January Medicare Disenrollment: How to Retain Members and Reduce Churn
Every January, Medicare Advantage members get a window to leave their plan and return to Original Medicare. For agencies and carriers, this disenrollment period represents one of the most significant churn risks of the year. The members who leave during this window are often the ones who felt neglected, confused, or dissatisfied — and most of that churn is preventable with proactive outreach and the right retention strategy.
What You'll Learn
- What the January disenrollment window is and who it affects
- Proactive outreach strategies to identify and retain at-risk members
- Retention scripts that address common disenrollment triggers
- Compliance guardrails during the disenrollment period
- How to measure and reduce churn with data-driven metrics
Understanding the January Disenrollment Window
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 through March 31 each year. During this window, beneficiaries who are already enrolled in a Medicare Advantage plan can make a one-time switch to a different MA plan or disenroll from MA entirely and return to Original Medicare (with the option to add a standalone Part D plan). This is distinct from the Annual Enrollment Period (AEP), which runs October 15 through December 7.
For a deeper understanding of how OEP fits into the broader Medicare enrollment landscape, see our OEP 2026 Strategy Guide and our comparison of Special Enrollment Period opportunities.
January is the most dangerous month because it represents the first opportunity for newly enrolled members — many of whom chose their plan during the hectic AEP season — to act on buyer's remorse. If a member enrolled in a plan they do not fully understand, discovered their preferred doctor is not in network, or received an unexpected bill, January is when they pick up the phone to switch or disenroll.
January Disenrollment by the Numbers
Why Members Disenroll: The Root Causes
Preventing disenrollment starts with understanding why members leave. Our analysis of call center data across dozens of Medicare agencies reveals consistent patterns:
Provider Network Issues
Member discovers their preferred doctor, specialist, or hospital is not in the plan's network. This is the single largest driver of early disenrollment.
Unexpected Costs
Higher-than-expected copays, deductibles, or prescription costs. Members often misunderstand plan cost structures during the AEP sales process.
Confusion About Benefits
Members do not understand what their plan covers, how referrals work, or why they need prior authorization. Complexity breeds frustration.
Poor Onboarding Experience
No welcome call, no plan orientation, no proactive outreach after enrollment. Members feel abandoned after the sale is complete.
Proactive Outreach: The 90-Day Retention Window
The most effective retention strategy is not waiting for a disenrollment call — it is reaching out proactively before members even consider leaving. The critical window is the first 90 days after enrollment (October through January). Agencies that implement structured outreach during this period see disenrollment rates drop by 30-50%.
Call every new enrollee within 7 days of plan effective date. Confirm they received their member ID card, understand their benefits, and know how to find in-network providers. This single touchpoint reduces first-year disenrollment by 15-20%.
Walk members through their specific plan benefits: copay structure, prescription drug coverage, dental/vision/hearing benefits, telehealth access. Answer questions before confusion becomes frustration.
Proactively verify that the member's primary care physician, key specialists, and preferred pharmacy are in-network. If there is a network gap, help them find alternatives before they discover it during an appointment.
Follow up at 30 days to ask: Have you used your plan yet? Any issues with coverage? Any questions about benefits? This catches problems early while they are still solvable.
Before the January disenrollment window opens, call enrolled members to assess satisfaction. Ask directly: Are you happy with your plan? Is there anything we can help with? This gives you a chance to resolve issues before the member acts on them.
Identifying At-Risk Members
Not every member is equally likely to disenroll. Smart agencies use data to identify at-risk members and prioritize outreach accordingly. Look for these warning signals:
| Risk Signal | What It Indicates | Action |
|---|---|---|
| No claims filed in 60+ days | Member may not understand how to use their plan | Benefits orientation call |
| Called customer service 3+ times | Frustrated with plan or coverage issues | Supervisor-level retention call |
| Provider out-of-network complaint | Primary doctor not in network | Help find in-network alternative |
| Prescription coverage denial | Drug not on formulary or requires prior auth | Formulary review + appeal assistance |
| No engagement with welcome materials | Did not attend orientation or open emails | Personal outreach with simplified explanation |
| Enrolled during last week of AEP | Rush decision, higher buyer's remorse risk | Priority welcome call + benefits review |
Retention Scripts That Work
When a member calls to disenroll — or when you reach them during proactive outreach and sense dissatisfaction — having tested retention scripts is essential. These scripts should be empathetic, solution-oriented, and compliant with CMS marketing guidelines.
The key principle: never argue with a member who wants to disenroll. Instead, understand why they want to leave and address the underlying issue. If their doctor truly is not in network and there is no comparable alternative, acknowledge that limitation honestly. Trust builds retention more effectively than pressure.
Compliance During the Disenrollment Period
Retention efforts during OEP must comply with CMS regulations. There are specific rules about what agents can and cannot say when a member expresses intent to disenroll. Violations can result in plan-level sanctions and agent decertification.
OEP Compliance Guardrails
- No unsolicited contact: You cannot proactively call members specifically to discourage disenrollment. Retention calls must be framed as service check-ins, not anti-disenrollment campaigns.
- No misleading comparisons: You cannot make inaccurate claims about Original Medicare to discourage a switch. All plan comparisons must be factual and verifiable.
- Honor the request: If a member requests disenrollment, you must process it. You can ask why and offer solutions, but you cannot refuse, delay, or create barriers to disenrollment.
- Document everything: Every retention interaction must be documented with call recordings and notes. CMS auditors will review these interactions for compliance.
For a comprehensive overview of CMS compliance requirements, review our Medicare Compliance Guide.
Measuring and Reducing Churn: Key Metrics
What gets measured gets managed. Track these churn metrics monthly to understand your retention performance and identify trends:
- Monthly disenrollment rate by plan
- First-year vs. renewal-year churn rates
- Disenrollment reason codes and distribution
- Time from enrollment to disenrollment
- Churn rate by lead source and agent
- Welcome call completion rate
- Days from enrollment to first outreach
- At-risk member identification accuracy
- Retention call success rate
- Member satisfaction scores (NPS)
Retention Impact Benchmarks
Welcome Call Program
Agencies with structured welcome call programs within 7 days of enrollment see 15-20% lower first-year disenrollment rates compared to agencies without.
Proactive Provider Verification
Verifying provider network coverage proactively before the member discovers a gap reduces network-related disenrollment by up to 40%.
30-Day Check-In
A simple 30-day satisfaction call catches 65% of issues that would otherwise lead to disenrollment during the OEP window.
Pre-OEP Outreach
Contacting enrolled members in late December, before the OEP opens, reduces January disenrollment by 25-35% compared to reactive-only approaches.
Building a Year-Round Retention Culture
The agencies with the lowest disenrollment rates do not treat retention as a January activity — they build it into their culture year-round. Every touchpoint after enrollment is a retention opportunity: annual wellness reminders, birthday calls, benefit utilization check-ins, and open enrollment preparation.
Combine proactive outreach with technology: use your dialer's automation to schedule follow-up sequences, tag at-risk members for priority routing, and track satisfaction scores over time. The data you collect during these interactions feeds back into your OEP strategy and helps you identify which plans, agents, and lead sources produce the most retainable members.
Conclusion: Retention Is the Highest-ROI Activity
Acquiring a new Medicare member costs 5-7x more than retaining an existing one. Every member who disenrolls in January represents not just lost revenue but wasted acquisition spend, wasted onboarding effort, and a missed opportunity for referrals and cross-selling. The math is clear: investing in retention delivers the highest return of any activity in your call center.
Start with the 90-day onboarding framework, build your at-risk identification system, train agents on retention scripts, and track your churn metrics religiously. The agencies that master retention do not just survive the January disenrollment window — they turn it into a competitive advantage by keeping the members that their competitors lose.
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