Medicare 2021 CX Profile

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Medicare Customer Support Services

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

Medicare provides health care coverage to more than 63 million people and offers services to help customers understand this coverage and empower future customers to make informed decisions about which Medicare plan is right for them. 

Medicare enrollees and those looking to enroll report high satisfaction with the service they receive when calling Medicare, and new online tools are helping make the agency’s website clearer and easier to navigate. Despite these successes, customers who are new to Medicare can struggle to navigate the service options available. To address the needs of these new customers, the agency redesigned the section of its website that offers information specifically for new customers and piloted a free “concierge service” to offer more in-depth support when these customers call Medicare. 

Service Overview

Primary customers

Individuals enrolled or seeking to enroll in Medicare, and their caregivers.  

  • 63.3 million people were enrolled in Medicare as of September 2021. 

Key services provided to customers

  • Answers to questions about medical services, tests and drugs covered by Medicare.
  • Help with understanding coverage options and shopping for, comparing, and enrolling in Medicare health plans, 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.  

Service Snapshot (all data for fiscal year 2020)

  • 24 million calls to contact center.
    • Average wait time: about 5 minutes.
  • 1.4 million webchats between the agency and customers.
  • 43 million users of Medicare.gov.

Data Highlights

point increase in customer satisfaction with Medicare.gov among customers who are new to Medicare (from January to August 2021).

of callers who participated in a pilot of Medicare’s free “concierge service” were satisfied with the service.


Customer Experience Insights

Improvement from last year

Room for improvement

In 2020, Medicare combined and improved several search tools to make it easier for customers to find health care providers who accept Medicare.

In late 2020, the agency launched a new Care Compare tool on Medicare.gov that is optimized for mobile devices. It enables customers to easily search for the type of care they are seeking and narrow down results to find the provider best match. This new feature combines several previous search tools that had been confusing to customers: before that, they would have to know exactly what type of care they were looking for and the specific technical term Medicare uses to describe it. The new tool enables customers to search by location, key words or phrases and includes improved filters and maps of provider locations, making it easier for customers to find the provider that is right for them. The tool also includes additional resources to help customers make decisions; for example, customers searching for a nursing home can see a checklist with common questions and considerations to help them evaluate their options.

Customers new to Medicare can find it difficult to navigate the service options available.

The process of enrolling in Medicare for the first time can be complicated for customers who must make several important decisions about the type and timing of coverage they want. Medicare’s customer research shows that these “new to Medicare” customers do not have as smooth an experience with Medicare services as existing customers and may need extra support. To address this gap, the agency recently redesigned the “Get Started with Medicare” section of Medicare.gov to help new customers more easily find the information they need to make decisions about their coverage. Medicare also improved its Initial Enrollment Period package to lay out more clearly the actions new customers must take when enrolling and partnered with the Social Security Administration to send personalized emails to these customers with important information they need to know during their first year enrolled in Medicare. With these changes, customer satisfaction with Medicare.gov increased by 24 points for “new to Medicare” customers between January and August 2021.

This year the agency also piloted free “concierge service” to offer more in-depth assistance to new customers calling 1-800-Medicare. For customers who accepted, call center representatives scheduled a follow-up call and noted any questions or topics the customer would like to discuss. Specialized call center representatives then returned the customer’s call at the scheduled time to talk through their specific questions. To ensure customers had the information they needed, representatives also offered to follow up after the call with a letter detailing the topics discussed and the next actions the customer needed to take. In survey data Medicare collected, 97% of callers who participated in the pilot were satisfied with the concierge service.

Online accounts could make it easier for caregivers to help manage benefits for people with Medicare.

Some people get help from caregivers in managing their Medicare benefits—whether family members or aides, nurses or other professionals. It can be hard for caregivers to access claims information and health care records on Medicare.gov, since only a Medicare beneficiary can set up an account on the site. In the future, CMS plans to add an option for caregivers to create their own accounts that link to the information for those they assist—potentially enabling them to manage benefits for multiple people (e.g., both their parents) with one login.

Delivering Medicare Customer Support Services Equitably

Achieving health equity is a priority for CMS. In 2015, CMS released The CMS Equity Plan for Improving Quality in Medicare—a framework outlining its “action-oriented, results driven approach for advancing health equity” with a focus on “increasing understanding and awareness of disparities, creating and sharing solutions, and accelerating implementation of effective actions.” A progress report on the past five years of work on that plan was released this year, called ”Paving the Way to Equity: A Progress Report.”  

Health Equity is one of six pillars in the CMS Strategic Vision: “Advance health equity by addressing the health disparities that underlie our health system.” In the past year, CMS has expanded affordable coverage through HealthCare.gov. According to CMS Administrator Chiquita Brooks-LaSure, “millions of new and returning consumers found coverage for $10 or less per month.” The agency now also provides more home-based and community-based services for seniors and people with disabilities, including making COVID-19 vaccinations available to 1.6 million hard-to-reach Medicare beneficiaries. 

Leading Customer Experience Practices

The Partnership and Accenture developed the following list of practices to understand how agencies prioritize 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. 

Organizational Commitment

Organizational Commitment

A strong commitment and plan from agency leaders to prioritize customer experience is essential for sustained progress.

The agency:

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

Yes

Customer experience improvements are included in several of Medicare’s 16 strategic initiatives.

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

Peartially

CMS uses customer feedback when measuring the performance of Medicare customer service programs, although it does not have a specific performance measure based on customer feedback. 

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

Partially

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

Ease of Customer Interactions

Ease of Customer Interactions

Interactions with the federal government should be easy, transparent and designed around user needs.

For the most common services provided, customers can:

1. Complete common transactions using the service delivery channel of their choice.  

Yes

Most common transactions can be completed online or over the phone. Customers can also use webchat to speak with the Medicare contact center. Medicare does not have field offices.

2. Obtain status updates through online self-service. 

Yes

Customers with MyMedicare accounts can log in to get information on the status of their Medicare enrollment and claims.

3. Receive a response to feedback or answers to questions over social media.

Partially

Medicare occasionally responds to basic customer comments on the agency’s social media by sharing links to the agency’s website.

4. Access online information and support in languages other than English.

Yes

Medicare.gov is available in both English and Spanish, and some service information is available in 22 additional languages.

Listening to Customers and Acting on Feedback

Listening to Customers and Acting on Feedback

To understand and prioritize customer needs, agencies should collect, publish, analyze and act on feedback.

The agency:

1. Collects meaningful customer experience data across interactions and service delivery channels and shares it with the public.

No

While Medicare collects customer experience data across service delivery channels, it does not currently share this data with the public.

2. Collects and analyzes first-hand customer feedback to understand customers’ experiences, based on their own words.

Yes

CMS regularly collects and analyzes first-hand customer feedback.

3. Aggregates and analyzes customer feedback across channels and programs, and shares feedback with relevant staff members so they can act on it.

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Footnotes and Methodology

Customer experience indicators methodology

The Partnership and Accenture developed the following list of practices to understand how agencies prioritize the customer experience, and steps they can take to improve. The list is based on research about effective customer experience practices in 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.

Organizational Commitment

A strong commitment and plan from agency leaders to prioritize customer experience is essential for sustained progress.

The agency:

  1. Includes high-quality customer experience in its strategic goals.
    • Criteria: a) 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 b) 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 agency priority goals that is based on feedback directly from customers. 
  3. Has a senior executive with the responsibility and authority to lead efforts to improve the customer experience across the organization.
    • Criteria: Based on a review of the agency’s organizational chart and online descriptions of leadership positions, the agency has an executive who meets the following criteria: a) customer experience is that executive’s primary responsibility b) the executive reports to the head of the organization or a deputy c) the executive’s work spans all major service delivery channels (e.g., online services, contact centers, face-to-face services).

Ease of Customer Interactions

Interactions with the federal government should be easy, transparent and designed around user needs.

For the most common services provided, customers can:

  1. Complete common transactions using the service delivery channel of their choice.
    • Criteria: Based on a review of the agency’s website, customers have multiple options to complete common transactions including going online, calling, using webchat and visiting field offices or other physical locations. 
  2. Obtain status updates through online self-service.
    • Criteria: customers can get real-time updates through an online self-service channel that provides estimated timelines.
  3. Receive a response to feedback or answers to questions over social media.
    • Criteria: Does the agency respond to questions through the direct message feature on Facebook and Twitter, or in the comment section of posts? To assess this, we examined social media posts on the service’s primary account across a three-month period. “No” indicates the agency never or rarely responds to comments; “partially” indicates the agency responds sometimes, but not consistently; and “yes” indicates the agency responds to comments on a frequent and consistent basis.
  4. Access online information and support in languages other than English.
    • Criteria: “No” indicates content is available only in English and translation features are not available on the website; “partially” indicates that some content or services are available in English and Spanish; “yes” indicates that content or services are available in English and Spanish and additional languages.

Listening to Customers and Acting on Feedback

To understand and prioritize customer needs, agencies should collect, publish, analyze and act on feedback.

The agency:

  1. Collects meaningful customer experience data across interactions and service delivery channels and shares it with the public.
    • Criteria: In alignment with the Office of Management and Budget’s guidance on customer experience measurement, the agency shares customer feedback with the public and that: a) represents multiple service delivery channels b) provides details into different aspects of the experience (i.e., beyond overall customer satisfaction)
  2. Collects and analyzes first-hand customer feedback to understand customers’ experiences, based on their own words.
    • Criteria: In alignment with Office of Management and Budget’s guidance on customer experience measurement, in customer or user research such as interviews, focus groups, surveys and other feedback mechanisms, customers can describe their experiences in their own words, and the agency has automated analytic capabilities to identify and act on insights that emerge from customer feedback data.
  3. Aggregates and analyzes customer feedback across channels and programs, and shares feedback with relevant staff members so they can act on it.
    • Criteria: Agency has an automated system to collect feedback across multiple channels and programs into a centralized location, analyze it for insights, and share those insights with relevant agency business owners or other appropriate colleagues responsible for taking action. The agency also tracks the impact of actions taken in response to customer feedback.

This customer experience profile was produced in collaboration with Accenture Federal Services.