Over 15% of Medicare Advantage Organizations Fail Customer Service Standards

Worst Performing Companies Include Several Popular Brands

Out of over 50 million Medicare beneficiaries in 2014, approximately 30% are enrolled in a private Medicare Advantage plan.¹ Medicare Advantage plans offer consumers enhanced medical coverage beyond what is offered by Original Medicare, and most Medicare Advantage plans offer additional benefits such as prescription drug, vision, hearing, and dental coverage.² In order to help consumers compare the quality of customer service in Medicare Advantage plans, HealthPocket analyzed recently released government data³ on average call center performance for Medicare contracts. For each Medicare Advantage organization’s drug and health plan call centers, HealthPocket found the average customer satisfaction score, accuracy rate, hold time, and disconnection rate.⁴ Among thirty Medicare Advantage organizations present in multiple states, HealthPocket ranked organizations with respect to each customer service performance measure and then calculated an average customer service ranking for each organization across all measures.⁵

In terms of the overall customer service ranking, the top five Medicare Advantage companies were:

1. HealthPartners, Inc.
2. Gundersen Lutheran Health System Inc.
3. Cambia Health Solutions, Inc.
4. Health Plan of the Upper Ohio Valley
5. University of Pittsburgh Medical Center

Out of the thirty Medicare Advantage companies that were examined, the bottom five (with the #1 rank representing the lowest customer service scores) were:

1. Universal Health Care Group, Inc.
2. Health Net, Inc.
3. UnitedHealth Group, Inc.
4. WellCare Health Plans, Inc.
5. Munich American Holding Corporation

Three of the five lowest scoring companies (Health Net, UnitedHealth, and WellCare) are well-known brands in the Medicare Advantage market serving multiple states. In fact, UnitedHealth had the greatest total enrollment by firm in the 2013 Medicare Advantage market.⁶

Insurance Company Call Center Performance

Call centers are the primary means by which seniors can resolve medical claim problems, confirm drug coverage, or receive other vital information on the benefits and healthcare provider network of a Medicare Advantage plan. Consequently, the government’s Centers for Medicare & Medicaid Services (CMS) establish performance standards for a variety of measures associated with call centers. For example, the average hold time to reach a representative is monitored, as is the rate at which inbound calls are disconnected. The accuracy rate for information provided to callers is also tracked.

Five of the thirty Medicare Advantage organizations had an average below CMS compliance standards⁷for at least one of the call center performance measures. Medica Holding Company, CIGNA, and Health Net, Inc. all fell below the 75% compliance standard for average drug plan accuracy rate, but CIGNA’s average (74.53%) was close to the threshold. Highmark was the only company that had an average hold time over the two minute compliance standard, while Universal Health Care Group, Inc. was the only company that had an average drug plan disconnection rate over the 5% compliance standard. All five companies that failed a compliance standard were in the bottom half of the overall ranking.

The table below contains the results for each of the thirty Medicare Advantage organizations in order of overall ranking.

Customer Service Rankings for Medicare Advantage Companies

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Customer Satisfaction

HealthPocket also compared Medicare Advantage contracts in each state (with the exception of Alaska) as well as DC and Puerto Rico, to determine which regions had the best and worst customer satisfaction. Within the government data, customer satisfaction metrics are known as “consumer assessment scores.” Consumer assessment scores are numbers between 0 and 100 assigned to each plan, with higher numbers being better, based on enrollee responses to surveys about their satisfaction with the plan.

Connecticut had the lowest average consumer assessment score for health plans (86.13), while Michigan had the highest (90.33). For drug plans, Puerto Rico had the lowest average consumer assessment score (78.5) and New Jersey had the highest (87.5). The table below shows the contracts with the best and worst consumer assessment scores for both health and drug plans in each state.

Consumer Assessment Scores by State

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Information Accuracy

Calling a Medicare Advantage plan is a waste of time if the answer to an enrollee’s question is incorrect. Accordingly, the government monitors the accuracy of information provided to members by periodically calling the plan with questions. The resulting accuracy rate is the number of test questions answered correctly divided by the total number of test questions.

For the information accuracy rate of health plans, Maryland had the lowest average (77.6%), while Maine and Ohio had the highest (87%). For drug plans, Puerto Rico again had the lowest average accuracy rate (71.83%) and Kentucky had the highest (90.4%). Twelve states and Puerto Rico had a Medicare Advantage contract with an accuracy rate for health plans below the compliance standard of 75%. Moreover twenty-five states and Puerto Rico had a Medicare Advantage contract with an accuracy rate for drug plans below 75%.

Accuracy Rates by State

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Waiting on the Phone for a Representative

Even though an enrollee’s call might be answered quickly, the response may be of little use if the party answering the phone is an automated voice menu that informs the caller of a wait for the next available representative. The government tracks this waiting period, known as the “hold time,” from the moment the caller finishes navigating an automated answering menu until a live person is reached.

Wyoming had the lowest average hold time for calling health plans (14.5 seconds) and Michigan had the highest average hold time (43.15 seconds). For calling drug plans, Maine had the lowest average hold time (15.71 seconds) and Michigan had the highest average hold time (43.31 seconds). Five states (Florida, Michigan, New York, Pennsylvania, and West Virginia) had a Medicare Advantage contract with an average health plan hold time that exceeded the two-minute compliance standard. The same Medicare Advantage contracts in each of those five states also had average drug plan hold times that exceeded two minutes.

Hold Times by State

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Dropped Calls

Few things are as irritating for a consumer as calling a customer service number and having the call disconnected somewhere during the process. The government tracks dropped calls and produces a “disconnection rate” representing the number of calls unexpectedly dropped divided by the total number of calls.⁸

Wyoming was the only state with an average disconnection rate of 0% for calling Medicare Advantage health plans, while Puerto Rico had the highest average disconnection rate (1.83%). Wyoming also had a 0% average disconnection rate for calling Medicare Advantage drug plans, while DC had the highest average disconnection rate (4.41%). No states had Medicare Advantage contracts with health plan disconnection rates exceeding the compliance standard of 5%, but eighteen states had contracts with drug plan disconnection rates exceeding 5%.

Disconnection rates by state

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Conclusion

The optimal use of a Medicare Advantage plan is closely tied to strong customer service. Health insurance is a complex service with myriad details regarding items such as medical out-of-pocket costs, benefits, in-network healthcare providers, and drug formularies. Given that Medicare Advantage plans serve a predominantly senior population⁹ who are more likely to use medical services and medications frequently, accurate information that can be reliably accessed in a timely fashion is crucial. Poor customer service, such as inaccurate answers to questions, dropped calls, or unacceptably long hold times, can result in incorrect healthcare choices and paying a price monetarily or physically.

Methodology

Customer service performance measures for each 2013 Medicare Advantage contract were from the 2014 Medicare Part C and D Performance Data.¹⁰ Records for companies with Medicare Advantage contracts containing no data were not included in the analysis. The states in which contracts were present were from the 2013 MA Landscape Source Files.¹¹ Company averages for each performance measure were calculated across Medicare Advantage contracts that listed the company as their Parent Organization. State averages for each performance measure were calculated across Medicare Advantage contracts present in the state.

Medicare Advantage companies present in at least two states were ranked in order of their performances for each of the customer service measures. An average rank was computed for each company, and then the companies were assigned an overall ranking in order of their average rank. If a company did not have data for one or more performance measures, then their average rank was calculated only over the categories for which the company had data.

AUTHORS

This analysis was written by Jesse Geneson, data researcher at HealthPocket, and Kev Coleman, Head of Research & Data at HealthPocket. Correspondence regarding this study can be directed to Mr. Geneson at jesse.geneson@healthpocket.com.

Sources:

¹Medicare Advantage Fact Sheet. Kaiser Family Foundation. May 1, 2014. http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/
²HealthPocket examined the prevalence of vision, hearing, and dental coverage in Medicare Advantage plans in an earlier study.
Jesse Geneson, Kev Coleman. 97% of Medicare Advantage Plans Provide More Medical Benefits Than Original Medicare. April 16, 2014. /healthcare-research/infostat/medicare-advantage-extra-benefits-supplemental-benefits
³The data on call center performance measures is for 2013 Medicare Advantage plans. Exact timeframes for each performance measure can be found in the CMS documents “Medicare 2014 Part C & D Display Measure Technical Notes” last updated December 12, 2013 and “Medicare 2014 Part C & D Star Rating Technical Notes” last updated April 2, 2014.
⁴Consumer assessment scores for drug plans are numbers between 0 and 100 (higher is better) based on enrollee responses to the following questions: In the last 6 months, how often did your health plan’s customer service give you the information or help you needed about prescription drugs? In the last 6 months, how often did your plan's customer service staff treat you with courtesy and respect when you tried to get information or help about prescription drugs? In the last 6 months, how often did your health plan give you all the information you needed about which prescription medicines were covered? In the last 6 months, how often did your health plan give you all the information you needed about how much you would have to pay for your prescription medicine?
For health plans, a similar set of questions is asked in the consumer assessment: In the last 6 months, how often did your health plan’s customer service give you the information or help you needed? In the last 6 months, how often did your health plan’s customer service treat you with courtesy and respect? In the last 6 months, how often were the forms for your health plan easy to fill out?
Call center hold times were truncated to ten minutes for calls in which the call surveyor was on hold for at least ten minutes. Information on consumer assessment scores for health and drug plans comes from the CMS documents “Medicare 2014 Part C & D Display Measure Technical Notes” last updated December 12, 2013 and “Medicare 2014 Part C & D Star Rating Technical Notes” last updated April 2, 2014.
⁵If a Medicare Advantage organization did not have data for a particular performance measure, then that measure was not included in the average for the overall ranking.
⁶Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman. Medicare Advantage 2013 Spotlight: Enrollment Market Update. http://kaiserfamilyfoundation.files.wordpress.com/2013/06/8448.pdf
⁷For call center accuracy rate, hold time, and disconnection rate, the CMS compliance standards were at least 75%, at most 120 seconds, and at most 5% respectively. Compliance standards were not listed for the consumer assessment score. Compliance standards are from the CMS document “Medicare 2014 Part C & D Display Measure Technical Notes” last updated December 12, 2013.
⁸Information on call center performance measures comes from the CMS documents “Medicare 2014 Part C & D Display Measure Technical Notes” last updated December 12, 2013 and “Medicare 2014 Part C & D Star Rating Technical Notes” last updated April 2, 2014.
⁹In some cases, an individual may be under the age of 65 and enrolled in a Medicare Advantage plan due to a qualifying medical disability.
¹⁰The data set is from the file 2014_Display_Measure_Output_2014_02_11.csv in the folder Display Measures 2014 of the download 2014 Part C & D Medicare Display Measures at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html
¹¹The 2013 MA Landscape Source Files are available at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/