Plan fit, decided with the consumer, before the first call.
Plan alignment runs a consumer’s own medications, doctors, pharmacy and expected care against every plan available to them, and ranks those plans by what this person is actually likely to spend. We call it plan before agent.
Premiums are the easy part. Total cost is what matters.
Medicare’s own Plan Finder shows premiums and estimates drug costs. It does not estimate what a person is likely to spend out of pocket on medical care, which for many members is the larger and less predictable share.
Projecting that total with a claims-based actuarial model used to live mostly inside carriers and actuarial firms. Three things now make it practical in everyday distribution:
- Complete plan data. CMS publishes detailed benefit data for every plan each year, which can be loaded and priced at scale as soon as it is released.
- Claims-based actuarial modeling. Instead of comparing premiums and copays on a page, the model projects what a person like this consumer is likely to spend under each plan.
- Real-time delivery. Alignment runs in seconds, inside the flow where leads are captured, transferred and sold.
What a premium-only comparison misses
In an actuarial study of 81,597 Medicare Advantage members, the plans members chose on their own cost them about half again as much out of pocket as their best-fit plans.
| Milliman case study finding | Result |
|---|---|
| Members who would have spent less in the recommended plan | 90% |
| Average saving across all members | $691 a year |
| Average out-of-pocket: recommended vs. self-chosen | $1,317 vs $2,006 |
Mueller, Boschert & Swasono, “Case Study: Assessing Cost Savings with Informed Medicare Plan Shopping”, Milliman, March 2024. Out-of-pocket includes premiums and cost sharing for Medicare-covered services.
A few questions in. A ranked, documented answer out.
The consumer shares
- Medications and dosages
- Preferred doctors and pharmacy
- ZIP code and county
- Expected health care use
- Cost preferences
Plan alignment returns
- Every plan available to them, ranked by expected total out-of-pocket cost
- Drug coverage, pharmacy and doctor network status for each plan
- The reasons each top plan fits
- A record of the CMS pre-enrollment checks
- All in seconds, by API
Plan before agent
The best place for alignment is right after the consumer raises a hand, before they talk to anyone. Capture the lead first, then align, so alignment never costs a lead.
On the form or landing page
Right after the consumer’s contact details are captured, alignment shows them their best-fit plans and attaches the result to the lead.
Before the transfer or appointment
Live transfers and appointments arrive with the ranked plan list, so the agent confirms instead of discovers.
On consumer and enrollment sites
Shoppers who want to research first get a real answer, including ACA shoppers who prefer to enroll on their own.
Alignment can also run inside an agent’s quoting tool for agent-sourced business. That is a secondary use; the consumer is always best served by seeing the answer first.
Three rules that keep alignment on the consumer’s side
Plan before agent
The consumer sees their own best-fit plans before the agent conversation, so the answer belongs to them. The agent still advises, enrolls and serves.
Neutral by design
Plans are always ranked by the consumer’s own expected costs, never weighted by carrier, plan or who paid for the alignment. Any filters a distributor applies, such as the carriers its agents are appointed with, are its own, disclosed choices.
Documented fit
Every alignment leaves a record, so any enrollment can be compared with the consumer’s best-fit plans. It covers the checks CMS requires before enrollment: formulary, pharmacy and doctor networks, and cost preferences (42 CFR 422.2274(c)(12)).
Prove it on your own book this AEP
Plan alignment is new enough that the first organizations to measure it will set the benchmarks. We recommend a random holdout: align every consumer, but for a random 10–20% don’t share the results before the agent conversation. Same agents, same leads, a clean comparison.
Plan a measured pilot| Metric | When it reads out |
|---|---|
| Alignment match rate: enrollments in one of the consumer’s top plans | At enrollment |
| Contact and close rate; agent minutes per sale | Within weeks |
| Disenrollments within 90 days and chargebacks | Within one quarter |
| 12-month persistency and renewal commissions | One year |
| Complaints and member satisfaction | Ongoing |
See plan alignment on your own leads.
A 20-minute walkthrough, and a simple way to measure the results this AEP.