- Many workers struggle with choosing their health-insurance plans during open enrollment.
- Some healthcare companies are employing mobile apps and generative AI to help smooth out the process.
- This article is part of “Trends in Healthcare,” a series about the innovations and industry leaders shaping patient care.
During open-enrollment season, Reddit users inundate the platform’s forums on health insurance and personal finance every day, asking how to best pick from their health-insurance options.
In one post, a recently unemployed married woman in Texas asked whether she should enroll with her husband’s employer or stick to COBRA, which provides benefits to people who have lost their jobs. Another married person requested advice on which coverage to pick if they’re planning to have a baby in 2025. For an employee in California, fellow Redditors were a sounding board as they navigated dental-plan options, with costs ranging from $0 to nearly $440 annually.
Open-enrollment season typically takes place between October and December, and companies have their own set periods within those months. During this time, Americans elect their health-insurance coverage through either a private employer or marketplaces via subsidies offered under the federal government’s Affordable Care Act. Nearly all open-enrollment selections made this fall will go into effect on January 1 and be set until the following season, with a few exceptions.
The process can be immensely confusing.
Employees are expected to look both backward and forward, said Dan Beck, the president and chief product officer for SAP SuccessFactors, a cloud-based software platform that oversees HR, payroll, and talent management.
He told Business Insider that employees are tasked with reflecting on whether they maximized their benefits in the past year based on how much they tapped into the healthcare system. At the same time, they must anticipate health-related events, such as having a child or a major surgery.
To complicate matters further, workers may move to new roles with different insurance options or their employers could change providers or plan options, forcing employees to acquaint themselves with new choices. The makeup of their families could change, too: As employees’ marital statuses change and they raise children, they’ll likely want to optimize their healthcare plans for those life stages.
On Reddit, people making health-insurance decisions try to make sense of the complexities. If they choose health plans mismatched with their needs, they run the risk of overspending in two directions: shelling out for a premium-coverage plan they don’t really need or skimping on coverage and then experiencing an expensive life change.
Employees also need to keep track of life events that could change their coverage, including moving, having a baby, or adopting a child. There is a special enrollment period, outside of open enrollment, for those life events, but also a limited period of time to make the changes and retain health care coverage.
Increasingly, employers are encouraged — by both their employees and their HR-benefits companies — to share more easily digestible benefits information.
“What employees are telling us, overwhelmingly, is that they need help when they are enrolling,” Karen Frost, a senior vice president at the cloud-based employee-benefits vendor Alight, told BI.
Some employers are partnering with third-party companies that handle things like payroll and health benefits and have built software with with clear step-by-step prompts — which can help workers be confident about their healthcare elections.
Young workers want more employer support in demystifying healthcare
In Alight’s 2024 annual survey of 2,500 employees in the US, the UK, France, Germany, and the Netherlands, 63% of workers said they felt confident about their most recent health-plan election.
There are, however, some generational splits in the data. In the survey, 70% of Gen Z and 72% of millennial workers said they wanted personalized support for navigating the health system versus just 46% of baby boomers.
Before the mass digitization of benefits elections, employers would hand their employees printed packets outlining their medical-insurance offerings and ancillary benefits such as dental and vision, retirement plans, commuter reimbursement, gym memberships, and other wellness programs. Employees would pick from that menu, largely without guidance or input on what they’d like to see as alternative or additional benefit options.
Though the paper-packet method is much less common now, the enrollment process can still be overwhelming to navigate.
Life changes, like moving to a new state or employer, or a company picking new insurance providers to work with can complicate the enrollment process.
“You have a narrow window to actually get benefits, and you want to be successful,” Beck told BI.
Mobile apps and generative-AI tools aim to smooth out the open-enrollment process
To help employees sort through their options during the open-enrollment period, some healthcare startups are leveraging mobile apps and generative-AI chatbots.
Alight, for example, aims to learn more about employee preferences and the needs of their families through a Q&A and then make recommendations. Throughout this process, Alight’s recommendations coincide with clear definitions of complex benefits, like a health savings account, which lets workers set aside pretax money for qualified medical expenses.
“Instead of just letting people make their own choice, we guide them,” said Frost. As an example, if an employee were to pick a high-deductible health plan, Alight would guide them to an HSA and explain why enrolling in it may make sense to budget for potential healthcare expenses.
SAP SuccessFactors said it’s not yet comfortable with offering suggestions for health-insurance elections, citing concerns about data privacy.
Instead, the company — which has customers including McDonald’s, L’Oréal, and Delta Air Lines — said it’s focusing on further developing its recently launched mobile app.
The SuccessFactors mobile app is targeted at two demographics: workers under 40 who tend to be mobile-first in nearly every aspect of their lives and frontline workers of all ages with jobs in manufacturing and other sectors where they may be without frequent access to computers.
SAP SuccessFactors is also using generative-AI chatbots to answer policy questions to improve the user experience. In the future, the company plans to use these chatbots to automate some open-enrollment processes.
To bolster the company’s abilities to help employees navigate this process and other healthcare questions that may arise throughout the year, SAP earlier this year paid $1.5 billion in cash to buy WalkMe, a tool designed to provide real-time website navigation for healthcare, onboarding, and other employee-focused tasks.
AI-based virtual assistants are also becoming more pervasive in the open-enrollment process. Alight has Ask Lisa, SAP SuccessFactors is leaning on the company’s artificial-intelligence copilot, Joule, and the HR- and financial-software provider Workday uses Wex, an AI chatbot that internal employees can access on Slack to get automatically generated responses to their benefits questions. The same tool is offered to customers but branded as Workday Assistant.
“We try to appeal to all generations and age groups,” Ben Carter, the senior vice president of business partners and rewards at Workday, said. “Some people, the last thing they want to do is actually talk to somebody on the phone.”
This emerging technology benefits employers, too. Earlier this year, Workday unveiled an AI-enabled tool called Workday Wellness, which integrates with insurance providers like Aetna and Cigna. It allows Workday’s customers — like The Hartford, Guardian, and MetLife — to understand which wellness benefits employees are using and which ones aren’t resonating so they can invest more strategically.
“It brings a nice story,” Carter said, “to say, well, if I’m going to go invest another $20 million in my benefits programs next year, here’s where I need to go, or here’s where I need to double down, or here’s where I need to stop investing.”
