AEP 2027: Building Operational Resilience for a More Complex Enrollment Season

Healthcare | By Everise | Oct 08, 2026

Nearly 70% of Medicare Advantage health plan leaders expect 2027 benefit packages to be less rich than the year before, according to HealthScape Advisors’ 2026 survey of more than 35 health plans. No respondents expected benefits to become richer. This shift matters beyond product strategy. As benefits, networks, costs, and plan availability change, members face more decisions and more reasons to seek help from their health plans, creating a different operational challenge for payer organizations preparing for the Annual Enrollment Period (AEP).

For operations leaders, the question is no longer simply whether they will have enough people to handle AEP demand. It is whether they will have the right capacity to handle the type of interactions that demand will generate.

Key Takeaways

AEP 2027 may bring greater operational complexity, not just higher volume. Changes in plans, benefits, and member needs can create a more complex mix of interactions.
Headcount does not equal capacity. The same number of calls can require more operational capacity when interactions take longer or require greater expertise.
Operational resilience requires a more adaptive capacity strategy. Payers can strengthen readiness by aligning queue design, capacity assumptions, and experienced licensed talent with the complexity of member needs.

AEP 2027 and the Changing Call Mix

Humana’s planned 2027 Medicare Advantage exits are expected to affect approximately 600,000 members. The company has said it expects to retain a significant portion of those members in other Humana plans, based on its experience with previous market exits. Even so, a substantial number of members will need to evaluate alternative coverage during an already demanding enrollment period. These members are not necessarily calling because they are casually comparing plans. Some will be calling because a plan they relied on is changing or no longer available to them, while others may be trying to understand how reductions in benefits, changes in networks, or other plan adjustments affect their coverage.

That distinction can have a direct impact on operations. A straightforward transactional inquiry may be resolved quickly, while a member seeking help understanding a plan change may require more explanation, comparison, and guidance. As the proportion of these higher-complexity interactions increases, average handle time can rise, first-call resolution can become more difficult, and frontline teams may face greater quality and compliance demands. This is why headcount alone is an incomplete measure of AEP readiness: an operation can meet its staffing target and still fall short of its performance targets if the capacity model does not account for the complexity of the work coming through the queue.

Workforce Planning and Call Complexity

Traditional AEP planning tends to focus on familiar operational measures such as expected contact volume, required headcount, licensing throughput, training capacity, and ramp timelines. These measures remain essential, but they do not tell the entire story when the composition of member interactions changes. Two operations can receive the same number of contacts and require very different amounts of capacity depending on what those contacts involve.

A queue dominated by simple transactions does not place the same demands on agents, supervisors, or quality teams as one containing a higher proportion of members seeking guidance about coverage changes and alternative plans.

For payer organizations, this makes call-mix planning just as important as volume forecasting. The objective is not simply to determine how many people are needed, but to understand what those people will be handling and whether the workforce has the experience and capabilities required to resolve those interactions effectively. AEP readiness therefore needs to account for both the quantity of demand and the complexity behind it, particularly when changes in plan availability and benefits can create more counseling-oriented member interactions.

Three Actions to Strengthen AEP Readiness

With only weeks remaining before AEP, payer organizations should focus on adjustments that can improve the capacity they already have rather than relying exclusively on additional hiring. Three actions can help operations leaders align their workforce more closely with the demands they are likely to encounter.

1. Re-segment queues based on complexity

Rather than treating every AEP interaction as an equivalent unit of demand, operations teams can identify the types of calls most likely to require deeper member counseling, particularly interactions involving plan exits, benefit changes, coverage comparisons, or retention. Routing, scripting, escalation paths, and quality monitoring can then be aligned to those interactions, helping ensure that the appropriate level of expertise reaches the member at the right point in the journey.

2. Re-baseline AHT against the expected call mix

Staffing models that rely heavily on last year’s average handle time may not accurately reflect the demands of AEP 2027. Operations leaders should revisit AHT by interaction type and consider how a greater proportion of complex calls could affect overall capacity. Recalculating these assumptions before peak enrollment can provide a more realistic view of staffing requirements and help identify potential service-level gaps before they become operational issues.

3. Deploy experienced licensed talent strategically

Not every AEP interaction requires the same level of experience, so experienced licensed talent should be positioned where healthcare knowledge, judgment, and member counseling are most important. Simpler and more standardized transactions can be handled by appropriately trained newer talent where the operating model allows, while more complex interactions receive the expertise required to resolve them effectively. This approach allows payer organizations to make better use of available capacity without treating additional headcount as the only answer.

Operational Resilience Requires More Than a Staffing Plan

AEP 2027 will still bring many of the operational pressures that payer organizations have come to expect: increased demand, compressed timelines, licensing requirements, and the need to maintain consistent member experiences under pressure. What is changing is the environment in which those pressures are occurring. With Medicare Advantage plans adjusting benefits and exiting selected markets, members may enter AEP with more questions and greater uncertainty about their coverage options. HealthScape Advisors’ research points to broad expectations for leaner 2027 benefit packages, while Humana’s planned market exits illustrate how changes in plan availability can create additional enrollment activity.

For payer operations leaders, the implication is straightforward: AEP readiness cannot be measured by headcount alone. Workforce capacity needs to reflect the complexity of the interactions those employees will handle, particularly when more members require guidance rather than simple transaction support. The organizations best positioned to maintain performance through AEP 2027 will not necessarily be those with the largest staffing plans. They will be the ones that understand their expected call mix, build capacity around the work behind the volume, and deploy the right expertise where it can have the greatest operational impact.

The question for payer leaders is therefore not simply whether they have enough people for AEP 2027, but whether they have enough of the right capacity for the members who will need them.