Senator Smith Reports Incorrect and Misleading Answers with 1-800 Medicare:

What’s Your Experience with the Medicare Call Center?

At a November 15th hearing, Oregon Senator Gordon Smith reported that his staffers have repeatedly “received incorrect and misleading answers to several basic questions” during their recent ‘test’ calls to 1-800 Medicare (see, December 3, 2007 top story). For example, call center customer service reps told Smith staffers that: 1) Beneficiaries can switch plans at any time if they don’t like the plan in which they enrolled; 2) Not liking the plan might be on the list of reasons for which a special enrollment period is granted; and 3) All Medicare Advantage plans offer drug coverage – all of which is highly inaccurate and misleading. Explanations about the late enrollment penalty and the enrollment period for Medicare Advantage were also extremely inconsistent. In one case, a representative asked for a beneficiary’s zip code, and without asking for any additional information such as her prescribed drugs, proceeded to name a specific plan that would be the ‘best’ for someone in her area.

Besides receiving inaccurate answers, Smith’s staff reported difficulty in getting their phone calls connected. A Smith staffer said that for the 15 test calls placed “not a single call” connected to the system in less than 14 minutes and one took 31 minutes. This 14 minute wait is more than 50 percent greater than the eight-to-nine minute average wait time CMS is targeting for 2009.

With such disturbing findings, Smith challenged Centers for Medicare and Medicaid Services (CMS) Acting Administrator Kerry Weems to seriously address needed quality control on the 1-800 Medicare call-in system. Smith has also directed his staff to continue making calls and visit CMS call centers during the annual enrollment period currently underway (November 15 – December 31) to meet with call center management and review calls. Medicare beneficiaries rely on 1-800 Medicare as one of their primary sources of information, particularly during this annual enrollment period, and information must be accurate.

With a 2008 budget of $270 million dollars for 1-800 Medicare services solely provided by Arlington, Virginia-based Vangent, Inc. (formerly Pearson Government Solutions), CMS is handsomely paying yet another private contractor that is underperforming. Under Vangent’s management, CMS currently has over 3,000 customer service representatives (CSRs) available in eight call centers located across the United States offering help in English and Spanish. In preparation for the annual enrollment period, CMS also hired and trained over 300 additional customer service representatives and opened an extra 1-800 Medicare call center to meet the information needs of Medicare beneficiaries. Yet even as CMS claims their private contractor to be diligent in its CSR training (for example all new CSRs brought in for this annual enrollment period have received a minimum of three weeks classroom training followed by a week of practice calls, simulation, quality monitoring and follow-up coaching to ensure peak performance), Senator Smith’s findings demonstrate that areas for improvement remain plentiful.

In addition to Senator Smith’s findings, in September 2007 the Office of Inspector General published a report on customer satisfaction with 1-800 Medicare. Using the results of a 2004 customer satisfaction survey as a baseline, they found that:

  • Seventy-one percent of callers who completed their calls were satisfied overall with the customer service they received, a decrease of 13 percentage points compared with the 2004 baseline data. Callers’ overall satisfaction was associated with three experiences: (1) finding the interactive voice response (IVR) easy to use; (2) receiving answers to their questions or all of the information they needed; and (3) receiving answers to their questions as quickly as desired. In both the 2007 data and the 2004 baseline data, the most common reason callers gave for not being satisfied was not receiving resolution with their problems or questions.
  • More callers in 2007 than in 2004 reported hanging up before receiving answers to their questions and had concerns about wait times. Twenty-one percent of callers to 1-800-MEDICARE during the week of the OIG’s review hung up before receiving responses to their questions. Sixty-six percent of these callers hung up because they considered the wait time to speak with a customer service representative too long. In the 2004 baseline data, only 12 percent of callers hung up before receiving responses to their questions.
  • Similar to the 2004 baseline data, 44 percent of callers in the 2007 evaluation had difficulty accessing information. Thirty-one percent of callers reported that the interactive voice response (IVR) was not easy to use. Nineteen percent of callers reported not receiving answers to their questions or all the information they needed. Twelve percent of callers who completed their calls reported not receiving the answers as quickly as they desired. Only five of 206 callers reported receiving answers to their questions using the IVR.

In response to these findings, OIG recommends CMS:

  • Reassess the level of resources directed toward improving the question-answering capabilities of the IVR. Instead of continuing to direct resources toward further improving the question-answering capabilities of the IVR, CMS may consider supporting more customer service representatives (CSR) to answer questions in person.
  • Continue to seek ways to reduce wait times. Redirecting resources from the IVR’s question-answering capabilities and ensuring that callers’ questions are fully answered may reduce the need for callers to make multiple calls and shorten wait times.

In addition, one way callers can reduce call time is to bypass navigating the IVR and more quickly talk to a CSR. See the key phrase list below:

If you say…. at the main menu You get…
Agent (for general questions) General Medicare CSR
Doctor services Part B CSR
Hospital stay Part A CSR
Medical supplies Durable Medical Equipment (DME) CSR

Another way to improve caller’s successful experiences with Medicare’s hotline is to know in general what types of questions CSRs can and cannot answer. See the document “CMS Medicare CSRs Can/Cannot List” for this information.

What is your experience?

What are your experiences with and recommendations for 1-800 Medicare? Do Senator Smith’s and the OIG’s findings resonate with your or your clients’ experiences? If so, you can file a 1-800 Medicare complaint with CMS. Your feedback and complaints are a valuable part of improving 1-800 Medicare’s services. CMS’ manager for 1-800 Medicare compiles these complaints, along with the feedback from senator investigations, the US Government Accountability Office (GAO) and OIG reports, and addresses them with their helpline subcontractor.

To file a complaint, advocates can use the CMS Part D complaints email and fax number – and 415-744-3771. Emails and faxes should include the time and date the call was made, the number the person called from, and the CSR’s name if available. We also encourage advocates to email these complaints to CHA for follow-up with CMS and the media at our general email – .

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.