Description
1 in 4 Americans is covered by Medicaid (nearly 80 million) and Children’s Health Insurance Program (CHIP) (6.8 million); more than 60 million Americans are enrolled in Medicare; and 11.4 million consumers selected or were automatically reenrolled in an Exchange plan in 2020.
Designated Services
- Getting Started with Medicare
- Understanding eligibility results and next steps after the application
- Checking eligibility and applying for Medicaid
Previously-reported Services
Getting Started with Medicare
Description
Medicare is health insurance for people age 65 or older. Beneficiaries are first eligible to sign up for Medicare three months before they turn 65 and eligible to get Medicare earlier if they have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Medicare.gov provides information and resources for beneficiaries. The recently redesigned “Get Started with Medicare” section of Medicare.gov helps new customers find the information they need to decide about their coverage, including what Medicare is, the parts of Medicare, how to sign up, costs, understanding choices, and how to use the coverage. The getting started service includes a mailed enrollment package and a letter to encourage people to choose the coverage that best meets their needs. CMS partners 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. This year, the agency piloted a free “concierge service” to offer more in-depth assistance to new customers calling 1-800-Medicare.
Why this service was designated
Over 63 million people are enrolled in Medicare insurance. CMS customer research shows that the “New to Medicare” customers do not have as smooth an experience with Medicare Services as existing customers and may need extra support. Those joining the Medicare program are overwhelmed by the information available to them (from both the government and private sector) and are uncertain about what steps they need to take. Medicare enrollment is becoming even more complicated as a larger portion of the population continues to work beyond age 65 when Medicare enrollment begins for most people.
Understanding eligibility results and next steps after the application
Description
12.2M consumers enrolled in Marketplace coverage on HealthCare.gov during Open Enrollment 2023. Many more have gone through the journey to coverage over the years. Health insurance is often a complex product and consumers can struggle with identifying their needs, estimating costs, and understanding key factors to compare. Consumers have to weigh many factors when reviewing health plans from levels of coverage, coverage for doctors, facilities, and prescription drugs, other benefits, and financial considerations such as their monthly premiums and how much they’ll pay out of pocket for the services they might need throughout the year. Once a consumer chooses a health plan, they typically rely on that health insurance for a full calendar year to cover all of their healthcare needs, including both predictable and unexpected events.
Marketplace health plan offerings can bring additional complexity for consumers who are trying to compare and select a health plan that best meets their own personal needs. The Marketplace has tiers of health plan categories based on how costs are shared between the plan and the consumer for services (i.e. metal levels: bronze, silver, gold, platinum), and standardized plan options that set some out-pocket costs at the same rate across plans within a health plan category. Additionally, in some cases a consumer may be eligible for extra savings on their out-of-pocket costs if they select a silver tier plan, which may provide a better value.
Why this service was designated
The average number of plans available to consumers on the Marketplace has increased from 26 in 2019 to 114 in 2023. While having options benefits consumers overall, it can also make it more difficult to compare and make a meaningful selection. The Marketplace is pursuing a joint effort through proposed policy improvements and customer experience improvements on HealthCare.gov to help consumers compare meaningfully different plans that best meet their individual needs. Customer experience improvements will focus on helping consumers tailor their plan results through decision support and enhancing the plan selection process to provide better just-in-time assistance when comparing and enrolling in a Marketplace plan that’s right for them.
Checking eligibility and applying for Medicaid
Description
Recently, CMCS observed that more than 50% of Medicaid.gov site visitors are beneficiaries looking for information on Medicaid eligibility, enrollment, and other information provided by state and local resources. While each state Medicaid/CHIP agency has full responsibility for all aspects of the administration and operation of the Medicaid and CHIP programs, including determining eligibility for and enrollment into their program, Medicaid.gov can help to connect those seeking coverage with resources to determine their eligibility and begin their application.
As the current public health emergency (PHE) ends, CMCS will work to better understand the Medicaid.gov consumer journey in order to improve the website. Improvements will be designed to reduce consumer burden, increase access to eligibility and enrollment systems, and further instill trust in the Medicaid health care system.
Why this service was designated
Medicaid supports health benefits for more than 80 million Americans. In accordance with Executive Order 14058, “Transforming Federal Customer Experience and Service Delivery to Rebuild Trust In Government” CMCS shares the desire to improve the customer experience and increase the quality and efficiency of interactions with Medicaid. Medicaid.gov was launched in December 2011 as a hub for Federal program and policy information about Medicaid, the Children’s Health Insurance Program (CHIP) and the Basic Health Program (BHP). In 2020, Medicaid.gov had more than 7 million unique users and over 17 million page views.
Quarterly data reported
Q1 2023
What we learned from this quarter's data:
This quarter saw an increase in satisfaction among our Medicaid.gov user groups compared to the previous year. Interest and use of Medicaid.gov continues to rise as policy professionals and individuals navigate the Medicaid renewal process due to the expected end of the public health emergency (PHE). The majority of our users are individuals looking for renewal, coverage, eligibility, and enrollment information while others depend on the policy and data Medicaid.gov offers. While these are often disparate objectives, the goals for all of Medicaid.gov are to improve accessibility, increase ease of use, reduce the number of clicks to access relevant information, and efficiently help all users navigate to the information they need.
In Q1, we have seen modest improvements in all of these categories. We expect our research and design efforts to further address these goals in 2023 and beyond.
Service details
Transaction point: Medicaid.gov
Channel: website
People served: 16000000
Surveys offered: 8000000
Responses: 2020
Previously-reported Services
Prior to the first service designation exercise in 2022, HISPs were collecting data using methods unique to each agency, resulting in data that was not standardized. This previously-reported data was collected to increase visibility and awareness regarding customer experience through feedback data. Per A-11 guidance, service providers will collect feedback in a more standardized way.
Searching for health insurance on Healthcare.gov
Description
The Health Insurance Exchanges (Marketplace) help uninsured people find health coverage. By filling out an application on Healthcare.gov, consumers find out if they qualify for private insurance plans, Medicaid, or the Children’s Health Insurance Program (CHIP). Web, phone call and post- application satisfaction are measured via survey.
Quarterly data reported
Q2 2023
What we learned from this quarter's data:
This quarter encompasses the plan transition time period for Medicare beneficiaries as they begin to use the services from any plan changes made during the annual Open Enrollment Period. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. The Medicare.gov survey showed improvement in online customer satisfaction and anecdotal customer feedback provides insight to help guide improvements that are underway for enhancing the omnichannel experience. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 4467042
Surveys offered: 3613078
Responses: 187152
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 19262050
Surveys offered: 1466501
Responses: 1057
Q1 2023
What we learned from this quarter's data:
This quarter saw an increase in satisfaction among our Medicaid.gov user groups compared to the previous year. Interest and use of Medicaid.gov continues to rise as policy professionals and individuals navigate the Medicaid renewal process due to the expected end of the public health emergency (PHE). The majority of our users are individuals looking for renewal, coverage, eligibility, and enrollment information while others depend on the policy and data Medicaid.gov offers. While these are often disparate objectives, the goals for all of Medicaid.gov are to improve accessibility, increase ease of use, reduce the number of clicks to access relevant information, and efficiently help all users navigate to the information they need.
In Q1, we have seen modest improvements in all of these categories. We expect our research and design efforts to further address these goals in 2023 and beyond.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 4314101
Surveys offered: 3034662
Responses: 199607
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 25411394
Surveys offered: 2931355
Responses: 6503
Q4 2022
What we learned from this quarter's data:
This quarter encompasses ongoing usage and patterns as Marketplace consumers use the services from their plans. The Marketplace Teams continue to enhance and evolve the customer experience in preparation for the upcoming Open Enrollment period in the fall. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Call volume during this time continues to be lower year over year as the online resources improve and additional states graduate to operate their own Marketplace, reducing the overall population handled by the Federal Marketplace. Online web usage was consistent with previous periods as more users are continuing to rely on online services. Online customer satisfaction with Marketplace resources has remained consistent with similar time periods in prior years even as we have been addressing emerging user needs and information.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 1617952
Surveys offered: 1249859
Responses: 76590
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 11495539
Surveys offered: 200343
Responses: 343
Q3 2022
What we learned from this quarter's data:
Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. We continue to expand the pages on Medicare.gov where web chat is more easily available to users. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction and provides insight to help guide improvements that are underway for enhancing the omnichannel experience. This quarter, Medicare.gov evolved our experiences for new to Medicare users, releasing our “Hello Medicare!” designed homepage and landing pages for some of our more popular tools. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 1617952
Surveys offered: 1249859
Responses: 76590
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 11495539
Surveys offered: 200343
Responses: 343
Q2 2022
What we learned from this quarter's data:
Marketplace - This quarter encompasses the end of OE as well as the plan transition time period for Marketplace consumers as they begin to use the services from any new plans or plan changes made. Call center experiences maintain a high level of overall satisfaction. Call volume continues to be lower year over year. Online web usage was consistent with previous periods. Online customer satisfaction has remained consistent. Medicare - This quarter encompasses the plan transition period for Medicare beneficairies as they begin to use the services from any plan changes made during OE. Call center experiences maintain a high level of overall satisfaction. The Omicron variant required more beneficairies to inquire about Medicare coverage options for testing. Online customer support via online chat continues to supplement our web services. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 4225594
Surveys offered: 1091911
Responses: 143572
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 18444616
Surveys offered: 616334
Responses: 1001
Q1 2022
What we learned from this quarter's data:
This quarter encompassed the annual Open Enrollment (OE) for Medicare beneficiaries. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As the COVID-19 public health emergency continues, the needs and expectations of our customers continue to evolve. We saw an increase in phone inquiries and continue to see an increase in web traffic, as Medicare beneficiaries leverage online tools and services. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction and provides insight to help guide improvements that are underway for enhancing the omnichannel experience. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: phone
People served: 4522035
Surveys offered: 3175325
Responses: 186300
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 23765566
Surveys offered: 876140
Responses: 6859
Q3 2021
What we learned from this quarter's data:
During the third quarter, web and call center customer satisfaction remained in line with expectations for this time period, which is outside of Open Enrollment (OE). Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As expected, overall volumes are lower this quarter from last quarter as a result of being outside of OE (the busiest time of the year for both web and call center traffic). However, we are seeing a year over year increase in Medicare.gov website utilization, most likely due to ongoing improvements in online services and reliance of online technologies to receive information during the pandemic. Call volume is up slightly year over year, and web chat utlization continues to increase most likely a result from increased services online.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 2507189
Surveys offered: 2013865
Responses: 94041
Transaction point: Online survey; link provided at end of the online application
Channel: computer
People served: 14673883
Surveys offered: 437379
Responses: 2206
Q2 2021
What we learned from this quarter's data:
During the second quarter, web and call center customer satisfaction remained in line with expectations for this time period, which is outside of Open Enrollment (OE). Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As expected, overall volumes are lower this quarter from last quarter as a result of being outside of OE (the busiest time of the year for both web and call center traffic). However, we saw an increase in year over year web traffic most likely due to the 2021 SEP (which began in February 2021) and changes in Marketplace outreach and education which drove consumer volume. Call volume is down slightly year over year, as a result of increased state adoptions of Marketplaces, and a reduction in some of the complex casework usually associated with this time of year due to flexibilities established by the new Administration (reduction of data matching inquiries and SEP verification inquiries). We also note during this time that customer satisfaction has remained consistent with expectations.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 3508917
Surveys offered: 2557933
Responses: 113803
Transaction point: Online survey; link provided at end of the online application
Channel: mobile
People served: 15344146
Surveys offered: 437205
Responses: 599
Q1 2021
What we learned from this quarter's data:
This quarter encompassed the annual Open Enrollment (OE) for Medicare beneficairies. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As the COVID-19 public health emergency has continued evolving, we’ve continued to respond and adapt resources and information for people with Medicare through Medicare customer service channels. We saw a slight increase in phone inquiries and web inquiries, mostly likely due to restrictions on interpersonal interactions in the community, which resulted in people relying more heavily on the phone and web channels. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction in each period, which provides insight to help guide improvements that are underway for enhancing the omnichannel experience.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 5986566
Surveys offered: 3890279
Responses: 177004
Transaction point: Online survey; link provided at end of the online application
Channel: mobile
People served: 23011348
Surveys offered: 1143673
Responses: 4371
Asking About Medicare Benefits
Description
Medicare is health insurance for people 65 or older, people under 65 with certain disabilities and people of any age with End-Stage Renal Disease. Medicare.gov provides information and resources for beneficiaries. Contact center phone call and web satisfaction are measured via survey.
Quarterly data reported
Q2 2023
What we learned from this quarter's data:
This quarter encompasses the plan transition time period for Medicare beneficiaries as they begin to use the services from any plan changes made during the annual Open Enrollment Period. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. The Medicare.gov survey showed improvement in online customer satisfaction and anecdotal customer feedback provides insight to help guide improvements that are underway for enhancing the omnichannel experience. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 5979245
Surveys offered: 4296262
Responses: 410969
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 14520470
Surveys offered: 3630118
Responses: 55517
Q1 2023
What we learned from this quarter's data:
This quarter saw an increase in satisfaction among our Medicaid.gov user groups compared to the previous year. Interest and use of Medicaid.gov continues to rise as policy professionals and individuals navigate the Medicaid renewal process due to the expected end of the public health emergency (PHE). The majority of our users are individuals looking for renewal, coverage, eligibility, and enrollment information while others depend on the policy and data Medicaid.gov offers. While these are often disparate objectives, the goals for all of Medicaid.gov are to improve accessibility, increase ease of use, reduce the number of clicks to access relevant information, and efficiently help all users navigate to the information they need.
In Q1, we have seen modest improvements in all of these categories. We expect our research and design efforts to further address these goals in 2023 and beyond.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 6398117
Surveys offered: 4602706
Responses: 453123
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 16786915
Surveys offered: 4196729
Responses: 108656
Q4 2022
What we learned from this quarter's data:
This quarter encompasses ongoing usage and patterns as Marketplace consumers use the services from their plans. The Marketplace Teams continue to enhance and evolve the customer experience in preparation for the upcoming Open Enrollment period in the fall. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Call volume during this time continues to be lower year over year as the online resources improve and additional states graduate to operate their own Marketplace, reducing the overall population handled by the Federal Marketplace. Online web usage was consistent with previous periods as more users are continuing to rely on online services. Online customer satisfaction with Marketplace resources has remained consistent with similar time periods in prior years even as we have been addressing emerging user needs and information.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 5195649
Surveys offered: 3851545
Responses: 364757
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 13996389
Surveys offered: 3499097
Responses: 48212
Q3 2022
What we learned from this quarter's data:
Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. We continue to expand the pages on Medicare.gov where web chat is more easily available to users. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction and provides insight to help guide improvements that are underway for enhancing the omnichannel experience. This quarter, Medicare.gov evolved our experiences for new to Medicare users, releasing our “Hello Medicare!” designed homepage and landing pages for some of our more popular tools. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 5291010
Surveys offered: 3620135
Responses: 357133
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 14947305
Surveys offered: 3736826
Responses: 54795
Q2 2022
What we learned from this quarter's data:
Marketplace - This quarter encompasses the end of OE as well as the plan transition time period for Marketplace consumers as they begin to use the services from any new plans or plan changes made. Call center experiences maintain a high level of overall satisfaction. Call volume continues to be lower year over year. Online web usage was consistent with previous periods. Online customer satisfaction has remained consistent. Medicare - This quarter encompasses the plan transition period for Medicare beneficairies as they begin to use the services from any plan changes made during OE. Call center experiences maintain a high level of overall satisfaction. The Omicron variant required more beneficairies to inquire about Medicare coverage options for testing. Online customer support via online chat continues to supplement our web services. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 6188911
Surveys offered: 2090054
Responses: 398065
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 11872572
Surveys offered: 2968143
Responses: 88535
Q1 2022
What we learned from this quarter's data:
This quarter encompassed the annual Open Enrollment (OE) for Medicare beneficiaries. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As the COVID-19 public health emergency continues, the needs and expectations of our customers continue to evolve. We saw an increase in phone inquiries and continue to see an increase in web traffic, as Medicare beneficiaries leverage online tools and services. Online customer support via online chat continues to supplement our web services and expand our abilities to serve our customers on their preferred channel. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction and provides insight to help guide improvements that are underway for enhancing the omnichannel experience. Qualitative online feedback shows increased customer satisfaction with the services that are provided and the usability of the services.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 7239397
Surveys offered: 4006022
Responses: 427417
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 16143893
Surveys offered: 4035973
Responses: 108155
Q3 2021
What we learned from this quarter's data:
During the third quarter, web and call center customer satisfaction remained in line with expectations for this time period, which is outside of Open Enrollment (OE). Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As expected, overall volumes are lower this quarter from last quarter as a result of being outside of OE (the busiest time of the year for both web and call center traffic). However, we are seeing a year over year increase in Medicare.gov website utilization, most likely due to ongoing improvements in online services and reliance of online technologies to receive information during the pandemic. Call volume is up slightly year over year, and web chat utlization continues to increase most likely a result from increased services online.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 5242231
Surveys offered: 2906712
Responses: 261006
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 10945205
Surveys offered: 2736301
Responses: 56163
Q2 2021
What we learned from this quarter's data:
During the second quarter, web and call center customer satisfaction remained in line with expectations for this time period, which is outside of Open Enrollment (OE). Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As expected, overall volumes are lower this quarter from last quarter as a result of being outside of OE (the busiest time of the year for both web and call center traffic). However, we saw an increase in year over year web traffic most likely due to the 2021 SEP (which began in February 2021) and changes in Marketplace outreach and education which drove consumer volume. Call volume is down slightly year over year, as a result of increased state adoptions of Marketplaces, and a reduction in some of the complex casework usually associated with this time of year due to flexibilities established by the new Administration (reduction of data matching inquiries and SEP verification inquiries). We also note during this time that customer satisfaction has remained consistent with expectations.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 6175501
Surveys offered: 4304691
Responses: 306854
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 9882588
Surveys offered: 2470647
Responses: 74600
Q1 2021
What we learned from this quarter's data:
This quarter encompassed the annual Open Enrollment (OE) for Medicare beneficairies. Call center experiences continue to maintain a high level of overall satisfaction through phone interactions. As the COVID-19 public health emergency has continued evolving, we’ve continued to respond and adapt resources and information for people with Medicare through Medicare customer service channels. We saw a slight increase in phone inquiries and web inquiries, mostly likely due to restrictions on interpersonal interactions in the community, which resulted in people relying more heavily on the phone and web channels. The Medicare.gov survey continues to reflect an evolving rebaseline of current satisfaction in each period, which provides insight to help guide improvements that are underway for enhancing the omnichannel experience.
Service details
Transaction point: Post Call IVR Survey
Channel: automated_phone
People served: 7190179
Surveys offered: 4838098
Responses: 331080
Transaction point: Survey displayed to website visitors upon exit from website
Channel: computer
People served: 14216891
Surveys offered: 3554223
Responses: 93211