Department of Health and Human Services
 

OFFICE OF 

INSPECTOR GENERAL 

1-800-MEDICARE: CALLER 


SATISFACTION AND 


EXPERIENCES
 

Daniel R. Levinson
 

Inspector General 


September 2007
 

OEI-07-06-00530
 
 

 

 

 

 

 

 

 

 

 

 

 

 

Office of Inspector General 
 http://oig.hhs.gov 

The mission of the Office 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 statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components: 

Office of Audit Services 

The Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors 

in carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations. These assessments help reduce waste, 

abuse, and mismanagement and promote economy and efficiency throughout HHS. 

Office of Evaluation and Inspections 

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS, Congress, and the public with timely, useful, and reliable information on 

significant issues. Specifically, these evaluations focus on preventing fraud, waste, or 

abuse and promoting economy, efficiency, and effectiveness in departmental programs. 

To promote impact, the reports also present practical recommendations for improving 

program operations. 

Office of Investigations 

The Office of Investigations (OI) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 

and of unjust enrichment by providers. The investigative efforts of OI lead to criminal 

convictions, administrative sanctions, or civil monetary penalties. 

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG, rendering advice and opinions on HHS programs and operations and providing all 

legal support in OIG's internal operations. OCIG imposes program exclusions and civil 

monetary penalties on health care providers and litigates those actions within HHS. 

OCIG also represents OIG in the global settlement of cases arising under the Civil False 

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. 
 

 

Δ EXECUTIVE SUMMARY 

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 Medicare’s 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 12–16, 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 22–26, 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 

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E X E CUTIVE S U MMAR Y 

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. 

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EXECUTIVE SUMMARY 

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 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. 

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. 

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Δ TABLE OF CONTENTS 

EXECUTIVE SUMMARY ..................................... i 
 

INTRODUCTION ........................................... 1 
 

FINDINGS ................................................. 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 
 

RECOMMENDATIONS ..................................... 13 
 

Agency Comments...................................... 14 
 

APPENDIXES ............................................. 15 
 

A: Confidence Intervals ................................. 15 
 

B: Statistical Correlations ............................... 17 
 

C: Profile of Surveyed Callers ............................ 18 
 

D: Agency Comments ................................... 19 
 

ACKNOWLEDGMENTS .................................... 24 
 
 

ΔEXECUTIVE SUMMARY TABLE OF CONTENTS INTRODUCTION 

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 Medicare’s 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 12–16, 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. 

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INTRODUCTION 

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 2006–2009, 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 2006–2009,” pp. 34–35. 

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INTRODUCTION 

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 IVR’s 

capabilities. CMS contracted with a leading industry expert in the field 

of IVR speech recognition and usability to conduct an indepth 

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INTROD U C T I O N 

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 Medicare’s 

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 

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INTRODUCTION 

(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 22–26, 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 22–26), 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 

Tuesday 

Wednesday 

Thursday 

Friday 

 Total 

112,792 

97,336 

86,565 

82,334 

81,854 

460,881 

50 

50 

50 

50 

50 

250 

43 

42 

41 

37 

43

206 

Source: OIG analysis of telephone network data, 2007. 

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INTROD U C T I O N 

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 22–26, 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 President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

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Δ 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 

Nineteen percent of callers who 

completed their calls were 

unsatisfied overall, and 10 percent 

of callers were unsure whether they 

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% 

70.5% 

19.0% 

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. 

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FINDINGS 

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 

hanging up before receiving answers to their 

questions and had concerns about wait times 

Of the callers with whom we 

spoke, 79 percent reported 

completing their calls (i.e., they 

received responses to their 

 OEI-07-06-00530 

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 IVR’s 

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. 

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F I NDING S 

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 didn’t 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, 44 percent of 

callers in the 2007 evaluation had difficulty 

accessing information 

Similar to the 2004 baseline data, 

44 percent of callers in the 2007 

evaluation had difficulty accessing 

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. 

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FINDING 
 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 caller’s 

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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FINDING 
 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 

answer—that's frustrating.” 

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F I NDING S 

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. 

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Δ 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 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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RECOMMENDATIONS 

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 CMS’s comments, see 

Appendix D. 

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Δ APPENDIX~A 

Confidence Intervals 

2007 Caller Experiences 

Finding Point Estimate 

Confidence 

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 

customer service representative (CSR) too long 66.4% 52.0%–80.9% 

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 

service priority 23.9% 17.0%–30.6% 

Callers asked to rate satisfaction who were satisfied overall with the customer 

service received 70.5% 63.0%–77.7% 

Callers asked to rate satisfaction who were unsatisfied overall with the customer 

service received 18.9% 13.0%–25.1% 

Callers asked to rate satisfaction who were unsure whether they were satisfied with 

the customer service received 10.5% 6.0%–15.3% 

Callers who were not satisfied because their questions or problems were not 

resolved 13.1% 8.0%–18.4% 

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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APPENDIX~A 

2007 Caller Experiences 

Finding Point Estimate Confidence Interval 

95-Percent 

Callers who reported not receiving answers to their questions or all the 

information that they needed 

Callers who reported receiving answers to their questions and all the 

information that they needed 

Callers who reported receiving answers as quickly as they desired 

Callers who reported not receiving answers as quickly as they desired 

18.9% 

81.0% 

12.3% 

58.5% 

13.0%–24.9% 

75.0%–87.1% 

6.0%–18.4% 

51.0%–66.1% 

Source: Office of Inspector General analysis of caller interviews, 2007. 

2004 Caller Experiences 

Finding Point Estimate Confidence Interval 

95-Percent 

Callers who reported not receiving answers as quickly as they desired 

Callers who were not satisfied because their questions or problems were not 

resolved 

Callers who reported that the IVR was not easy to use 

Callers who reported not receiving answers to their questions or all the 

information that they needed 

Callers who reported difficulty accessing information from call centers 

Callers asked to rate satisfaction who were satisfied overall with the customer 

service received 

Callers who hung up before receiving answers to their questions 

Callers who ranked time spent on the telephone as the most important 

customer service priority 

12.0% 

11.7% 

84.5% 

8.4% 

43.7% 

31.6% 

24.4% 

12.4% 

8.0%–16.1% 

8.0%–15.8% 

80.1%–88.9% 

5.0%–12.0% 

37.7%–49.6% 

25.9%–37.4% 

18.9%–29.9% 

8.3%–16.4% 

Source: Office of Inspector General analysis of caller interviews, 2004. 

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Δ APPENDIX~B 

Statistical Correlations 

Caller Experiences 

Finding Degrees of 

Freedom P-value 

Weighted Chi-Square Test 

Relationship between finding the Interactive Voice Response (IVR) system easy to 

use and satisfaction (n=161) 

IVR easy to use/don't remember 

IVR not easy to use 

Percent Satisfied 

77% 

54% 

Percent Responding 

Other Than Satisfied* 

23% 

46% 

1 0.0089 

Relationship between receiving answers to questions and all information needed 

and satisfaction (n=161) 

Received answers 

Did not receive answers 

Percent Satisfied 

81% 

26% 

Percent Responding 

Other Than Satisfied* 

19% 

74% 

1 less than 

0.0001 

Relationship between receiving answers to questions as quickly as desired and 

satisfaction (n=161) 

Received answers quickly 

Did not receive answers quickly 

Percent Satisfied 

92% 

73% 

Percent Responding 

Other Than Satisfied* 

8% 

27% 

1 less than 

0.0001 

*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 12–16, 2004, evaluation (n=271) and overall caller 

satisfaction between January 22–26, 2007, evaluation (n=161) 

April 12–16, 2004 evaluation 

January 22–26, 2007 evaluation 

Percent Satisfied 

84% 

71% 

Percent Responding Other 

Than Satisfied* 

16% 

29% 

P-value 

0.0012 

*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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-

Δ APPENDIX~C 

 Profile of Surveyed Callers 

Number of 

Callers 

Who called? (Three callers called both for 

themselves and for a family member) 

 Beneficiary 

 Beneficiary’s family member 

 Other (e.g., provider or insurance office staff) 

160/206 

38/206 

8/206 

Why did they call? 

Benefit question 

 Medical bill or summary notice 

 Other (e.g., address change, multiple issues) 

134/206 

46/206 

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 

plan sponsor, secondary insurance) 83/206 

 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 

4-9 

 Average number of calls 

192/206 

14/206 

1.7 

Source: Office of Inspector General analysis of caller interviews, 2007. 

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Δ APPENDIX~C APPENDIX~D 

Agency Comments 

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APPENDIX D 

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APPENDIX D 

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APPENDIX D 

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APPENDIX D 

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Δ ACKNOWLEDGMENTS 

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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