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Behind the self-service exchange websites, contact centers are helping consumers with the tough questions they have about health insurance coverage.

Henry Ford once said that, “Coming together is a beginning, staying together is progress, and working together is success.” The same could be said for health reform, which represents one of the most complex and sweeping changes to our nation’s health care system since the introduction of Medicare and Medicaid. 

We’re more than halfway through the first open enrollment period. All over the country, hundreds of thousands of consumers are beginning the process of selecting and enrolling in insurance plans. While the initial launch of the exchanges has been bumpy, the reality is that we’re only months into a decade’s long journey. There are large milestones ahead, but perfecting the customer experience is one of the most critical things we must get right—now and into the future. Applying for health insurance coverage and choosing a health insurance plan are complex processes and many people are going to need support to successfully navigate the process.

Maximus operates eight customer contact centers for health insurance exchanges across the country. This gives us a firsthand perspective as consumers navigate the process of program eligibility and enrollment into a health care plan. Although exchange websites are the main entry point to shop and apply for coverage, most consumers have crucial questions and are looking to our exchange contact centers for answers—in dozens of languages. Questions like:

  • How much will my coverage cost?
  • How do I find out if I am qualified for help paying my premiums?
  • When does my coverage start?
  • What should I do if I am already on Medicaid?
  • Who is offering coverage in my area?
  • Do I have to change my doctor?

The early vision of a self-service experience comparable to “Travelocity” has proven to be far from reality. Our contact centers are answering thousands of calls every day from consumers that want help understanding their options and responsibilities under the Affordable Care Act (ACA). The past few months have clearly demonstrated that many consumers are not comfortable completing their entire application and health plan enrollment without assistance. They are coming to us with varying degrees of health literacy, many speaking a primary language other than English, and others are dealing with the health insurance industry for the very first time in their lives. To these consumers, securing health insurance coverage under the ACA is not just a simple online transaction. As a result, call times have steadily increased as general questions turned into detailed conversations; repeat calls have become common as consumers seek assistance at each stage of the application and enrollment process; and web chat is now a prevalent and welcome channel for communication.  Indeed, many have chosen to apply and enroll entirely by phone, with extremely long call lengths.  We expect this trend to continue through the end of this open enrollment period.

As more and more consumers enroll in health insurance under the ACA, we expect a continued reliance on our exchange contact centers as a source of help.  The experience of the past four months has taught us many lessons, paramount of which are the best ways to determine staffing levels to meet multi-channel volume and call length to ensure the optimal customer service experience.