🏥 Improving self-service access to Medicare benefits

Context

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Today, there are over 65,000,000 people on Medicare, and about 12,000,000 of them have online accounts.

CMS provides Medicare.gov accounts to help people on medicare:

  • Get information about their current benefits.

  • Understand their out-of-pocket costs.

  • Take advantage of benefits that keep them healthy and save their out-of-pocket costs.

But, there are various challenges with the current experience that erode trust and reduce adoption. For example:

  • Users don’t know what to expect from their accounts.

  • Information provided on the account isn’t specific to a user’s situation.

  • Medicare jargon prevents users from understanding their benefits.

I lead a team that is working with the Centers for Medicare and Medicaid Services (CMS) to redesign and rebuild the Medicare.gov account experience. At a program level, the problem we’re solving is:

How might we provide self-service experiences that help people on Medicare understand their Medicare benefits and make informed decisions about their Medicare coverage and healthcare?

Our design team includes three UX designers, a content strategist, and me. As the design lead, I am responsible for managing our relationship with CMS, ensuring each team member is positioned for success, guiding our approach, providing strategic direction, and contributing to design deliverables.

How we approached the program

Supporting CMS’ priorities

The Medicare.gov account experience has the attention of a lot of stakeholders from across the organization, so our team must navigate a variety of (sometimes competing) priorities. Some of the higher-level priorities that affect our work include:

  • Scaling with a growing population – The number of people on Medicare is projected to increase in the coming decade as baby boomers age into the program. To support the growing population, CMS needs more beneficiaries to use self-service tools to manage their benefits so it can scale to support all beneficiaries.

  • Adapting to changing priorities – So far, our project has spanned two administrations with very different priorities. The Trump administration prioritized price transparency while the Biden administration is prioritizing health access and equity. Therefore, our approach needs to be able to adapt to ever changing priorities.

  • Supporting existing users while improving the experience – While we are designing the new experience, we need to maintain the legacy account application. Each change from the legacy to the new experience tends to disrupt current users and decrease overall satisfaction temporarily. Website customer satisfaction is a critical performance metric for our project sponsors.


Evolving the account experience to provide increasingly personalized experiences

We proposed a phased approach, where each phase would build on the prior phase to create a more holistic, personalized self-service benefits experience for people on Medicare. The early phases focus on the foundational parts of the experience, navigation, messaging, and home. The later phases focus on the

Our goal is to create a new medicare.gov account that can provide personalized, guided experiences that help people on Medicare navigate complex coverage and health events.

1️⃣ Unifying the experience across Medicare.gov
Medicare.gov consists of eight separate applications. When we started on the program, each application had completely different navigation, leaving users with multiple unconnected tabs open when using the site. By starting with a new holistic navigation, we could make the eight disparate applications become one coherent website and we begin tracking how users were navigating across all of Medicare.gov.

2️⃣ Bringing Medicare to users when they need it
The legacy account experience included a message center where users could get messages and corresponding email notifications directly from Medicare. However, the messages and emails Medicare had been sending were generic and often felt like “advertising.” A new message center with more personalized messages and email notifications would deliver valuable coverage and health information to users without requiring them to log in.

3️⃣ Establishing a single point of entry with a new account home
The legacy account home provides all users with the same experience, including information that didn’t apply to every user. With a new account home, we could guide users to the right sections of their account based on their needs while providing context about their Medicare account and build expectations for what they could do online. Updating the account home before updating the subsections of the account experience would allow us to front-load the disruption to current users and reduce the sense of constant change.

3️⃣ Creating more personalized experiences with each new section of the account
In the legacy account, each section of the account is completely siloed requiring users to visit multiple pages to achieve a single goal. As we design each new section, we are able to identify all of the information users need to achieve their goal. Over time, we could continuously enrich the application with more data.


Establishing our design operations and processes

To make our work transparent and predictable for CMS stakeholders, we developed and maintained program design operations that define how we work. Each initiative is broken down into the following phases:

  • Understanding the problem domain and user needs

  • Aligning on opportunities and goals

  • Designing and testing solution ideas

  • Implementing the new experience

  • Observing our impact

The design operations we’ve created have been so successful that CMS now uses our tools and processes for the other programs that support Medicare.gov.

 

1️⃣ Unifying the navigation of Medicare.gov's eight applications

The eight Medicare.gov applications are each managed by a separate contracting team. As a result, the experience users had on the website matched the organizational structure of the teams creating the Medicare.gov applications. Users would frequently end up with upwards of five Medicare.gov tabs open when trying to complete a task like looking up what their current drug plan covers. The problem we were trying to solve was:

How might we help users easily find what they’re looking for no matter where they are on Medicare.gov?

Examples of the various navigations used by the eight applications from Medicare.gov when we started.

One critical constraint for our team was that we couldn’t change the underlying information architecture of the applications that make up Medicare.gov. Adding to the challenge, the team that manages the majority of the general information pages of Medicare.gov was making big changes to their information architecture while we were designing the new navigation. To address the constraint and dependency on other teams, our team facilitated regular working sessions with each of the other product teams to maintain alignment and identify gaps. 

Miro board from a working session with another product team.

Before we started on the project, the CMS Division of Research had completed generative research studies to understand how people on Medicare think about their benefits and what they expect Medicare to know about them. Using their research findings and our insights from our discovery, we facilitated co-design sessions with CMS stakeholders.

Miro board from an early co-ideation session.

In partnership with the CMS Division of Web Experience and the Division of Research, we designed and tested new concepts across three rounds of usability testing. One critical insight that we learned during our design process was that:

Users could find things easier when the experience was similar regardless of whether they were logged in or not. But, when they were logged in, they needed a clear separation of their information and general information.

Our final design allows users to seamlessly navigate all of Medicare.gov whether they are visiting as a guest or they’re logged in.

Screenshot of the new Medicare.gov navigation.

The final design for the new consistent navigation.

After we released the new experience, we tracked how users’ behavior had changed, what users were saying about their new experience, and how user satisfaction metrics changed. For example, one quote from a user was:

"...the web site has changed greatly for the better since the last time I was here. In the past it has been extremely challenging to find how/where to pay my premium. I almost didn't want to visit. Today, was a fabulous experience!"

Website survey response from Medicare beneficiary

While the new design greatly improved the experience, we found that logged in users needed to be able to more easily navigate between their account pages. We used this insight to design a better home and navigation experience for logged in users.

 

👀 The story isn’t over

Our team continues to work to improve the experience for millions of people on Medicare. I’ll continue adding to this story as our work progresses.