GoHealth started in 2001 when its founders realized that such an essential, basic need as health insurance surely is, should be more accessible, and easier to understand and compare. They decided to put their ideas into something tangible, started the company and built software solutions to help people navigate the complicated health insurance market. More than 20 years later GoHealth, as a leading health insurance marketplace and Medicare-focused digital health company, focuses on helping beneficiaries to find plan that fits their needs and budget.
What is the Difference between SK and US Health Insurance?
Slovakia’s health insurance system focuses on universal coverage, regulated funding, and government control to provide equitable healthcare services to all residents. In contrast, the U.S. system is characterized by its mixed model with significant private sector involvement, variable coverage, and higher out-of-pocket costs.
When it comes to health plans, in Slovakia you have three health insurance companies (in the US called “carriers”), namely Všeobecná zdravotná poisťovňa, Dôvera, and Union, and there is no such thing as plans. Yes, you get different benefits and you need to be mindful about your provider having an agreement with the chosen carrier, but that’s it. The age does not play a role here.
Compared to a single “plan” in Slovakia, when you’re in the United States; as of 2023, the health policy nonprofit KFF estimated there were 43 different Medicare Advantage plans available to the average Medicare-eligible person.
What is Medicare?
In summary, Medicare is public health insurance for Americans who are over 65 years old (or have qualifying disabilities). So-called Original Medicare covers most standard medical services and is provided by the federal government.
Another option is Medicare Advantage which is a private insurance providing basically the same coverage with a little extra advantage. It often covers prescription drugs and provides additional benefits like dental, vision or hearing coverage.
The beneficiary (a person over 65 years old) must choose between those two and enroll in Original Medicare or try to find a plan tailored a bit more to their unique needs. With choices varying based on the beneficiary’s location, the coverage they need, and their budget, it might be a bit difficult to find the right Medicare Advantage plan. This is where GoHealth, as a leading health insurance marketplace, can help. As a consumer-centric company, our unbiased licensed agents help them make sure they have the right plan, even if it means staying with the current plan.
Traditional Way of Finding Insurance vs Utilizing Technology
There are multiple ways of obtaining information or enrolling in Medicare. You don’t need to go anywhere anymore (but you still can, if you like to talk to someone in person), you can just make a call or even apply online. Or you can use one of the health insurance marketplaces like GoHealth, too.
Compared to the past there is much more technology involved.
This comes naturally as multiple factors are involved in the decision-making. Consumer preferences in categories like coverage, benefits offered, prescription drugs, in-network doctors & pharmacies, and of course, the price need to be evaluated.
As customers, we like when earnest effort is put into making a product or service. Whether it is sourdough bread, running shoes, haircut or various home equipment. Of course, we deliver what we expect from others and we even do not hesitate to go above and beyond inspired by the quote of Marcus Aurelius: “Be tolerant with others and strict with yourself.”. Not to mention that health, unlike other products, is irreplaceable.
Therefore, we’ve built a sophisticated technology platform that leverages modern machine learning algorithms while utilizing our deep industry expertise and long-term experience. But we also understand that what’s really important is seamless interaction and a bit of human touch. Here is how it looks from both the user and technical perspective.
The Flow Itself
Our Technology department is the one responsible for making our digital products outstanding and according to our consumers’ needs. Our Product Management team is making sure the voice of the consumer is heard as well as translating it into concise requirements programmers from Product Engineering can understand.
First, we need to let people know that we can help them navigate the complicated process of selecting a plan and choosing the appropriate plan with the right coverage and benefits. To achieve this, we use various forms of ads like TV, mailer campaigns or those on social media. We have a dedicated unit called Marketing Technology that helps streamline the process of getting the right ads to the right people.
There are multiple ways how to get in contact with us and start the process of choosing the best plan, either by direct call or through our Consumer Marketplace. Here we collect necessary data like zip code to determine the plans that are available to the beneficiary based on the location. To get a better understanding of the beneficiary’s needs, providers and prescription drugs are selected along with preferred benefits. If the beneficiary does not want to refine the plan options, they can view the plans right away.
Once again, the point is to make the flow smooth like silk. We collect only essential data and those that can help us find the plan that best fits the needs of the consumer. The choice between inserting a bit more data to get the perfect recommendation or getting straight to all available plans is in the hands of our consumers. This part of our software ecosystem is maintained in a collective effort of various engineering teams as it integrates with a few other systems.
Simplifying Medicare
Our CARES Engineering unit focuses on helping our Call Center agents check and record all the necessary consumer data while also streamlining the process of choosing the most fitting plan.
Thanks to the effort of all teams in these units, our agents can walk a beneficiary through the decision process of finding a suitable plan.
We also take consumer feedback seriously; therefore, we build our products based on it as well as other data gathered by our Data teams.
The key element of our engineering team is Platform Engineering; our colleagues producing reusable services for multiple products we offer to internal or external customers. One of them is our Telephony team empowering our solutions for Call Center agents. Or the Infrastructure team making sure every team has all the required hardware or software it needs.
As soon as the consumer has decided which plan is the right one, they can call us to speak to a licensed agent over the phone and get over the details of a plan while also making additional checks to make sure we are not missing anything essential for the enrollment. For that purpose, agents have a software tool built by our team of developers dedicated to making enrollment a smooth experience. With multiple carriers, there are naturally multiple approaches to submitting an application, which makes the process complicated.
After everything is done, the consumer receives a summary of the essential information about the step-by-step process of choosing the plan and the information that proved to be decisive in choosing the plan. This part is once again a joint effort of the Marketing Technology and CARES units.
But enrolling the beneficiary is not the end of the journey.
In fact, a whole lot of things need to be done. As a consumer-centric company, we help get them most out of their plans by activating benefits and providing educational materials and on-call assistance. We also make sure they access their benefits throughout the year as well, so we are always there to answer any key questions and monitor evolving consumer needs.
The bottom line
As you can see, what at first glance seems like a straightforward solution is a collection of applications tied together and maintained by a variety of teams maintaining multiple pieces or components working together like a well-oiled machine. But there is a little exception to this comparison; in contrast to a rigid machine designed to work in one way or another, we are constantly working on enhancements with the focus on providing beneficiaries with what they need at the given time. It is only natural, that beneficiaries’ needs evolve over time, and so are we.
