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.

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.

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.

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.

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.