare—clear validation of an education‑first approach. Employees reported greater clarity and confidence, and HR experienced fewer last‑minute questions and exceptions. The employer realized lower health insurance premiums from a leaner risk pool, a proportional decrease in employer HSA funding as fewer Medicare‑eligible employees remained on the HDHP, and reduced risk exposure, including the transition of a Medicare‑aged high‑cost claimant off the group plan.
The Strategy
JA partnered with HR and Finance to run a year‑long, coordinated education program intentionally timed ahead of Medicare Open Enrollment and the company’s own enrollment window. We delivered multi‑channel support: live Q&A sessions, on‑demand resources, simple decision guides, and confidential 1:1 access to benefits counselors so employees could compare Medicare to the group plan based on their own needs. We clarified Medicare eligibility rules, HSA do’s and don’ts, and mapped step‑by‑step timelines to avoid gaps in coverage. Targeted outreach, plain‑language materials, and a shared HR playbook ensured consistent messaging and a smooth transition experience.
THE OUtcome
74% of Medicare‑eligible employees elected to transition during the fall enrollment cycle, and 92% reported they felt confident in their decision after counseling. HR ticket volume related to Medicare dropped 38% during the enrollment window.
Medical premiums decreased 6.9% year over year, driven by a leaner risk pool, while employer HSA contributions declined 18% as fewer Medicare‑eligible employees remained on the HDHP. Large‑claim exposure improved: one Medicare‑aged high‑cost claimant transitioned off the group plan, averting an estimated $240,000 in projected plan spend and reducing volatility for the year.
Things Employers Should Consider
Are your Medicare communications intentionally sequenced ahead of both Medicare Open Enrollment and your own enrollment window, with accessible 1:1 counseling for personalized decisions? Can HR and Finance quantify the downstream impact—premiums, HSA outlays, and large‑claim risk—of Medicare‑eligible employees remaining on the group plan?
Build a simple decision pathway, track outcomes, and iterate: when employees are informed early and privately, transitions accelerate—and so do financial results.