What the toughest year in Medicare Advantage has taught us about cutting costs.

With efficiency requirements more intense than ever, why is streamlining customer support such a delicate issue? Part of the story is that when margins tighten, businesses often shift volume to self-service tools that weren't designed for older adults. In practice, repeat contacts increase, complaints accumulate, and the savings get consumed by the rework these misunderstandings generate.

This effect is only amplified by the market instability defining 2026: KFF reports that 2.6 million Medicare Advantage beneficiaries are facing plan terminations this year - around double the 1.3 million affected in 2025. Health plans are tasked with onboarding millions of new members who are already stressed and disoriented by the transition. More than any other form of cutbacks, live support reductions transfer this burden onto members in the form of confusion, and back onto the plan in the form of elevated grievances and preventable churn. 

The consequences don't stop at member experience, either. Administrative disruption has real clinical effects downstream. Prior authorization delays lengthen when support teams are understaffed and coordination workflows break down. Care gaps widen when members transitioning into new networks can't get timely answers about which providers are covered or whether their existing treatment plans will continue uninterrupted. For an older adult managing multiple chronic conditions, that kind of navigational failure is more than an inconvenience. It's a health risk. And unlike the forced closures driven by market disruption, voluntary disenrollment is a choice - one organizations can prevent by making sure that members don’t feel unsupported when they need guidance most.

That’s why the location of the cost cuts matters just as much as their size. Administrative reductions that eliminate preventable work lower expenses durably, but those that eliminate human connection cause an equally permanent decrease in trust.

The stakes become clearer once you examine the metrics health plans are ultimately judged by. Traditional administrative reporting measures damage after it occurs. Call volume, claims lag, and escalation rates reveal where things went wrong, but almost never early enough to prevent the next wave. For Medicare Advantage plans, the consequences of that lag extend well beyond metrics. CMS's Star Ratings system ties closely to revenue. Plans rated 4 stars or above qualify for quality bonus payments that can reach up to hundreds of millions of dollars annually. CAHPS survey results capturing member-reported experiences with care and customer service feed heavily into these ratings. That’s how a sustained drop in CAHPS scores triggers a financial penalty - one that compounds over multiple plan years, as ratings are calculated on a rolling basis and recovery is slow. 

For a VP of Operations or Director of Member Experience, this is a compelling reason to protect member-facing support: the regulatory and financial consequences of administrative failure aren't abstract. They're scheduled, measurable, and difficult to reverse once the damage is done. Plans that treat member support as a cost center to be minimized are, in effect, trading Star Rating points for short-term savings. And with them, the quality bonus payments and member loyalty that sustain long-term plan performance. Every dropped score signals eroding member trust, and in a market defined by disruption and choice, that trust is the most valuable asset a plan holds. The question that naturally follows is this: how do you run a tight ship while still ensuring strong member support?

One of the most overlooked ways to improve both efficiency and member support is simply reaching out before problems escalate. The plans doing proactive outreach well already know that a newly diagnosed member with a complex condition will likely struggle to understand their durable medical equipment coverage next month, so they call today to explain it. They treat every coverage transition as a fragile moment that requires proactive reassurance, not a reactive response after confusion has already set in. That shift, from reacting to crises to anticipating human needs, is what puts predictive modeling at the center of cost-efficient, member-focused healthcare operations.

When you know who will be confused and why, you can deploy outreach before a disenrollment decision is made. In one case study, proactive callbacks analyzed by our Conversational Analytics improved NPS by 6.85 points within six months. The most successful health plan operators aren't cutting support. They're using predictive insights to map the emotional and clinical journeys of their members, building a service model where the plan reaches out first, and the member never has to wonder whether anyone is paying attention. And health plans are saving twice the effort later as a result.

Proactivity, like all other aspects of streamlined member experience, depends on our next crucial factor: coherent systems. When a support professional toggles between five platforms to answer a single coverage question, the member waits, handling time climbs, and interactions lose their human quality fast. An integrated workspace that brings every relevant data point into a single, coherent view is what makes confident first-contact resolution possible. Broken handoffs compound the problem. When members are transferred without context, they repeat sensitive health information to each new agent, and that repetition signals institutional indifference. Support professionals handling complex Medicare Advantage inquiries are under substantial pressure to synthesize benefit details, prior authorization status, network changes, and clinical context simultaneously, often urgently, while keeping the conversation empathetic.

Mapping the real member journey, eliminating blind transfers, and building intelligent routing with shared context across every touchpoint preserves continuity and demonstrates genuine respect for the member's circumstances. Frontline teams also need the right tools to act on that coherence in real time. The best practice is to surface that information dynamically, in the flow of the conversation, so professionals can focus on members rather than their screen. Transcom’s AI Agent Assist, for instance, does exactly that, delivering real-time, context-aware guidance during live interactions so resolution happens faster without sacrificing the human connection. Just as importantly, it helps preserve the quality of support that drives Star Ratings and strengthens long-term member loyalty.

The plans that emerge from 2026 in the strongest position won't be the ones that cut the deepest. They'll be the ones that cut the smartest, protecting the human touchpoints that drive retention and Star Ratings while eliminating the administrative friction that drives neither.

When predictive modeling, integrated operations, and well-equipped frontline teams work together, cost reduction becomes the natural byproduct of delivering care that members actually feel. This is not an aspirational model. For the plans building it, it's already working. Ready to elevate your healthcare experience while saving record resources? Get in touch with Transcom.