Every fall, Medicare Advantage and ACA member services organizations staff open enrollment like a one-time emergency. The requisition goes out in August, temporary hires ramp through October, and by January, when the hardest calls of the year arrive, the people answering the phones are the least experienced they will be all season.<\/p>\n\n\n\n
That is not a staffing plan. It is a recurring crisis, and the cost lands where the seasonal budget never looks: complaint volume, disenrollment, and the member experience scores that increasingly decide your revenue.<\/p>\n\n\n\n
This post makes the operational case for a different model. Instead of assembling and disassembling a surge force every year, the plans that hold their numbers run one continuous, dedicated team across the full October to March arc, serving both their Medicare and ACA books at once. Here is why that matters more than it used to: member experience is becoming the score, and the call center is where it is won or lost.<\/p>\n\n\n\n
For years, plans could absorb a rough call-center season because administrative and clinical measures carried the rating. That cushion is disappearing, and the timing puts the call center at the center of the Star Ratings math.<\/p>\n\n\n\n
Beginning with the 2026 Star Ratings, the per-measure weight for patient experience, complaints, and access measures moved to 2, down from 4 in prior years (Centers for Medicare & Medicaid Services, 2026b). At first glance, that reads as experience matters less. In practice, the opposite is happening. CMS is also removing several high-performing administrative measures that plans long relied on as a safety net. As those measures come out, the surviving experience measures become a larger share of what remains. Press Ganey estimates the removals equate to roughly $1.3 billion in lost Quality Bonus Payment dollars when applied to the 2026 results, and projects that CAHPS and HOS together will approach 40 percent of total Star weight by 2029 (Press Ganey, 2026).<\/p>\n\n\n\n
The timing makes the call center decisive. CAHPS surveys return to members’ hands in March 2026, which means the first-quarter experience, the same window when seasonal teams are thinnest, is what members carry into the survey (Press Ganey, 2026). Plans are explicitly advised to stabilize operations and avoid disruptive telephony changes during the call center study period.<\/p>\n\n\n\n
The conclusion for an operations leader is direct. The member services team is no longer a seasonal cost center to be minimized. It is the lever that determines next year’s rating and the revenue associated with it.<\/p>\n\n\n\n
Most staffing models treat open enrollment as a single fall spike. The actual calendar is a six-month operational arc with two distinct surges, across two product lines that peak on overlapping but different schedules.<\/p>\n\n\n\n
On the Medicare side, the Annual Enrollment Period (AEP) runs October 15 to December 7, with coverage effective January 1 (Centers for Medicare & Medicaid Services, 2026a). The Medicare Advantage Open Enrollment Period (OEP) then runs January 1 to March 31, giving members already in a Medicare Advantage plan a one-time switch (Centers for Medicare & Medicaid Services, 2026a).<\/p>\n\n\n\n
On the ACA side, open enrollment for 2026 coverage ran November 1 to January 15 in most states (KFF, 2025). Beginning with the 2027 plan year, that window shortens and ends December 15 in many states, compressing the same volume into fewer weeks (healthinsurance.org, 2026).<\/p>\n\n\n\n
Read those dates together, and the problem is obvious. This is not one peak to staff against. It is an enrollment surge in the fall, immediately followed by a surge in retention and switching in the winter, with two member populations calling at once. A team built only for the October rush is already understaffed for January, and a team built only for Medicare leaves the ACA book uncovered at exactly the wrong moment.<\/p>\n\n\n\n
Most outsourcing conversations, and most provider content, treat Medicare as the whole story. For any plan or health entity that carries both a Medicare Advantage and an ACA book, that framing misses the harder operational reality.<\/p>\n\n\n\n
The two product lines peak at overlapping times but follow different rules, scripts, and member expectations. A Medicare AEP call about a formulary change is a different conversation than an ACA subsidy and plan-tier question, and both are arriving in the same weeks. Staffing them as two separate seasonal efforts doubles the recruiting, doubles the ramp, and splits institutional knowledge across teams that never quite cover for each other.<\/p>\n\n\n\n
A single dedicated team trained on both books removes that fragmentation. The same professionals carry Medicare and ACA members through the full arc, which is only possible when the team is continuous rather than rebuilt each season for one product at a time.<\/p>\n\n\n\n
The seasonal surge looks efficient on a spreadsheet. In operation, it leaks value in four predictable ways.<\/p>\n\n\n\n
Ramp lag. <\/strong>New hires take weeks to reach productive handle times and first-call resolution. By the time a seasonal class is fully ramped, the AEP peak is already passing.<\/p>\n\n\n\n Mid-season attrition. <\/strong>Seasonal staff begins leaving in December for permanent roles elsewhere. Picture the agent who finally mastered your formulary and network in late October. In December, with the holidays approaching and a permanent offer in hand, that agent is gone, exactly as the January OEP switching calls, the hardest of the year, begin to land.<\/p>\n\n\n\n Knowledge loss. <\/strong>The professional who learned your plan in October is gone in January. The institutional knowledge resets every single year, and you pay to rebuild it from zero.<\/p>\n\n\n\n Inconsistent staffing produces inconsistent service: longer waits, lower first-call resolution, and more transfers. Members feel it, and so do your survey results. None of these costs show up cleanly in the seasonal labor line. They surface later as complaint volume, disenrollment, and a member experience score that the operations team cannot easily trace back to a staffing decision made the previous summer.<\/p>\n\n\n\n For the leader who lives in the daily dashboard, the surge model’s damage is visible long before it reaches a survey. Average handle time is high throughout October and November because a green class is still learning the formulary during live calls. First-call resolution sits low for the same reason, which drives the repeat contacts that inflate volume precisely when volume is already peaking. Abandonment rates climb as hold times stretch, and every abandoned call leaves a member wondering whether the plan can be reached at all.<\/p>\n\n\n\n The deeper problem is how generic outsourcers manufacture surge capacity. The fast way to hit a headcount number for October is to flex in temporary, lightly trained, and often unlicensed agents, then release them in January. That satisfies a staffing plan on paper and quietly fails the metrics that matter, because a member with a plan-comparison question or a subsidy problem does not want to reach an available agent. They want to reach one who can resolve the issue without a transfer. Scalability measured only in seats, rather than in seats that can actually carry a regulated conversation, is the trap.<\/p>\n\n\n\n A continuous team scales the other way. It enters the season already fluent in the plan’s products, formulary, and network, so average handle time, first-call resolution, and abandonment hold steady through the peak instead of degrading exactly when members are paying the most attention. The operating metrics a call center director is measured on are, in the end, the same inputs that feed the rating, which is why staffing for them is not a cost-control exercise but a revenue-protection one.<\/p>\n\n\n\n A continuous model is not simply the same temporary staff kept on longer. It is a single team designed for the full member journey, October through March, with the roles each surge actually requires.<\/p>\n\n\n\n The defining feature is continuity. The professional who handles a plan-comparison call in October is the same professional who handles a formulary complaint in February. The plan stops re-teaching its book every year.<\/p>\n\n\n\n One operational nuance is worth naming: licensed and non-licensed work should be drawn cleanly. Plan recommendations, quoting, and any activity requiring licensure stay with appropriately licensed staff, while qualification, education, and member-services support are handled by the broader team. A continuous model makes that division stable instead of improvised under surge pressure.<\/p>\n\n\n\n In a regulated book, staffing is only half the question. The other half is whether the team meets the compliance bar before it touches a single member call. A continuous model builds that in rather than re-certifying a temporary class every fall. The baseline for Medicare and ACA member services includes:<\/p>\n\n\n\n A seasonal model pays the full cost of certifying and onboarding a new class against this checklist every year. A continuous team carries the certification forward, which is both a cost advantage and a risk advantage when an audit arrives.<\/p>\n\n\n\n The financial case for continuity rarely lives in the hourly rate. It lives in the second-order math that seasonal models ignore. Consider a 20-seat program as a simple frame.<\/p>\n\n\n\n Training. <\/strong>Every seasonal cycle pays the full cost of recruiting, onboarding, certifying, and ramping all 20 seats, then pays it again next year because the class is gone within months. A continuous team amortizes that investment across the full arc and the off-season. In practice, the penalty of restarting every seat from zero each year adds a meaningful double-digit percentage to per-season labor cost, a cost a retained team simply does not carry.<\/p>\n\n\n\n Productivity. <\/strong>A team that resets every October never compounds its expertise, so handle times and first-call resolution start over from a lower baseline each season. Returning, plan-fluent professionals reach productive performance far faster than a cold class, which means a retained team enters AEP already operating at the level a seasonal team only reaches in December, if at all.<\/p>\n\n\n\n Retention. <\/strong>The first quarter is when members switch, and a single point of improved retention carries real per-member-per-month revenue across a book. The team most likely to win that conversation is the one that has been having it with your members since October, not a class hired in December and gone by spring.<\/p>\n\n\n\n Put those three together and the hourly comparison, where seasonal staffing looks cheaper, inverts. The continuous team wins on total cost once repeated training, lost productivity, and disenrollment are factored in.<\/p>\n\n\n\n Where the team sits matters as much as how long it stays. ConfieBPO runs this continuous model near San Diego, in Tijuana, Mexico, with a second campus in Mexico City. For the California-heavy Medicare and ACA markets, that means genuine Pacific Time alignment with members’ business hours, not an offshore queue operating on the other side of the clock.<\/p>\n\n\n\n It also means bicultural, cross-border professionals embedded across every role rather than isolated in a separate Spanish-language queue. For member populations where Spanish-first service is a quality-and-access issue, not a nice-to-have, that distinction shows up directly in first-call resolution and survey results.<\/p>\n\n\n\n This is the model ConfieBPO has refined for insurance and regulated industries since 1998, staffed by 2,000 highly trained, bicultural, cross-border professionals. The principle behind it is what matters most: continuity beats surge, and member experience is now the score.<\/p>\n\n\n\n The market for open enrollment support is crowded, and not all of it is built for a regulated health plan. A few patterns are worth recognizing before a contract is signed, because each one transfers a hidden cost or risk back to the plan.<\/p>\n\n\n\n For a chief operating officer weighing cost, operational risk, and vendor reliability, and for a customer-experience leader who owns the member journey end-to-end, the through-line is the same. A partner purpose-built for regulated health plans, staffed by licensed and certified professionals, priced transparently, and aligned to U.S. business hours and culture, removes the operational risk a generalist introduces. Consistency across the whole journey- the enrollment call, the onboarding call, and the first-quarter save call- is what protects both the experience score and the member, and that consistency is only possible when the same team carries the relationship the whole way through.<\/p>\n\n\n\n Continuity only works if the team is in-seat and ramped up before the season opens. With a 30-day activation runway, a dedicated team can be live roughly 30 days before each window: before Medicare AEP opens on October 15, before ACA open enrollment opens on November 1, and before OEP begins on January 1. That makes this a decision to commit about a month ahead of each window, not a fall scramble.<\/p>\n\n\n\n The runway is what makes this work. Standing up a trained, certified, plan-fluent team takes about 30 days, so the practical commitment point sits roughly a month before each enrollment window opens, not in the middle of the season when the calls are already arriving.<\/p>\n\n\n\n The plans that run a calm, consistent season are not the ones with the most temporary staff in October. They are the ones who committed about 30 days before the window and had the same professionals on the phone in March.<\/p>\n\n\n\n Decide before the season decides for you.<\/strong><\/p>\n\n\n\n When does open enrollment actually start?<\/strong><\/p>\n\n\n\n Medicare AEP runs October 15 to December 7, and the Medicare Advantage OEP runs January 1 to March 31 (Centers for Medicare & Medicaid Services, 2026a). For 2026 ACA coverage, open enrollment ran November 1 to January 15 in most states (KFF, 2025), and from the 2027 plan year it shortens to end December 15 in many states (healthinsurance.org, 2026).<\/p>\n\n\n\n Why is a continuous team better than seasonal hires?<\/strong><\/p>\n\n\n\n A continuous team is better because it removes ramp lag, mid-season attrition, and the annual loss of plan-specific knowledge. The same professionals carry both the Medicare and ACA books from October enrollment through first-quarter retention and onboarding, which protects service consistency and the member experience scores that now drive the rating.<\/p>\n\n\n\n How does call-center staffing affect Star Ratings?<\/strong><\/p>\n\n\n\n Call-center staffing affects the rating directly, because member experience measures are a growing share of the Stars as administrative measures are removed, with CAHPS and HOS projected near 40 percent of total weight by 2029 (Press Ganey, 2026). CAHPS surveys reach members in March, so first-quarter call quality shapes the rating that drives next year’s revenue.<\/p>\n\n\n\n What operating metrics does the surge model put at risk?<\/strong><\/p>\n\n\n\n The surge model puts average handle time, first-call resolution, and abandonment at risk, because a green seasonal class is still learning the plan on live calls during the peak. Low first-call resolution drives repeat contacts that inflate volume when it is already highest. A continuous, plan-fluent team holds those metrics steady through the season.<\/p>\n\n\n\n What compliance standards should an open enrollment team meet?<\/strong><\/p>\n\n\n\n At minimum, an open enrollment team should meet HIPAA with a signed Business Associate Agreement, CMS Medicare Communications and Marketing Guidelines with approved scripts, TCPA compliance on outbound contact, AHIP or equivalent product certification, SOC 2 Type II controls, PCI-DSS where payment handling applies, and CMS-required call-recording retention, all in place before go-live.<\/p>\n\n\n\n Does this apply to ACA plans or only Medicare?<\/strong><\/p>\n\n\n\n Both. The two product lines peak on overlapping schedules, and the operational challenge is the same: a fall enrollment surge followed immediately by a winter retention and onboarding surge. A single team built for the full arc serves both the Medicare and ACA books rather than staffing them as two separate seasonal efforts.<\/p>\n\n\n\n When do we need to decide in order to be ready?<\/strong><\/p>\n\n\n\n To be trained and live before AEP opens October 15, ACA open enrollment opens November 1, or OEP begins January 1, the team needs a 30-day activation runway. That puts the practical commitment point about a month before each window opens, not in the middle of the season when calls are already arriving.<\/p>\n\n\n\n What roles should a full open enrollment team include?<\/strong><\/p>\n\n\n\n A full team should include warm welcomers and greeters, inbound member-services professionals, retention specialists, onboarding specialists, after-hours and weekend coverage, and bilingual and bicultural professionals embedded throughout rather than siloed in a separate queue. Continuity across those roles carries the member relationship from October enrollment to the February save call.<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Every fall, Medicare Advantage and ACA member services organizations staff open enrollment like a one-time emergency. The requisition goes out in August, temporary hires ramp through October, and by January, when the hardest calls of the year arrive, the people answering the phones are the least experienced they will be all season. That is not […]<\/p>\n","protected":false},"author":21,"featured_media":3219,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[4,6],"tags":[],"class_list":["post-3211","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bpo-solutions","category-featured"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/posts\/3211","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/comments?post=3211"}],"version-history":[{"count":6,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/posts\/3211\/revisions"}],"predecessor-version":[{"id":3228,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/posts\/3211\/revisions\/3228"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/media\/3219"}],"wp:attachment":[{"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/media?parent=3211"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/categories?post=3211"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.confiebpo.com\/knowledge-center\/wp-json\/wp\/v2\/tags?post=3211"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}The Experience Tax Nobody Budgets For<\/h3>\n\n\n\n
What the Surge Model Does to Your Operating Metrics<\/h2>\n\n\n\n
What a Six-Month Dedicated Team Includes<\/h2>\n\n\n\n
The Six Roles Across the Full Arc<\/h3>\n\n\n\n
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Compliance and Certification Built In<\/h3>\n\n\n\n
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The Continuity Math<\/h2>\n\n\n\n
A Nearshore Model Built for This<\/h2>\n\n\n\n
What to Evaluate in a Partner, and What to Avoid<\/h2>\n\n\n\n
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Activate 30 Days Before the Season Opens<\/h2>\n\n\n\n
Three Recommendations for Open Enrollment Staffing<\/h2>\n\n\n\n
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Frequently Asked Questions<\/h2>\n\n\n\n
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References<\/h2>\n\n\n\n
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