An aging population, an insufficient number of caregivers, escalating costs, and the erosion of insurance coverage are all contributing to a growing long-term care crisis in America. But there's one often-overlooked issue fueling the crisis: a passive, fragmented enrollment process that leaves employees uninformed and unprepared to face their future needs.
Consider the following: by 2030, the number of people over age 65 is expected to outnumber those under 18 for the
While the gap between need and coverage is widening, it also shines a spotlight on the dire need for good, affordable, long-term benefit options that employees can understand. The challenge goes beyond just the gap in insurance protection; it's as much a challenge of engagement and education given our enrollment landscape. Employees need education and engagement to maximize these benefits, but offering that education is difficult in a self-enrollment model or with limited internal resources to support benefits education.
Perhaps no one knows this better than Tom Smith, VP of Enrollment Services and creator of Trustmark Enroll For Life, at Trustmark Voluntary Benefits. Smith has been working in the benefits space for over three decades, developing enrollment solutions to help companies provide their employees with affordable and understandable long-term care options.
"There is a crisis in this country when it comes to long-term care," warns Smith. "It used to be a popular benefit in the employee benefits space, but over time, insurance carriers specializing in long-term care have exited the market. It's almost impossible to get a long-term product on a group basis through an employer, and if it is available, employees often find it difficult to understand the benefits without proper education, which is scarce. You can get these benefits from a financial planner, but it's expensive. The average employee simply doesn't have access to the knowledge or benefits they need."
Recognizing this critical gap, Trustmark acquired Smith's Enroll For Life in late 2024, having already partnered with the company for more than three years. Their decision was driven by the technology behind the enrollment platform—the cutting-edge tools that empower employees and drive engagement.
Ahead of his time
Smith first started using technology to enroll employees in benefits in 1999. However, at that time, Smith met resistance. "In those days, we spent a lot of time overcoming the 'not being onsite' objections. The employees weren't ready for the technology," remembers Smith. In fact, he created a paper-based version of the enrollment process to ease the experience for employees who weren't comfortable taking part in an online process.
"The irony is our online tools were complementary to the paper version. This was from 2005 to 2020. In 2020, we got rid of the paper and moved to a totally digital environment," says Smith.
Still, the challenge with online enrollment is the passive nature of it. "When employers say, 'The benefits are online, go to this website,' no one does it because no one is interested in insurance," says Smith. This conundrum got Smith thinking: how could long-term care benefits gain better user engagement? He concluded that it came down to the education of the product. Enroll For Life addressed the issue with its design requiring employees to make a selection. This is what caught the eye of Trustmark.
"The Enroll For Life platform reduces a pain point for brokers on smaller case enrollments and helps drive growth and awareness of permanent life products in that market. The technology enhances enrollment process efficiency and utilizes behavioral economics to simplify benefit selection and improve participation," said John Anderson, President and CEO of Trustmark.
The need for an engaging employee experience
The biggest challenge for brokers today is getting employees educated on the benefits. In the aftermath of the COVID-19 pandemic, many employers moved to a more self-service enrollment model—sending employees to a website rather than offering face-to-face, personalized guidance from benefits counselors. In itself, this isn't problematic, but when that self-service model becomes largely passive—without employee support, communication, or education—it becomes challenging to get employees enrolled in their benefits.
In fact, more than half of employers now use passive enrollment methods as their benefits enrollment style. As a result of this, combined with less availability of long-term products in the market, the number of people with long-term care insurance has plummeted. Only 3% of all U.S. adults, or 15% of those ages 65+, have long-term-care insurance, while 80% of 65-year-olds are expected to need long-term care at some point
Trustmark's Enroll For Life is addressing this issue. Having easily accessible videos, articles, online chats, and specialists ready to answer questions in real-time via phone or online regarding voluntary benefits makes for an informed and educated employee. These tools help demystify the often-complex world of long-term care, ensuring employees are not only aware of their options but also equipped to make informed decisions.
Even better is when the employee is then pushed to their benefits website and presented with simple options to review and select, which is exactly what Smith implemented. By leveraging a proven enrollment methodology, employees are required to either opt in to select the minimum coverage amount, opt up to select a higher level of coverage, or opt out to decline coverage. Even if the selection is no, this simple requirement creates a more educated and aware employee who is prompted to imagine their life with or without coverage.
This foundational principle of Enroll For Life was crystalized for Smith after talking with Dan Ariely, a prominent Duke University professor and best-selling author. Ariely told him that focusing on capturing a decline was an ideal example of the economic principle, the "power of the regret of no," because consumers will say "yes" more often in an "accept or decline situation."
"Our goal is to get employees engaged, even if that means getting a no," says Smith. "We want them to understand the benefits. Stronger participation, which comes from requiring employees to go to the website at least for education, leads to more yeses over time, which is so important considering the long-term care crisis our nation is facing. It is also important for the employers to have a selection on record, taking any potential for ambiguity out of the equation."
Without the required response, the employee may never consider the benefits of the product and the risks of not having it. They may not realize they have a need, much less take action to purchase coverage. By requiring the employee to accept or decline the product, they are forced to consider it, if only for a moment, and start to evaluate scenarios. Simply reviewing the product's features ignites them to imagine the consequences of not having it. An employee may have to consider: "What if I don't buy this and I'm confined to a nursing home? Will I have enough savings to cover living and health care expenses? Will my spouse be able to manage?"
Another benefit of forcing an election is that there can be no confusion if an employee (or beneficiary) claims they were not offered the plan. Having an opt out on record protects all parties and establishes historical documentation of the enrollment event.
Creating a more engaging and informative environment not only aids the employee and hopefully sets them on the right benefits path, but it also improves the employer and broker relationship. When a broker brings a solution that provides enrollment support with a simplified process backed by years of trusted experience, employers feel that their broker is listening to them and providing a solution that works for them and their employees. This dynamic establishes a true partnership.
The path forward
Unlike when Smith started out more than two decades ago, the majority of today's employees want self-service options, yet still want the reassurance of having live support available if needed. It's important to strike this balance for employees while requiring them to make a selection. By actively encouraging engagement, the resulting population of "yes" is more balanced and informed. Additionally, Enroll For Life addresses a key challenge for brokers – streamlining the process of offering valuable long-term care benefits to employees, especially at smaller companies. As a result, more individuals will likely gain access to essential coverage that can provide them and their loved ones with financial security going forward.
About Trustmark
Trustmark Voluntary Benefits provides innovative solutions that help policyholders achieve greater financial security. Clients trust us because, with more than 100 years of industry experience, we have the expertise to provide complete benefit solutions that simplify the lives of employers while providing much needed protection to their employees.
