GOVERNMENT FOR THE PEOPLE: PROFILES ON THE CUSTOMER EXPERIENCE

Medicare Customer Support Services

Centers for Medicare and Medicaid Services, Department of Health and Human Services

This customer experience profile is from 2019. To view this year’s profile, click here.

This profile focuses on the range of online and over-the-phone customer support services provided to people with Medicare, and does not address health care services people receive at doctors’ offices, hospitals or other providers. The profile does not discuss the experience with Medicaid, a state-based health coverage program for low-income people.

Signing up for Medicare is a big turning point in the lives of Americans who become eligible for the largest health insurance provider in the United States when they turn 65. The program currently serves more than 60 million customers, also providing health insurance to people younger than 65 who have certain disabilities and illnesses.

To get Medicare information and services, people can call the 1‑800‑MEDICARE contact center or use Medicare’s website and mobile applications. Customers express satisfaction with many of their Medicare interactions, such as getting answers to their questions about covered services and the enrollment support they get through the 1‑800‑MEDICARE line, according to customer feedback and CMS survey responses. Customers also commend contact center representatives for being courteous, well-informed and helpful. 

Medical and health insurance language can be highly technical, and our analysis of select Medicare web pages reveals CMS could do better at using plain language to communicate with customers. In October 2018, CMS identified Medicare online services as an area for improvement and launched a major initiative called eMedicare to help people complete tasks and get online information more easily.


Service Overview
Key Services

  • Answers to questions about the medical services, tests and drugs Medicare covers. 
  • Help with understanding coverage options and shopping for, comparing and enrolling in Medicare health plans or Medicare prescription drug plans or both. 
  • Information about Medicare premiums.  
  • Assistance with finding and comparing Medicare health care providers. 
  • Assistance with coordinating Medicare benefits. 
  • Information and answers to questions about claims and payments. 

Overview1

CALLS

23.8 million 

calls to the 1-800-MEDICARE
call center 

WAIT TIME<

3.5 minutes 

average time to speak with a representative at the
1-800-MEDICARE
call center

ONLINE VISITS

412.8 million 

visits to
Medicare.gov

FACE-TO-FACE- CONTACTS

N/A 

Medicare does not have field offices

Social Media Presence

CMS has a social media presence for the Medicare program on Facebook and Twitter that keeps people updated on programs and benefits. For example, social media posts have highlighted new online tools, informed customers about Medicare access when abroad and provided reminders to get flu shots.  

For the protection and security of people’s personal and potentially sensitive health information, the agency does not answer individual Medicare account questions or resolve account issues on social media channels. Instead, the agency redirects customers to Medicare’s website and call center for individual questions.  

As of September 2019, Medicare’s social media presence includes:


Twitter

@MedicareGov
Joined: June 2011 


Followers:
32K 

Posts:
6K 


Facebook

@medicare
Joined: February 2015 


Followers:
411K 

Likes:
412K 

Customer Feedback 

CMS collects data and feedback from customer interactions but does not publish any of that data possibly due to restrictions imposed by the Paperwork Reduction Act. However, interviews with agency officials provided the following information on progress and challenges:   


Customer Experience Highlights

  • Call center representatives received high marks for their courtesy and knowledge about the services covered under different Medicare plans, according to surveys offered at the end of calls. Nearly 90% of respondents rate their overall experience with Medicare customer service as “very good” or “excellent.” Callers are typically pleased with the support they get from Medicare representatives over the phone, said Erin Bradshaw of the Patient Advocate Foundation, an organization that helps guide patients through health care issues, including their interactions with Medicare.   
  • People appreciate the “Medicare and You” handbook, according to CMS officials. The handbook helps customers understand how to apply for and renew Medicare coverage, what tests and services are covered under the program, and more. Customers can download a digital handbook or request a hard copy from the Medicare contact center.   

PROMISING PRACTICE
CREATING A SEAMLESS EXPERIENCE BY CONNECTING CUSTOMER CONTACT POINTS

CMS leadership strives to create a good customer experience, particularly for people calling the agency’s 1-800-MEDICARE line, since many people with Medicare prefer receiving services over the phone.   

That said, about two-thirds of people with Medicare use the internet daily or almost daily, according to data CMS collects. With CMS’s eMedicare initiative enabling people to go online and text with Medicare representatives, the agency plans to integrate those options with the contact center for a unified experience. 

“Our intent is not to replace traditional channels that beneficiaries trust and depend on, but to improve and enhance them with the emerging digital options to create a user-centered, seamless consumer experience,” said CMS Administrator Seema Verma in a press release about eMedicare. 

As one example, the agency recently launched new capabilities to send callers text messages following a call to help them complete tasks discussed during the interaction. For example, a Medicare text could provide instructions on changing an address, a task the Social Security Administration, not Medicare, manages.   

CMS is also improving a webchat option launched several years ago on the website MyMedicare.gov, which enables users to create accounts and access personalized information. The webchat feature originally helped users connect with contact center representatives for help with logging in, navigating the website or completing other basic online tasks.   

After evaluating the experiences of individuals who used the webchat feature, officials learned many of them had to call the 1-800-MEDICARE phone line because the webchat agent was not authorized to address the issue. Medicare recently expanded the scope of services available through a webchat. For example, the agents now advise people which Medicare plan might be best for them and answer basic questions about differences among plans and the types of drugs that are covered. 

These changes contributed to a drop in the number of webchats that led to a referral to the contact center, according to agency officials, suggesting more customers were able to resolve their issues online. With more people taking care of their tasks online, Medicare officials can focus contact center resources on the more complex issues people have.  


Opportunities to Improve the Customer Experience

  • Customers can find it difficult to understand the various Medicare plan options and determine the best one for them. Medicare has many different types of plans available, and CMS provides a tool to help people sort through the options. Based on customer research and testing, the agency launched an upgraded version of this tool in August 2019 that enables people to enter information about themselves (e.g., where they live, how frequently they travel) and receive tailored suggestions for Medicare plans to meet their needs.  
  • People can struggle to understand technical health insurance language about their Medicare coverage. CMS officials noted that the agency strives to make complex medical terms easy for customers to understand, and regularly assesses ways to improve online content through user testing and other research.  
  • The Medicare online experience could be improved. For example, Medicare’s two primary websites—Medicare.gov, which offers general information, and MyMedicare.gov, which enables users to create accounts and access personalized information—can feel different to users and create confusion, according to CMS officials.

    The agency is working to create a more consistent experience across these sites through its eMedicare initiative. As part of this work, CMS has rolled out several new online tools, including the “What’s Covered” mobile application, which gives customers information about what tests, items or services Medicare covers. The agency also launched a new “lookup tool” for checking the price of medical procedures to help patients compare payments and copay­ments for procedures at different hospitals enrolled in Medicare.  

Our scan of more than 12,000 online posts about Medicare customer support services found examples of posts that can help understand the customer experience, such as people commenting on the complexity of Medicare billing statements and citing delays in receiving new Medicare cards. Here, we provide two examples of posts that reinforce themes in customer feedback identified elsewhere in the profile. Along with comments on other topics, our scan found instances of customers both praising and providing constructive feedback on online features, including the “What’s Covered” app and the plan finder tool. 

For example:    

“Medicare.gov now has a great app I recommend that is named What’s Covered? to help you determine coverage under Medicare health plans? Download it today!”

“Have you tried to use the Medicare plan finder tool? It is very complicated! To improve elderly decision making, we need improved information, less complexity, greater transparency, better use of defaults & personal reminders.”

More information about our methodology.

 

Website Experience: How Easy Is It to Navigate and Understand Online Information? 

In April 2019, the Partnership and Accenture partnered with the Center for Plain Language, a nonprofit organization that champions clear language, to conduct an analysis of selected CMS web pages. We analyzed selected Medicare.gov pages that provide information on getting drug coverage or filing a claim to see how easy they were to understand and navigate. Reviewers from the Center for Plain Language assessed the sites from the perspective of three different people: someone enrolling for coverage, someone already enrolled but looking to add coverage, and someone submitting a claim for durable medical equipment.   

More information about our methodology.

MEDICARE GRADE
(April 2019)

C

Note: In a separate study, the center examines a range of government websites annually and issues a Federal Plain Language Report Card. The average grade in calendar year 2018 was a “C.”


What the Analysis Found 

It can be difficult to find, understand or act on the information the CMS site provides. For example, a user seeking to file a Medicare claim would find a page explaining it is up to Medicare doctors and suppliers to file claims. What is missing is information on the exceptions, that is, when the beneficiary actually does needs to file a claim, such as when a physician is not a Medicare provider. For that information, a website user must go halfway down the page and click to open a claim form. On that form, a third of the way down the first page, are details on when it is up to the beneficiary to file the claim.   

Several pages related to getting drug coverage are heavy with text, use a lot of jargon and acronyms and, in some places, are overwhelmingly busy. The web pages lack pictures, graphics or charts to support the content. 

The information is organized—to a point—and follows several plain-language principles, such as consistently calling the user “you,” rather than “Medicare beneficiary” or another similarly impersonal term. Yet the site could be more user-friendly. Experienced users, and users familiar with the Medicare system and plan options, probably could make their way to useful information, but people unfamiliar with the complex range of Medicare choices would likely find the site difficult to use.

Figure 1: Pages are dense and use unnecessary acronyms.

Indicators that the Customer Experience is a High Priority 

The Partnership and Accenture developed the following list of indicators to understand how agencies are prioritizing the customer experience, and steps they can take to improve. The list is based on research about effective customer experience practices in both government and the private sector, and aligns with practices in a customer experience maturity self-assessment for agencies developed by the Office of Management and Budget. Leaders who participate in the Partnership’s federal customer experience roundtable provided input.       

More details about our methodology.

Commitment to customer experience

The agency:

Includes high-quality customer experience in its strategic goals.

Partially.

CMS does not publish a strategic plan, though it includes 16 strategic initiatives on its website, some of which address customer experience issues.

Specifies customer feedback as a key measure of the organization’s performance.

No.

While CMS does not publish customer feedback on Medicare as one of the agency’s overall performance measures, it does use customer feedback when measuring the performance of Medicare customer service programs.

Has a senior executive with the responsibility and authority to lead efforts to improve customer experience across the organization.

Partially.

CMS coordinates customer experience efforts across the agency through its Office of Communications, and the head of this office has customer experience as one responsibility.

Has a process for standardizing across channels the information and guidance provided to customers.

Yes.

Shares meaningful customer feedback with the public.

No.

Possibly due to restrictions imposed by the Paperwork Reduction Act.

Customer Service Basics 

For the most common services provided, customers can: 

Complete frequently used transactions online.

Yes.

Customers can go online to shop for and enroll in Medicare plans, and get information about the costs and services that are covered. 

Easily find information to call an appropriate representative.

Yes.

Schedule in-person appointments.

N/A

Not applicable. Medicare does not have field offices.   

Obtain status updates.

Yes.

People can get online information on the status of their Medicare enrollment, and can check personalized information, such as the status of claims on MyMedicare.gov. 

Customer Feedback 

The agency collects and analyzes data and information on customer perceptions:    

Of specific interactions, including website visits, phone calls and in-person appointments. 

Yes.

Of the customer journey through a series of interactions or multistage processes that build toward a specific goal.

Yes.

Of the overall service the organization provides.

Yes.

Through qualitative research, such as customer interviews, focus groups, analysis of social media comments or direct observation.

Yes.

  

Footnotes and Methodology

Expand

Footnotes

1  Data provided by the CMS for fiscal 2018.  


Social Media Methodology

Accenture conducted the social media scan using a social media intelligence platform. Using keyword searches, the team identified comments posted from November 2018 through February 2019 about each federal service on popular social media sites such as Twitter, Reddit, Instagram, Yelp, Google and other online forums. The majority (61%) of the posts ultimately included in the analysis were from Twitter. 

The team excluded posts primarily containing political commentary and grouped posts to identify themes in customer feedback for each federal service. The methodology allowed us to identify common trends in posts about each service and identify potential issues customers face but cannot be used to draw firm conclusions about the experience of the full range of its customers.   


Web Experience Methodology

For each agency, we selected for review a set of web pages that provided information on how customers apply for or access one of the agency’s highest-volume services. 

We partnered with the Center for Plain Language to conduct this review. The center followed the same methodology it uses to assess plain language for its annual ClearMark awards for a range of organizations and its annual Federal Plain Language Report Card for the government. This process involved developing two profiles of typical users for each set of agency web pages. The user profiles helped focus reviews on typical tasks, for example, an individual applying for a green card for the first time.

Two plain-language experts individually and independently reviewed and scored each set of pages, using five plain-language criteria to assess each site. They rated each criterion on a five-point scale:

  • Information design and navigation.
  • Pictures, graphics and charts.
  • Style or voice.
  • Structure and content. 
  • Understanding of audience.

The reviewers then met to reach consensus on strengths and weaknesses of each site and to assign a letter grade based on their ratings. 


Detailed Methodology for Our Review of Indicators That Customer Experience Is a High Priority

We reviewed each agency and service against indicators that customer experience is a high priority using the following criteria.

Commitment to customer experience

The agency, subagency or bureau:

1. Includes high-quality customer experience in its strategic goals.

Criteria: 1) Customer experience with the agency’s services is listed in the strategic plan as one of the organization’s top priorities, or a supporting goal of one of the priorities; 2) the strategic plan provides specific actions the agency will take to improve customer experience.

2. Specifies customer feedback as a key measure of the organization’s performance.

Criteria: There is a performance measure included in the agency’s strategic plan, annual performance report or on performance.gov that is based on feedback directly from customers.

3. Has a senior executive with the responsibility and authority to lead customer experience efforts.

Criteria: Based on a review of the agency organizational chart and online descriptions of leadership positions, the agency has an executive who meets the following criteria: 1) customer experience is their primary responsibility; 2) they report to the head of their organization, or a deputy; 3) their work spans all major service delivery channels (e.g., online services, contact centers, face-to-face services).

4. Has a process for standardizing across channels the information and guidance provided to customers.

Criteria: At least two service delivery channels have integrated knowledge management systems so that when content for customers on one channel is updated, it is updated on the other channel.

5. Shares meaningful customer feedback with the public.

Criteria: In alignment with the Office of Management and Budget’s guidance on CX measurement, the agency makes public customer feedback that: 1) represents multiple service delivery channels; 2) provides details into different aspects of the experience (e.g., beyond overall customer satisfaction).

Customer service basics

For the most common services provided, customers can:

1. Complete frequently used transactions online.

Criteria: Based on a review of the agency’s website, customers can complete all major services or
transactions online.

2. Easily find information to call an appropriate representative.

Criteria: The agency’s website provides a clear explanation of which number to call for specific issues or provides one number that customers can call to get routed to the appropriate person.

3. Schedule in-person appointments.

Criteria: Based on a review of the agency’s website, customers have the ability to schedule appointments for in-person services.

4. Obtain status updates.

Criteria: Customers can get real-time updates through an online or self-service channel.

Customer feedback

The agency, subagency or bureau collects and analyzes data and information on customer perceptions:

1. Of specific interactions, including website visits, phone calls and in-person appointments.

2. Of the customer journey through a series of interactions or multistage processes that build toward a specific goal.

3. Of the overall service the organization provides.

4. Through qualitative research, such as customer interviews, focus groups, analyzing comments on social media, or direct observation.

The “Government for the People: Profiles on the Customer Experience” are produced in collaboration with Accenture Federal Services.