Department of Health and Human Services
 
OFFICE OF 

 
INSPECTOR GENERAL 

 
 
 
 
 
 
 
 
1-800  -MEDICARE:   CALLER 

 
S
ATISFACTION AND 

 
 
E  
XPERIENCES 

 
 
 
 
 
 
 
Daniel R. Levinson 
  
Inspector General 

 
September 2007 
 
OEI-07-06-00530 
 
 
   
Office of Inspector General 

 
http://oig.hhs.gov 
 
 
The mission of the Offic e of Inspector General (OIG), as mandated by Public Law 95-452,  
as amended, is to  protect the integrity of  the Department of Health and Human Services 
 
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statuto ry mission  is  carried  out through  a nationwide network  of  audits, 
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Audits examine the performance of HHS programs and/or its grantees and  contractors  
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The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
 
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To promote impact, the reports also present practical recommendations for improving 
program operations.    
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The Office of Investigations (OI) conducts criminal, civil, and administrative  
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The  Office of Counsel to the Inspector General (OCIG)  provides  general legal services  to  
 
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Claims Act, develops and monitors corporate integrity agreements, develops compliance 
 
program guidances, renders advisory opinions on OIG sanctions to  the health care  
 
community,  and issues fraud alerts  and other industry  guidance.  
 
 
   
  E X E C U T I V E   S U M M A R Y
OBJECTIVE 
To assess callers satisfaction and experiences with Medicare telephone 
customer service and make comparisons with 2004 baseline data. 
BACKGROUND 
The Centers for Medicare & Medicaid Services (CMS) uses various 
outreach efforts to educate and assist Medicares 42 million 
beneficiaries with decisions that affect their health care.  The most  
commonly used communication channel is the telephone customer  
service system, which callers access by calling 1-800-MEDICARE.  In 
fiscal year (FY) 2004, callers made approximately 29 million calls to 
Medicare call centers, at a cost of $200 million to CMS.  In FY 2006, 
callers made approximately 49 million calls to Medicare call centers, at 
a cost of $441 million to CMS.  This represents an increase of more than 
68 percent in the total number of calls to Medicare call centers from 
FY 2004 to FY 2006 and more than a doubling of costs. 
In August 2005, the Office of Inspector General issued a report entitled 
Medicare Beneficiary Telephone Customer Service (OEI-07-04-00030), 
which assessed callers satisfaction and experiences with the customer 
service they received between April 1216, 2004.  The earlier study 
provides the 2004 baseline data for the comparisons in this evaluation, 
for which we conducted interviews with a random sample of callers over 
a 1-week period (January 2226, 2007) to assess their satisfaction and 
experiences  with Medicare telephone customer service.   We asked 
callers whether they were satisfied with the customer service they  
received, whether they believed their questions were answered, and  
whether they received all the information they needed.  We also asked  
callers about their priorities for customer service. 
FINDINGS 
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 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   i     
   
EE XX EE CC UU TT II VV EE    SS UU MM MM AA RR YY    
common reason callers gave for not being satisfied was that their 
problems or questions were not resolved. 
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 our 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 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. 
RECOMMENDATIONS 
Call volume increased 68 percent between FY 2004 and FY 2006; during 
this same period, call center costs more than doubled. Overall, the 
majority of callers were satisfied with telephone customer service during 
the week of our fieldwork in 2007; however, satisfaction decreased by 
13 percentage points when compared with the 2004 baseline data. The 
percentage of callers who experienced difficulty accessing information 
remained the same, at 44 percent. Callers negative comments 
regarding the IVR also remained similar to the results of our 2004 
baseline data, with callers citing confusion, aggravation, and too much 
time spent navigating the menus. We note that more callers hung up 
before receiving responses to their questions in our week of fieldwork in  
2007 than in the 2004 baseline data and that an increased number of 
callers cited  the amount of time spent on the telephone as their highest 
customer service priority. We  recommend that CMS: 
Reassess the level of resources directed toward improving the 
question-answering capabilties of the IVR.  Only 5 of 206 callers 
reported receiving answers to their questions using the IVR. CMS 
should reassess whether it should continue to direct resources toward 
further improving the question-answering capabilities of the IVR or 
toward supporting more  customer service representatives (CSR) to 
answer questions. 
OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   ii     
   
E X E C U T I V E   S U M M A R Y   
Ensure that callers receive all needed information.  When  
1-800-MEDICARE fails to provide needed information, callers often 
have few alternative methods to obtain it.  CMS should consider ways to 
ensure that callers questions are answered during their first call.   
Continue to seek ways to reduce wait times.  CMS should continue to  
seek ways to reduce the time callers  must wait to speak with a CSR.  
Redirecting resources from the IVRs 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.  
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
In its comments to the draft report, CMS did not indicate whether it 
concurred with our recommendations.  However, CMS described several 
actions that it has taken or planned that relate to our findings and 
recommendations.  CMS stated that it will further determine how best 
to simplify choices and menu options within the IVR, conduct a study to 
help determine why callers are not receiving the information they need, 
and implement technological solutions to provide beneficiaries with 
options for obtaining answers to their questions  without having to wait 
to talk to a CSR.  CMS provided information on efforts underway or 
planned for the future aimed at improving call-center operations.  We  
ask that, in its final management decision, CMS more clearly indicate 
whether it concurs with our recommendations and what steps, if any, it 
will take to implement them. 
 
 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   iii     
   
  T A B L E   O F   C O N T E N T S  
 
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
  
 
 
 
 
I N T RO DUC T IO N  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1 
  
 
 
 
F I N D IN G S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7 
  
    Overall satisfaction decreased compared to 2004 data . . . . . . . . . .  7 
  
    More callers reported hanging up and wait time concerns . . . . . . .  8 
  
 
  Callers reported similar difficulties in 2004 and 2007 . . . . . . . . . .  9 
  
 
 
R E C O MMEN D A T ION S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13 
  
  Agency Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  14 
  
 
 
 
APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15 
  
 
  A:  Confidence Intervals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   15 
  
 
  B:  Statistical Correlations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17 
  
 
    C:  Profile of Surveyed Callers . . . . . . . . . . . . . . . . . . . . . . . . . . . .  18 
  
  D:  Agency Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  19 
  
   
 
 
 
A C K NO WL E D G M E N T S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  24 
  
 
 
 
 
 
  OEI-07-06-00530  1-800-MEDICARE:  CALLER SATISFACTION AND EXPERIENCES  iv   
E X E C U T I V E   S U M M A R Y  
  TI NA TB RL OE D  OU FC  T CI OO NN T E N T S  
OBJECTIVE 
To assess callers satisfaction and experiences with Medicare telephone 
customer service and make comparisons with 2004 baseline data. 
BACKGROUND 
Medicare Beneficiary  Telephone Customer Service 
The Centers for Medicare & Medicaid Services (CMS) uses various 
outreach efforts to educate and assist Medicares 42 million 
beneficiaries with decisions that affect their health care.  The most  
commonly used communication channel is the telephone customer  
service system, which callers access by calling 1-800-MEDICARE.  In 
fiscal year (FY) 2004, callers made approximately 29 million calls to 
Medicare call centers, at a cost of $200 million to CMS.1 In FY 2006, 
callers made approximately 49 million calls to Medicare call centers, at 
a cost of $441 million to CMS.2  This represents an increase of more  
than 68 percent in the total number of calls to Medicare call centers 
from FY 2004 to FY 2006.  According to CMS, much of the increase in 
call volume  is because of the implementation of  Medicare Part D and  
other changes to Medicare that the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA) mandated.     
In August 2005, the Office of Inspector General (OIG) issued a report 
entitled Medicare Beneficiary Telephone Customer Service  
(OEI-07-04-00030), which assessed caller satisfaction and experiences 
between April 1216, 2004, and identified CMS and contractor efforts to 
ensure quality customer service. The earlier study provides the 2004 
baseline data for the comparisons made in the  current evaluation.   
 
1 CMS provided these call volume and cost figures in e-mails to OIG dated  
December 6 and 7, 2004. 
2 CMS provided these call volume and cost figures in an e-mail to OIG dated  
September 21, 2006. 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   1     
   
I N T R O D U C T I O N   
1-800-MEDICARE  
Two contractors operate  1-800-MEDICARE call centers.3  These 
contractors employ customer service representatives (CSR) to operate 
seven call centers to answer calls to  1-800-MEDICARE.   
Carriers, fiscal intermediaries, and durable medical equipment regional 
carriers, which are contractors that process Medicare claims, also 
employ CSRs to operate approximately 50 call centers.  These call 
centers are commonly referred to as fee-for-service (FFS) call centers.   
Only certain calls are routed to the FFS call centers. In 2004, FFS call 
centers handled approximately 44 percent of the total volume of calls to 
Medicare-funded call centers; in 2006, they handled 18 percent.  
Therefore, the proportion of calls that FFS call centers handle is 
decreasing. 
Changes in Telephone Customer Service 
On July 27, 2004, CMS completed the transition to 1-800-MEDICARE 
as the single point of entry for Medicare telephone customer service.  
Previously (and when OIG collected the 2004 baseline data), callers 
could directly call 1-800-MEDICARE  or they could call the claims 
contractor that paid claims in their region.   Now, callers must call 
1-800-MEDICARE; their calls may be routed to  CSRs at 
1-800-MEDICARE or to  FFS call centers depending on their responses 
to the Interactive Voice Response (IVR) questions. 
According to the CMS Strategic Action Plan 20062009, implementing a 
single point of entry for Medicare telephone customer service will 
improve operational efficiency, reduce operating costs, and increase the  
consistency and accuracy of information provided to callers.  
Specifically, the CMS strategy includes maintaining the IVR to provide 
24-hour access to information, standardizing the software CSRs use to 
answer Medicare inquiries, and establishing one national information 
warehouse.4  
Call Routing 
The IVR answers each call to 1-800-MEDICARE.  The IVR presents 
options callers can choose from by speaking a word or phrase or  
pressing a number on their telephone.  Depending on the options callers 
 
3 At the time of our review, two contractors operated the 1-800-MEDICARE call centers.  
According to CMS, one of these contractors assumed operations of all the 1-800-MEDICARE 
call centers in June 2007. 
4 CMS, Strategic Action Plan 20062009, pp. 3435. 
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I N T R O D U C T I O N   
choose, the IVR will either provide information or route the caller to a 
CSR. 
Calls to 1-800-MEDICARE are routed to CSRs at any of the call centers 
(1-800-MEDICARE or FFS), depending on the options callers choose in 
the IVR. For instance, if a caller has a question about a specific claim, 
the IVR may route the caller to a CSR at an FFS call center. Other 
inquiries, such as Part D questions, may be handled by a CSR at a 
1-800-MEDICARE call center.   
Customer Service Representatives Responses to Callers Questions 
CSRs access information needed to answer many callers questions 
using desktop computer software.  The software queries a database of 
prepared scripts that CSRs access using keywords from callers 
questions.  CSRs respond to callers questions by reading the prepared  
scripts rather than by formulating a unique response based on their 
knowledge of the Medicare program.   In some instances, the information  
that the CSR is reading is the same information that is included in the 
Medicare & You handbook. General CSR training does not focus on 
learning Medicare program policy; some CSRs receive specialized  
training to answer questions about specific claims. 
Although callers can access Medicare information through the IVR or  
speak with a CSR about general Medicare questions 24 hours a day, 
7 days a week, CSRs who handle specific claim inquiries are available 
only from 8 a.m. to 7 p.m. eastern time at 1-800-MEDICARE call 
centers and for more limited hours at FFS call centers.   
2004 Baseline Data  
In our previous evaluation, 84 percent of callers were satisfied overall 
with the customer service they received.  However, many callers 
reported having difficulty accessing information through Medicare call 
centers.  Thirty-two percent of callers found the IVR they encountered  
difficult to use, citing problems such as the recording being too long,  
being presented with too many options, or not knowing which option to  
select.  Twenty-four percent of callers reported that they did not receive 
answers to their questions or all of the information that they needed, 
and 12 percent of callers reported not receiving answers as quickly as 
they desired.   
In comments to the previous report,  CMS described efforts to improve 
the telephone customer service system by enhancing the IVRs 
capabilities.  CMS contracted with a leading industry expert in the field 
of IVR speech recognition and usability to conduct an indepth 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   3    
   
II NN TT RR OO DD UU CC TT II OO NN    
evaluation of the IVR. In 2005, CMS released several major upgrades to 
the IVR to address customer feedback and expert advice. One specific 
change was the addition of synonyms to the possible responses to 
appropriately route more callers to requested information. For example, 
the terms drug coverage, drug benefit, and prescription drugs were 
added to the responses that route callers to information on Medicares 
prescription drug program.  
Other Related Studies 
In addition to the August 2005 OIG evaluation, the Government 
Accountability Office (GAO) issued an MMA-mandated study in 
December 2004 entitled Accuracy of Responses from the 
1-800-MEDICARE Help Line Should Be Improved (GAO-05-130). This 
report assessed the accuracy and consistency of information  provided 
through 1-800-MEDICARE. GAO found that CSRs provided accurate 
answers 61 percent of the time. A June 2006 GAO report on 
prescription drug plan call centers, entitled Prescription Drug Plan 
Sponsor Call Center Responses Were Prompt, but Not Consistently 
Accurate and Complete (GAO-06-710), found that these call centers 
provided accurate and complete responses in about one-third of calls. 
Additionally, GAO released reports in 2002 and 2004 regarding 
telephone customer service for health care providers enrolled  in 
Medicare (GAO-02-249 and GAO-04-669). These reports found that the 
CSRs they tested rarely provided complete and  accurate answers to  
questions that a health care provider might typically ask. 
METHODOLOGY 
Call Center Site Visits  
We conducted site visits to two 1-800-MEDICARE call centers in 
November 2006. We interviewed CSRs and CSR supervisors, collected 
information on CSR training, and observed telephone and computer 
equipment use during live calls. The information we gained through the 
site visits provided a broad context of call center operations as we 
considered recommendations. 
Methodological Differences Between the Current and Previous Evaluations  
As previously mentioned, callers accessing Medicare telephone customer 
service could either call 1-800-MEDICARE or the claims contractor for 
their region at the time OIG collected the 2004 baseline data. To ensure 
that the sample represented callers  to all types of call centers, we 
sampled from strata that made up the universe of callers to 
OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   4    
   
I N T R O D U C T I O N   
(1) 1-800-MEDICARE, (2) large FFS call centers, and (3) small FFS call 
centers.  Because callers now have  only a single point of entry through 
1-800-MEDICARE, we did not stratify by call center.  However, callers 
in our 2007 evaluation sample may have been routed by the IVR to 
CSRs either in 1-800-MEDICARE or in FFS call centers.   
Caller Interviews  
Repeating a process used to collect the 2004 baseline data, we obtained 
from CMS a listing of all calls made to 1-800-MEDICARE on each day 
in a 1-week period (Monday through Friday).  This listing included the 
following information: city and State of caller, originating (caller) 
telephone number, and date and time  of call.  Demographic information, 
such as gender or age of callers, is not collected in the CMS data. 
We chose the week of January 2226, 2007, for caller interviews. We 
worked with CMS to select a period that would be representative of 
normal call volume and during which CMS and contractor staff would 
be available to make the necessary daily transmissions of caller data. 
For each day (January 2226), we eliminated duplicate originating 
telephone numbers (some callers called more than once in a given day) 
and then randomly selected 50 callers (50 x 5 days = 250 randomly 
selected callers).  We contacted these callers by phone regarding their 
satisfaction and experiences calling 1-800-MEDICARE.  As indicated in 
Table 1, we completed 206 interviews from the sample of 250 callers, for 
an 82-percent response  rate.   
Table 1:  Population, Sampled Calls, and Completed Interviews  
by Day 
Day of Week  Population  Sampled Calls  Completed Interviews 
Monday  112,792  50  43 
Tuesday  97,336  50  42 
Wednesday  86,565  50  41 
Thursday  82,334  50  37 
Friday  81,854  50  43
  Total  460,881  250  206 
Source:  OIG analysis of telephone network data, 2007. 
 
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We completed 98 percent of our interviews within 2 business days of the 
sampled call to 1-800-MEDICARE. The other 2 percent were completed 
within 4 business days. We ensured that we spoke to the person who 
placed the call to 1-800-MEDICARE rather than to another individual 
in the household. We conducted telephone interviews to determine 
factors such  as how callers rated their experience overall, whether they  
found the IVR easy to use, whether callers questions were answered, 
whether callers received all the information they needed, and whether 
callers questions were answered as quickly as they desired. Findings 
are projected to the universe of calls for January 2226, 2007. We used 
the same interview questions that we used to collect the 2004 baseline 
data so that we could compare the results of the interviews to determine 
whether caller satisfaction and experiences differed.   
Scope 
We did not assess the accuracy of the information CSRs gave to callers, 
although we did ask callers whether they believed the information they 
received fully answered  their questions. We did not differentiate 
between first-time and repeat callers. Finally, we did not follow up on  
calls in which the CSR promised a return call; these callers were asked 
to report their experiences only with the service they received in their 
sampled call to 1-800-MEDICARE. 
Standards 
This study was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and 
Efficiency and the Executive Council on Integrity and Efficiency. 
OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   6    
   
  F I N D I N G S  
Seventy-one percent of callers who completed their  Nineteen percent of callers who 
calls were satisfied overall with the customer  completed their calls were 
unsatisfied overall, and 10 percent 
service they received, a decrease of 13 percentage  
of callers were unsure whether they  
points compared with the 2004 baseline data  
were satisfied. Figure 1 illustrates 
the level of satisfaction for callers who completed their calls.  In 
comparison, 84 percent of callers in the 2004 baseline data were 
satisfied overall with the customer service they received.  (See Appendix 
A for confidence intervals for all point estimates.)  
 
Figure 1:  Overall Satisfaction Among Callers Who Completed 

  Their Calls to 1-800-MEDICARE
 
 
10.5% 
 
 
19.0% 
 
 
 
70.5% 
 
 
  Satisfied  Unsatisfied  Unsure 
  Source: OIG analysis of caller interviews, 2007. 
We asked all callers about their use of the IVR and their priorities for  
telephone customer service.  Additionally, we asked callers who 
completed their calls about a variety of  experiences, such as the need to  
call multiple times, receipt of answers and all the information they 
needed, actions taken as a result of the call, receipt of answers quickly 
or being placed on hold, courtesy of the CSR, and overall satisfaction 
with the customer service received.  Based on all questions we asked,  
callers overall satisfaction was associated with three experiences:   
  finding the IVR easy to use, 
 	 receiving answers to their questions  and all of the information they 
needed, and   
  receiving answers to their questions  as quickly as desired. 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   7    
   
F I N D I N G S  
Correlations are statistically significant at the 95-percent confidence 
level. (See Appendix B for statistical correlations.)   
In both the 2007 data and the 2004 baseline data, the most common 
reason callers gave for not being satisfied was that their problems or 
questions were not resolved.  Although this is not a statistically 
significant difference, more callers were not satisfied because their 
questions or problems remained unresolved in 2007 (13 percent) than 
in 2004 (8 percent).  Callers in both  years reported other reasons for 
not being satisfied, such as difficulty with the IVR or encountering a 
discourteous CSR, but not in sufficient numbers to make meaningful 
comparisons.  We also looked for relationships between the reasons 
for callers calls (e.g., prescription drug benefits, claims questions) and 
caller satisfaction but found no significant correlations. 
 
More callers in 2007 than in 2004 reported  Of the callers with whom we 
spoke, 79 percent reported 
hanging up before receiving answers to their 
completing their calls (i.e., they  
questions and had concerns about wait times 
received responses to their 
questions from CSRs or  the IVR).5  The remaining 21 percent of callers 
hung up before completing their calls, citing reasons such as  
experiencing long hold times or confusion with the IVR, an increase of 
9 percentage points over 2004.  Additionally, more callers offered 
negative comments relating to the amount of time spent waiting to 
speak with a CSR compared to the 2004 baseline data.   
Twenty-one percent of callers to 1-800-MEDICARE hung up before receiving 
answers to their questions 
Sixty-six percent of these callers hung up because they considered the  
wait time to speak with a CSR too long.6  Callers  reported that the IVRs 
estimated wait times ranged from 10 minutes to 1 hour. In the 2004 
baseline data, only 12 percent of callers hung up before receiving 
responses to their questions.  Of the 34 sampled callers who hung up in 
 
5 Receiving a response does not necessarily mean  that callers believed their questions 
had been fully answered.  Of the 206 sampled callers, 164 completed interactions with the 
IVR or a CSR, but some of these callers did  not believe that their questions or issues had  
been resolved by those interactions.   
6 Three callers reported getting  disconnected during their calls, and five callers reported 
not being able to successfully  navigate the IVR. 
  OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   8    
   
FFF III NNN DDD III NNN GGG SSS  
2004, 2 said that they hung up because the wait time to speak with a 
CSR was too long. 
Callers varied in how  long they  were willing to wait to speak with a CSR 
Some callers believed that a 30-minute wait was acceptable, while 
others believed that a 5-minute wait was too long. Overall, 38 percent 
of callers who spoke with a CSR believed they had to wait too long. One 
caller described her strategy for dealing with the long wait, saying [The 
IVR said the wait would be] 30 to 40 minutes. I gave the phone to my 
husband who was reading a book during the wait. I didnt want to risk 
hanging up and calling back and then waiting again. 
Three callers reported that after navigating the IVR, a person came on 
the line and took their name and number, explaining that 
1-800-MEDICARE was currently experiencing a high volume of calls 
and that someone would call them  back. These callers did not have long 
hold times, but did have to wait for calls back. 
In 2007, more callers ranked time spent on the telephone as the most  
important customer service priority than in the 2004 baseline data  
In addition to asking callers about their experiences during their calls 
to 1-800-MEDICARE, we also asked them about their priorities for 
customer service.   We identified three priority areas for telephone  
customer service: the accuracy of the answer given, the courtesy of 
the person spoken with,  and the amount of time spent on the 
telephone. In both studies, accuracy was ranked the most important 
of the three priorities.7   However, in our 2004 baseline data, 
12 percent of callers ranked time spent on the telephone as the most 
important of these three, while in this evaluation, 24 percent of 
callers ranked time as the most important. 
 
Similar to the 2004 baseline data, 
Similar to the 2004 baseline data, 44 percent of 
44 percent of callers in the 2007 
callers in the 2007 evaluation had difficulty  
evaluation had difficulty accessing  
accessing information  
information, reporting at least one 
of the following experiences: (1) finding the IVR  not easy to  use,    
(2) not receiving answers to their questions or all the information they 
needed, or (3) not receiving answers to their questions as quickly as 
 
7 Sixty-five percent of the 2004 callers ranked accuracy most important; 61 percent of 
2007 callers ranked accuracy most important. 
OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   9    
   
F I N D I N G
  S  
desired.  A profile of callers and their experiences can be found in 
Appendix C.    
Thirty-one percent of callers reported that the IVR was not easy to use; 
callers offered a variety  of concerns about the IVR  
Callers reported experiences with the IVR are similar to the 2004 
baseline data, in which 32 percent of callers who encountered an IVR 
said the IVR was not easy to use.  Twenty percent of callers said that 
the IVR did not understand their spoken responses.  They described  
problems such as having to repeat their response several times or the 
IVR not being able to understand certain types of information spoken to  
it, such as Social Security numbers or addresses.  For example, one  
caller reported that the IVR could not understand the suffix at the end  
of his Medicare identification number. 
Thirty-seven percent of callers reported negative opinions of the IVR,  
giving reasons such as the IVR not providing an option for the callers 
question or being too  time-consuming.  Callers  expressed aggravation, 
annoyance, and nervousness regarding the IVR. As one caller put it, 
The recording gets me upset and confused.  I want something simple.  
Overall, 18 percent of callers expressed a desire to speak with a live 
person.  Five percent of  sampled callers (11 of 206) described how they  
bypassed the IVR, pressing buttons randomly or immediately pressing 
0 for the operator rather than attempting to provide any responses to 
the IVR.   
Only five callers successfully received an answer to their question from the 
IVR.   In March 2007, a 1-800-MEDICARE CMS official stated that in 
January 2007, approximately 19 percent  of all calls were completed or 
terminated in the IVR without being transferred to a CSR, indicating 
that those callers resolved their questions or problems using the 
information available through the IVR or hung  up.  During our week of 
fieldwork, 21 percent of callers hung up before receiving answers from 
either the IVR or a CSR, and only 5 of 206 callers reported receiving 
answers to their questions using the IVR.  Although 5 callers are too 
few to allow  projection of the results,  it suggests that few of the 
19 percent of callers that the CMS official described to us resolved their 
issues using the IVR. It is more likely that callers were simply hanging 
up.  In communications with OIG, CMS stated  that one of the goals of 
the IVR is to readily answer Medicare questions 24 hours per day, 
7 days per week, 365 days per year.  The responses of our callers may 
indicate that the IVR is not achieving this goal. 
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F I N D I N G
  S  
Nineteen percent of callers reported not receiving answers to their 
questions or all the information they  needed during the sampled calls, an 
improvement of 5 percentage points over 2004 
Eighty-one percent  of callers reported that they received answers to  
their questions and all the information they needed.  Nineteen percent  
of callers provided negative responses to one or both of two  questions 
concerning  whether they received answers to their questions and  
whether they received all the information they needed.  In comparison 
with our 2004 baseline data, 24 percent of callers reported not receiving 
answers or  all the information they needed.   
We asked callers to explain why they believed that they had not 
received answers or all the information needed.  Some callers expressed  
that the CSR could not  answer their questions  or transferred them to 
another CSR, but the transfer did not result in answers to their 
questions.  One caller said, [I was]  bounced around to several CSRs, 
but never got the information [I] needed.  Two callers described being 
asked to call back at a different time  because the office with the 
information they needed was closed.  One caller said [The CSR] said I 
should call again on Monday and ask for Part B Claims and speak with 
a specialist. CMS officials explained that CSRs trained to respond to 
questions regarding specific claims are available only from 8 a.m. to 
7 p.m. eastern time, because data from the mainframe computer 
systems these CSRs use to answer questions are not available outside 
these hours. The limited availability of these CSRs resulted in some 
callers not receiving answers to their questions  during the sampled call. 
Other callers reported that they received no information or received 
incomplete information.  For example, one caller said that she was 
interested in the Welcome to Medicare physical and looked in the  
Medicare handbook for information on it, but still had a question.  
During her call to 1-800-MEDICARE, she navigated the IVR to attempt 
to order the Preventative Services brochure, but the IVR said the 
brochure was unavailable.  The caller then waited for a CSR to answer  
her question, but the caller reported that all the CSR could do was read 
her what she had already read in the handbook.  The caller summed up 
her experience by saying, To have spent the time and not get an 
answerthat's frustrating.   
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FF II NN DD II NN GG SS  
Twelve percent of callers who completed their calls reported not receiving 
the answers as quickly as they desired 
We asked those callers who completed their calls whether they received 
the answers as quickly as they desired. Fifty-nine percent of callers 
who completed their calls reported that they received the answers as 
quickly as desired; 12 percent of callers reported they did not.8 The 
callers who did not receive answers as quickly as they desired described  
difficulties such as having long waits, spending time navigating the 
IVR, having to call other organizations such as their prescription drug 
plan, and having to make multiple  calls to 1-800-MEDICARE because  
the claims history system had not been updated. During the week of 
our fieldwork, sampled callers made  an average of 1.7 calls to 1-800-
MEDICARE, ranging from 1 to 9. This average has decreased since 
2004, when sampled callers made an average of 2.4 calls during the 
week of fieldwork. In our 2004 baseline data, 12 percent of callers also 
reported not receiving answers as quickly as they desired.  
 
 
 
8 This question was not applicable to the remaining callers, because they had previously  
reported not receiving  answers to their questions or all the information they  needed and  
therefore could  not comment on  how quickly they received answers. 
OEI-07-06-00530   1-800-MEDICARE:   CALLER SATISFACTION AND  EXPERIENCES   12    
   
  R E C O M M E N D A T I O N S  
 
Call volume increased 68 percent between FY 2004 and FY 2006; during 
this same period, call center costs more than doubled.  Overall, the 
majority of callers were satisfied with telephone customer service during 
the week of our fieldwork in 2007; however, satisfaction decreased by 
13 percentage points when compared with the 2004 baseline data.  The 
percentage of callers experiencing difficulty accessing information has 
remained the same, at 44 percent.  Callers negative comments 
regarding the IVR also remained similar to the results of our 2004 
baseline data, with callers citing confusion, aggravation, and too much 
time spent navigating the menus.  We note that more callers hung up 
before receiving responses to their questions in our week of fieldwork in  
2007 than in the 2004 baseline data and that an increased number of 
callers cited  the amount of time spent on the telephone as their highest 
customer service priority.  We  recommend that CMS: 
Reassess the Level of Resources Directed Toward Improving the 
Question-Answering Capabilities of the IVR  
Only 5 of 206 callers reported receiving answers to their questions using 
the IVR. In both the 2004 baseline data and 2007 data, callers 
emphasized their preference to  obtain answers to their questions from  
live persons.  CMS should reassess whether it should continue to direct  
resources toward further improving  the question-answering capabilities 
of the IVR or toward supporting more CSRs to answer questions. 
Ensure That Callers Receive All Needed Information 
In many instances, 1-800-MEDICARE is the primary source of 
telephone customer service for Medicare information.  When 
1-800-MEDICARE fails to provide needed information, callers often 
have few alternative methods to obtain it.  The most common reason  
callers gave for overall dissatisfaction was that their questions or 
problems were not resolved.  CMS should consider ways to ensure that 
callers questions are fully answered during their first call.  For 
example, CSRs could ask at the end of every call whether questions 
were fully answered, followed by asking the caller if there is anything 
else they could help them with.  CMS could also evaluate CSR training 
on escalating unresolved calls to more highly trained CSRs and/or 
supervisors. Providing callers with complete answers during their first 
call may reduce the number of repeat calls on the same issue. 
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R E C O M M E N D A T I O N S  
Continue To  Seek Ways To Reduce Wait Times 
Since the 2004 baseline data were collected, a new call routing system 
has been implemented that routes callers to the first available CSR  
regardless of geographic location, thereby reducing caller wait times.   
Other improvements to the call routing system allow callers to key 
information while waiting to speak to CSRs so that they do not have to  
provide that information while speaking with the CSRs, thereby 
reducing call handling and transfer times.  CMS should continue to seek 
ways to reduce the time callers must wait to speak with CSRs.  
Increasing the number of CSRs available to answer a broader range of 
questions and ensuring that callers questions are fully answered  may 
reduce the need for multiple calls and shorten wait times.  
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
In its comments to the draft report, CMS did not indicate whether it 
concurred with our recommendations.  However, CMS described several 
actions that it has taken or planned that relate to our findings and 
recommendations.  CMS stated that it will further determine how best 
to simplify choices and menu options within the IVR, conduct a study to 
help determine why callers are not receiving the information they need, 
and implement technological solutions to provide beneficiaries with 
options for obtaining answers to their questions  without having to wait 
to talk to a CSR.  CMS provided information on efforts underway or 
planned for the future aimed at improving call-center operations.  We  
ask that, in its final management decision, CMS more clearly indicate 
whether it concurs with our recommendations and what steps, if any, it 
will take to implement them.  For the full text of CMSs comments, see 
Appendix D.  
 
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  A P P E N D I X ~ A
Confidence Intervals  
2007 Caller Experiences 
Confidence  
Finding  Point Estimate  Interval  
95-Percent 
Callers  who hung up before receiving answers to their questions  20.6%  15.0%26.3% 
Callers who completed their calls  79.3%  74.0%85.0% 
Callers  who hung up because they considered the wait  time to speak with a 
66.4%  52.0%80.9% 
customer service representative (CSR) too long 
Callers  who spoke with  CSRs and believed they had to  wait too long  38.0%  31.0%45.6% 
Callers  who ranked time spent on the telephone as the most  important customer 
23.9%  17.0%30.6% 
service priority 
Callers  asked to rate satisfaction who were satisfied overall with the customer  
70.5%  63.0%77.7% 
service received 
Callers  asked to rate satisfaction who were unsatisfied overall with the customer 
18.9%  13.0%25.1% 
service received 
Callers  asked to rate satisfaction who were unsure whether they were satisfied with  
10.5%  6.0%15.3% 
the customer service received 
Callers  who were not satisfied because their questions  or problems were not 
13.1%  8.0%18.4% 
resolved 
Callers  who reported difficulty accessing information from call centers  43.8%  37.0%50.7% 
Callers  who reported that the Interactive Voice Response (IVR) was not easy to use  30.7%  24.0%37.1% 
Callers  who repeorted that the IVR did not understand their spoken responses  20.2%  15.0%25.8% 
Callers  who reported negative opinions  of the IVR  37.3%  31.0%44.0% 
Callers  who expressed a desire to speak with a live person  18.4%  13.0%23.8% 
Source: Office of Inspector General analysis of caller interviews, 2007. 
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A P P E N D I X ~ A  
2007 Caller Experiences 
Confidence Interval 
Finding  Point Estimate 
95-Percent 
Callers  who reported not receiving answers to their questions or all the 
18.9%  13.0%24.9% 
information that they needed 
Callers  who reported receiving answers to their questions and all the 
81.0%  75.0%87.1% 
information that they needed 
Callers  who reported not receiving answers as quickly as they desired  12.3%  6.0%18.4% 
Callers  who reported receiving answers as quickly as they desired  58.5%  51.0%66.1% 
Source: Office of Inspector General analysis of caller interviews, 2007. 
2004 Caller Experiences 
Confidence Interval 
Finding  Point Estimate 
95-Percent 
Callers who hung up before receiving answers to their questions  12.0%  8.0%16.1% 
Callers who ranked time spent on the telephone as the most important  
11.7%  8.0%15.8% 
customer service priority 
Callers asked to rate satisfaction who were satisfied overall with the customer 
84.5%  80.1%88.9% 
service received 
Callers who were not satisfied because their questions or problems were not  
8.4%  5.0%12.0% 
resolved 
Callers who reported difficulty accessing information from call  centers  43.7%  37.7%49.6% 
Callers who reported that the IVR was not  easy to use  31.6%  25.9%37.4% 
Callers who reported not receiving answers to their questions  or all the 
24.4%  18.9%29.9% 
information that they needed 
Callers who reported not receiving answers as quickly as they desired  12.4%  8.3%16.4% 
Source: Office of Inspector General analysis of caller interviews, 2004. 
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  A P P E N D I X ~ B
Statistical Correlations  
Caller Experiences 
 
Weighted Chi-Square Test 
Finding   
Degrees of  
  P-value 
Freedom 
 
Relationship between finding the Interactive Voice Response (IVR) system easy to  
use and satisfaction (n=161)   
 
Percent Responding  
Percent Satisfied   
Other Than Satisfied* 
 
IVR easy to use/don't remember  77%    23%  1  0.0089 
 
IVR not easy to use  54%    46% 
 
Relationship between receiving answers to questions and all information needed 
 
and satisfaction (n=161) 
 
 Percent Responding  
Percent Satisfied 
O ther Than Satisfied* 
less than  
Received answers  81%    19%  1  0.0001 
 
Did not receive answers  26%  74% 
 
Relationship between receiving answers to questions as quick ly as desired and 
satisfaction (n=161)   
 Percent Responding  
Percent Satisfied 
O ther Than Satisfied* 
less than  
  1 
Received answers  quickly  92%  8%  0.0001 
 
Did not receive answers  quickly  73%  27% 
 
*Includes sampled callers who reported that they were unsure  or neither satisfied nor unsatisfied, in addition to 
sampled callers who reported that they  were unsatisfied.   
Caller Experiences 
Finding  T-test 
Relationship  between overall caller  satisfaction between April  1216, 2004, evaluation (n=271) and overall caller  
satisfaction between January  2226, 2007, evaluation (n=161) 
Percent Responding Other  
Percent Satisfied  P-value 
Than Satisfied* 
April 1216,  2004 evaluation  84%  16% 
0.0012 
January 2226,  2007 evaluation  71%  29% 
*Includes sampled callers who reported that  they  were  unsure  or  neither satisfied nor unsatisfied, in  addition to  

sampled callers who reported that  they  were  unsatisfied. 

Source: OIG analysis of caller interviews, 2004 and 2007. 

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  A P P E N D I X ~ C
                        Profile of Surveyed Callers 
 
 
 
  Number of 
Callers  
   
Who called?  (Three callers called both for 
themselves and for a family member) 
 
  Beneficiary   160/206 
    Beneficiarys family member  38/206 
  Other (e.g., provider or insurance office staff)  8/206 
 
Why did they call?   
 
Benefit question  134/206 
  Medical bill or summary notice  46/206 
 
   Other (e.g., address change, multiple issues)  26/206 
 
How did they know to call 1-800-MEDICARE?  
(Five callers knew about 1 -800-MEDICARE from   
  more than one source) 
   Printed on a notice I received  69/206 
 
   Someone gave me the number  41/206 
 
Medicare card  36/206 
     Medicare & You handbook  29/206 
   Previous knowledge    25/206 
 
   Other (e.g., Internet, telephone book)  11/206 
 
  Did they try to get their questions answered through 
any other source before calling?  (Six callers 
  consulted more than one source before calling) 
   No other source consulted  115/206 
 
   Called other organization (e.g., provider, health 
83/206 
  plan sponsor, secondary insurance) 
   Internet Web site  8/206 
 
Medicare handbook or brochure  5/206 
     Friend, family  member, counselor  1/206 
How many times did they call 1-800-MEDICARE   
  during the week? 
1-3  192/206 
 
4-9  14/206 
     Average number of calls  1.7 
Source: Office of Inspector General analysis of caller interviews, 2007. 
 
 
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  A C K N O W L E D G M E N T S
This report was prepared under the direction of Brian T. Pattison, 
Regional Inspector General for Evaluation and Inspections in the 
Kansas City regional office, and Gina C. Maree, Deputy Regional 
Inspector General.    
Tricia Fields served as the team leader for this study.  Other principal 
Office of Evaluation and Inspections staff from the Kansas City regional  
office who contributed to the report include Michala Walker and Megan 
Buck. Central office staff who contributed include Robert Gibbons and 
Scott Manley. 
 
 
 
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