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


Executive Summary

By 2030, about 80 million Americans are projected to become eligible for Medicare, underscoring a need to make services easy to use for widespread adoption.1 In 2019, satisfaction with aspects of Medicare’s customer support remained high, including assistance from the 1-800 MEDICARE contact center. CMS also launched a multiyear eMedicare initiative to modernize the health care experience for patients online, on the phone and on other channels. The agency made significant upgrades to online customer options, such as a tool to help people find the best Medicare plan for their needs—making it easier for customers to explore and understand plan options.

When the coronavirus pandemic hit in early 2020, CMS successfully transitioned more than 2,000 Medicare contact center employees to telework in just a few weeks—a process that agency staff estimate could normally take up to eight months—largely without hindering its ability to provide customer service.

Based on insights from customer research, CMS found it can be hard for caregivers to access claims information and health care records needed to help manage the Medicare benefits of people they support.  The agency is planning an option for caregivers to create their own online accounts that link to the account information for the people they assist—potentially allowing them to manage benefits for multiple people (e.g., both their parents) with one login.


Data at a Glance

of callers to the 1-800 MEDICARE line rated their experience as “very good” or “excellent” in fiscal 2019

people were enrolled in Medicare as of June 2020

Service Overview

Primary Customers

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

  • 64 million people were enrolled in Medicare as of June 2020 (60 million as of Sept. 2019).

Key services  

  • Answers to questions about medical services, tests and drugs Medicare covers. 
  • 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. 


People Interact With Medicare By

(All data for fiscal year 2019 unless otherwise noted)

CALLING THE MEDICARE CONTACT CENTER

25.4 million 

calls


(23.8 million in fiscal 2018)2

VISITING ONLINE

>72.2 million 

visits to Medicare.gov


(92.8 million in fiscal 2018)3

AVERAGE WAIT TIME FOR CALLS

~4.5 minutes


(3.5 minutes in fiscal 2018)

VISITING A FIELD OFFICE

N/A


Medicare does not have field offices.


Customer Experience Insights

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The agency rebuilt its online Medicare Plan Finder to deliver a better, more user-friendly customer experience. The new, mobile-optimized tool features faster information processing and webchat capabilities and enables users to enter more personal information such as the medications they take to make informed choices. After the revamp, customer satisfaction with the tool increased by 10%, according to Medicare officials.

Even with slightly longer wait times, Medicare was able to maintain rapid service and high levels of customer satisfaction with its contact center over the past year. This quality of service continued even as the agency quickly transitioned customer service staff to telework during the coronavirus pandemic.

  • 94% of callers rated their experience as “very good” or “excellent.”

Webpages that explain which tests and services are covered under Medicare, and what the process is for filing an appeal if a claim is denied, received an A in our analysis.

Website Experience:
How easy is it to navigate and understand online information? 

Reviewers looked at the pages from the perspective of people seeking to answer two questions:

CMS Grade

A


Strengths

  • Language adheres to plain language principles such as using active voice, defining acronyms, using short sentences and presenting information in lists.
  • Content speaks directly to the user through personal pronouns in a conversational yet professional tone.
  • Difficult terms are defined in blue boxes that appear when the user hovers over text.
  • Consistent use of white space and clear, action-oriented headers help the reader find information for completing tasks.


Standout feature: Medicare coverage search tool

We searched for multiple tests and medical conditions, and the site delivered easy-to-understand results on what is covered and what the co-pay costs are. The agency also launched a mobile app, called "What's Covered," that provides the same content and data available on the website.

Figure: Clear, task-oriented page on filing an appeal (https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal)
Figure: “Hover over” definitions make it easy for the user.
(https://www.medicare.gov/your-medicare-costs/costs-for-medicare-advantage-plans)
Figure: Easy to find information about what tests are covered (https://www.medicare.gov/coverage?coverage_search=covid%2019)

While many people get their Medicare premiums deducted from their Social Security payments, more than 2 million people need to pay premiums directly to Medicare because they are not yet receiving Social Security benefits. Previously, these people could not pay their premiums online, or see their payment history and details about how their payments had been calculated.

In February 2019, Medicare launched an online option for people with Medicare to pay their premiums. Users quickly took advantage of this new feature. In the first year, people with Medicare made more than 1 million payments, and the program received positive feedback from customers. The tool also reversed a trend of increasing calls to the 1-800 MEDICARE line about premium payments, enabling agents to focus on other issues.

Some people get help from caregivers in managing their Medicare benefits—whether family members or nurses, aides 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.

While many people are automatically enrolled in Medicare when they retire and apply for Social Security retirement benefits, individuals who continue working need to decide when to apply. This can be a complex decision, involving factors like their current health care needs and what medical coverage they currently have.

To help people decide, CMS has been conducting customer research to understand how people approach this situation and what information they would like to know. Based on this research the agency is updating its online information about signing up for Medicare and has plans to create digital tools to help people decide when to enroll, based on their circumstances.

Key

Improvement from last year

Ongoing challenge


Connecting on Social Media

CMS has a social media presence for the Medicare program that keeps people updated on benefits and program changes. For example, social media posts highlight new online tools; inform customers about accessing Medicare services when abroad; educate people about Medicare fraud schemes; provide reminders to get flu shots; and inform and update people about COVID-19.  

As of September 2020, the Centers for Medicare and Medicaid Services’ social media presence related to Medicare customer support services included:


Twitter

(@MedicareGov)

Joined: June 2011



Followers: 40,800



Total tweets: 7,777


Facebook

(@Medicare)

Joined: February 2015



Followers: 442,400



Total likes: 436,800

Social media practices

Posts almost daily?
Yes



Responds to customers?
Yes – occassionally



Includes multimedia content?
Yes

For background information on these metrics and our full methodology click here.

How Medicare Adjusted Services During COVID-19

Most people who receive Medicare are 65 years old and above and at a higher risk for complications from the coronavirus. When the pandemic began, the agency received a flood of questions on whether Medicare covered coronavirus tests, and what telehealth services were covered. Officials added information to the agency’s website and social media accounts and trained call center representatives to inform customers that Medicare covered tests related to the virus and had expanded its coverage to telehealth services.

Staff members at the Centers for Medicare & Medicaid Services also worked to protect people from identity theft. Scammers sought to defraud Medicare recipients by offering free coronavirus tests—with the intention of stealing Medicare account numbers. CMS launched an advertising campaign alerting people to the scam and reminding them that CMS (or the government) will not call to ask for their Medicare numbers. Tactics included public service announcements on iHeart Radio—a podcast and radio streaming service—and promotional videos and ads through partners such as AARP. With 117 million media impressions, the campaign may have prevented many people from being scammed.

CMS transitioned about 2,000 Medicare contact center representatives from across the county to full-time telework, without disrupting customer service. This was a noteworthy achievement, as telework had not been allowed prior to the pandemic. With more employees working from home, call centers could set up physical workspaces with social distancing to accommodate the employees who were unable to telework. 1-800 MEDICARE continued to deliver quick and helpful services, with average wait times remaining between three and five minutes, and customer satisfaction rates between 93% to 95%. 

Indicators that the Customer Experience is a High Priority 

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Commitment to Customer Experience

CMS:

Includes high-quality customer experience in its strategic goals.

Improvement from 2019.


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


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


Shares meaningful customer feedback data with the public.

Customer Service Basics 

For the most common services provided, customers can: 

Complete frequently used transactions online.


Easily find information to call an appropriate CMS representative.


Schedule in-person appointments.


Obtain status updates.


Find standardized and consistent information and guidance across channels.

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. 


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


Of the overall service the organization provides.


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


Through a structured analysis of comments about the service left on social media channels.

More details about our methodology

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