How to Create a Great Health Insurance Customer Experience

From the advent of competitive individual markets in the Affordable Care Act (ACA) to the growth of the Medicare Advantage market, insurers today need to be more attuned to their customer experience than they have in the past. Direct-to-consumer sales can grow a health insurance business, and customer satisfaction, customer reviews, and customer experience are vitally important to attracting and retaining individual buyers.

With that in mind, here are six key drivers of a great health insurance customer experience:


The average cost of a health insurance premium in 2020 for a family in an employer-sponsored plan was $21,342, with employees covering $5,588 of that cost. For families in the insurance exchanges, that number is slightly lower for a silver tier plan (see our health insurance exchange terminology guide for more information about metal tiers), around $19,092. Silver-tier plans have much higher deductibles, averaging $4,604 in 2020, compared to employer plans at $1,644.

To put it lightly, health insurance is not inexpensive. As a result, consumers expect more than they would from purchases costing a lot less. They expect to get value out of their insurance plan. As an insurer, your job is to deliver that value. Improving all the following items will help you reinforce the value you offer. But the bottom line: The better the value, the more likely consumers will like – and recommend – your organization. Containing the cost of your insurance products can have a significant impact on overall customer satisfaction.

Enrollment Experience

First impressions matter. A study found that one-tenth of a second is all it takes for humans to start determining if someone is trustworthy. First impressions play a large role in determining customer satisfaction.

As a result, health insurers must invest in technology and communication that streamlines the enrollment process. For example, information about the health plan, the plan network, copays and deductibles, and more can help streamline the decision-making process for consumers and improve their first impression. Consider these items when examining the enrollment experience:

    • Easy to understand paperwork — Ensure your enrollment forms and other explanatory materials are easily understood. Your goal is to make the enrollment process as easy to complete as possible. Actively seek user feedback and leverage that feedback to find common issues. Prioritize and work to resolve those issues.
    • Availability of enrollment specialists — Though consumers continue to expect great online resources, a personal touch is always appreciated. Make sure you have enrollment specialists available to help consumers. Live chat and AI chat assistants can also help quickly resolve or route common questions.
    • Ability to enroll over the phone or online — The Maryland Health Connection found that those with low incomes and minority populations primarily depend on their phones for online access. So they decided to build a phone app to make it easier for those populations to enroll. Your goal is to make the enrollment process as painless as possible. Frictionless consumer interactions are the new norm and enrolling in a health insurance plan shouldn’t be any different. So make it easy for consumers to enroll online — or even by phone with personal assistance.
    • Engaging, clear website support tools — Finally, make sure you have decision support tools readily available on your website. Include clear documentation about covered expenses as well as network guides.


I once had a contractor install a paver patio, a fairly straightforward installation. When he was done, he applied a sealant that, unfortunately, was applied incorrectly and turned the pavers an ugly shade of gray. He tried to charge me to remove the sealant and reapply another coat. I was not amused.

If you want to anger a customer, send them an unexpected bill. For health insurance companies, that means delivering clear coverage information and making those materials readily available for consumers to review.

The best way to do that is to make that information available on your website. Make it searchable and easy for consumers to contact you should they have questions that aren’t readily available in your materials. Make sure it’s mobile-friendly since many consumers leverage their phones to access the internet.

Even better, build an environment that learns from your customers. Track what terms customers use when searching, how satisfied they are with the search results, and which questions require escalation. Then, leverage that data to make consistent improvements to your documentation. Over time, you’ll build a great database of coverage information that’s likely to improve customer satisfaction.

Provider Network

“If you like your doctor, you can keep your doctor.” One of President Obama’s most famous messages when passing the ACA was that if you liked your doctor, you could keep your doctor. When the ACA passed and some consumers had to switch insurance plans — and lost their doctor — because the new ACA regulations required plans to cover certain essential benefits — Obama faced significant backlash.

People like their existing doctors and networks. Insurers with broad networks are more likely to deliver satisfied customers.

But that’s not the only factor driving satisfaction. Making it easy to see who is in-network is also important. Insurers with tools that make it easy to see who is in their network AND learn more about in-network providers are more likely to find a good provider, thus increasing their satisfaction with their insurance plan. Build a provider database that includes quality and cost scores, specialties, and even consumer reviews to make it easy for consumers to find a great provider.

Billing Experience

In individual and Medicare Advantage markets, health insurers regularly overlook the billing experience as a customer touchpoint. Insurers bill their customers monthly but don’t pay much attention to how that process looks from the consumer’s point of view. That’s 12 opportunities a year to make a great impression.

Consumers like easy payment processes — from Amazon’s simple buying process to recurring, automated payments for credit cards. Consumers expect a simple process, payment flexibility, and convenience.

For insurers, that means simplifying setup for recurring and one-time payments as well as delivering useful information on every invoice. A single billing issue can irreparably damage your brand in a consumer’s eye. So make sure your health insurance premium billing exceeds customer expectations.

Customer Service

Perhaps the most important aspect of a health insurer’s customer satisfaction is general customer service acumen. Generally speaking, there are two main customer service improvements that consumers appreciate:

  • Access to a live person. Consumers hate waiting and especially hate not being able to resolve a question quickly. Though chatbots and AI can alleviate some issues, some require live human interaction. You not only need to have individuals available to answer consumer questions, but you also need to route them to the right person quickly. Anything else will impact customer satisfaction scores.
  • Knowledgeable representatives.  Getting to a customer service rep isn’t the only part of the customer service experience. That person also needs to be able to answer the questions asked. For health insurance, that means hiring and training quality customer service representatives, measuring their work, and consistently growing their knowledge.

Certifi’s health insurance premium billing and payment solutions help healthcare payers improve member satisfaction while reducing administrative costs.



Member Engagement - A Health Insurer's Guide

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