October 16, 2023

Open Enrollment 2023: Patient Benefits and Enrollment Assistance

Everything you Need to Become an Open Enrollment Expert for your PT Patients

It's that time of year again when millions of Americans can browse the U.S. healthcare marketplace, and physical therapists (PTs) should check in with their patients to ensure their benefits coverage stays uninterrupted.

During enrollment, your clients may feel frustrated. But you can help them navigate insurance complexities by assisting them in selecting the most suitable plan for their needs.

To effectively guide patients during open enrollment, staying prepared and knowledgeable about the open enrollment process is important.

We've covered everything you need to become an enrollment assistance expert for your PT patients.

What is Open Enrollment?    

Open Enrollment in the US is when people can sign up for or switch their health insurance coverage. It's an annual chance for Americans to review and choose insurance plans that work best for them.

During the open enrollment period, PT patients must evaluate the coverage and plan that best suits their therapy needs.

When is Open Enrollment?    

It's important to note that open enrollment for health insurance and Medicare have different dates. So, when is open enrollment for health insurance? When does open enrollment end?

Open health insurance enrollment typically occurs between November 1st and January 15th each year. What about Medicare?

Medicare Open Enrollment this year lasts from October 15, 2023, to December 7, 2023. PTs should take note of this as many Medicare beneficiaries utilize their services. A study found that the proportion of Medicare beneficiaries managed by each physical therapist in their caseload ranged from 1.4% to 24.3%, with an average of 9.9%.

Understanding the Patient Decision Journey During Open Enrollment 

The patient decision journey is a helpful framework for PTs to understand what their patients go through when making informed decisions about their health. Understanding your patients' experiences during open enrollment is important to address their questions throughout the process effectively.

Here are each patient's steps when considering providers and enrolling in an insurance plan.

Step 1: Initial Consideration Set    

During this stage, patients evaluate different insurance plans and determine which ones are worth further consideration. This might include:

Network of providers: Patients may consider insurance plans with a wide network of healthcare providers, including primary care physicians, specialists, and physical therapists.

Coverage for physical therapy: Patients who require or anticipate needing physical therapy services may prioritize insurance plans that offer comprehensive coverage for these services

Premiums and costs: Cost is a major consideration for patients choosing insurance plans. Factors such as monthly premiums, deductibles, copayments, and out-of-pocket maximums are considered.

Step 2: Active Evaluation

Active evaluation is when patients assess and compare options in their consideration set.
Such as:

Comparing coverage: Patients engage in an in-depth comparison of the coverage offered by the insurance plans in their consideration set.

Examining provider networks: Patients review provider networks of insurance plans to ensure the inclusion of their preferred physical therapists and healthcare providers.

Seeking recommendations and feedback: Patients may consult healthcare professionals, friends, family, or online forums for insights and experiences with insurance plans they are considering.

Step 3: Moment of Choice

This is a crucial stage for patients as they choose an insurance provider to enroll with.

Here are the final factors that might influence their decision:

Specific healthcare needs: Patients evaluate how well each insurance plan aligns with their specific healthcare needs.

Plan features: Patients evaluate each insurance plan's distinctive features and benefits (telehealth, prescription drug coverage, preventive care services).

Cost vs. coverage: Patients weigh the trade-off between the cost of the insurance plan and the coverage it provides.

Step 4: Post-choice Experience    

After the patient has decided, their relationship with the insurance provider begins, shaping their experience throughout their duration with them.

During this period, the patient will undergo the following steps:

Enrollment confirmation: Patients receive an enrollment confirmation from the insurance company after choosing a plan. They'll get details about the selected plan, coverage start date, premium payment instructions, and any additional information or documents needed for enrollment.

Membership materials: Patients usually get membership materials from the insurance plan, like insurance cards, policy documents, member handbooks, and provider directories.

Customer service and support: Patients with questions or concerns about navigating their insurance plan can contact their insurance assistant reps.

Thoroughly analyzing the patient journey allows PTs to provide optimal care and determine insurance coverage for effective treatment planning.

How to Prepare for Open Enrollment Marketing


During this time, PTs can attract new patients and keep existing ones by positioning themselves as experts during the open enrollment period. They can start marketing themselves and their brand during these months as their patients are actively engaged in shaping their health future.

Ideally, it's optimal for PTs to start marketing right now since Medicare enrollment starts in October.

Haven't started? We've got you covered on where to invest your time.

Boost your Presence Online

Make key revisions to your website: Identify areas that need updated content to reflect the current open enrollment period.

Optimize for SEO: Research keywords to improve your site's visibility in search results when potential patients search for healthcare or PT providers who accept the insurance they're considering.

Online reviews and testimonials: Positive reviews and testimonials from satisfied patients greatly influence your reputation and online presence. Reviews highlighting your helpfulness with insurance are especially valuable during the enrollment period.

Getting your Physicians Noticed

Communicate and educate your staff: Regularly update and educate physicians on the benefits of physical therapy services during open enrollment to enhance clinic credibility.

Provide timely updates: Keep your physicians updated on insurance coverage changes, reimbursement policies, and open enrollment plans. This ensures patients receive accurate information and are impressed by your staff's expertise.

Foster open communication: Stay in touch with physicians during open enrollment. This way, they can contact you with questions or concerns while interacting with clients. It strengthens the relationship between you and your physician and physicians and their patients.

Establish Segments for your Physicians and Providers

Analyze your existing data: Start by analyzing your existing data to identify patterns and trends among your physicians and providers.

Define segmentation criteria: Based on the analysis, define criteria that align with your goals and objectives.

Create segment profiles: Once you have defined the criteria, create distinct segment profiles for each group.

Segment your Current Patients

Gather patient data: Gather important data about your patients, including demographic info (age, gender, location), medical conditions, treatment history, appointment frequency, and other relevant details.

Define segmentation criteria: Based on the collected data, define segmentation criteria that align with your objectives (In this case, open enrollment period).

Create patient segments: Use the defined criteria and create distinct segments for your patient population.

Patient Acquisition Strategy

With the dropping and picking up of new insurance providers during open enrollment, PTs have new opportunities to attract new patients to their practice.

Healthcare providers and physical therapists (PTs) can use effective strategies and tactics to attract new patients during open enrollment. Here are some approaches to consider:

Leverage online directories: Claim and update your profiles on popular healthcare directories, such as Healthgrades or Zocdoc. This increases your visibility and makes it easier for potential patients to find you.

Patient referrals: Encourage current patients to refer their friends, family, or colleagues to your practice. 

Open house or free consultation events: Host open house events or offer free consultations during the open enrollment. This allows potential patients to learn more about your services, ask questions, and experience your practice firsthand.

But it doesn't stop there. Keep track of your efforts during each enrollment period to ensure a successful ROI. Analyze metrics like website traffic, conversion rates, and patient inquiries. Adjust as needed to optimize your approach and attract new patients during open enrollment.

Patient Retention Strategy Tips


Patient retention rates in physical therapy can vary, posing a challenge in the industry. A survey found that practices with multiple therapists had retention rates as low as 7%.

Open enrollment is a great time to maximize patient retention because healthcare is at the top of your client's minds.

Here are tips to boost patient retention during enrollment:

Personalized care and communication: Use PT software with useful features like notifications, patient portals, and messaging to enhance communication and engagement.

Exceptional patient experience: Offer resources like exercise programs, educational materials, and online tutorials to empower patients in their recovery. (Utilize PT software with  features to provide home exercise programs and educational content to empower patients to take the initiative.)

Post-treatment follow-up: Use post-treatment follow-up procedures to monitor patient progress and address ongoing concerns. Using automated appointment reminders and post-visit surveys can maintain engagement and gather feedback.

Be Open to your Patients During Open Enrollment

Help patients during open enrollment by guiding them in selecting insurance providers so they keep you in their network as their PT provider. Whether your patients are covered by a big brand insurance company or Medicare, they're entering an intimidating and confusing process. Being there for them and delivering an excellent patient experience can boost their confidence during this time and reassure them that they've made the right choice with their PT provider.

Having efficient PT management software is beneficial for an optimal patient experience. It streamlines administrative tasks, improves patient communication, and offers valuable features like notifications and portals. Check out PtEverywhere to explore effective PT management software options.