RCS vs. SMS: What Health Plans Need to Know

Odds are, texting your member population is already part of your health plan's strategy, especially within Medicare and Medicaid where member activation is directly correlated to financial performance. It probably looks something like this: alert a member that they’re due for services or have a notification in the portal where you direct them to log in to learn more.

Your open rates are probably high. Average open rates for text messages hover around 90% in the first three minutes the message is sent, blowing email performance out of the water.  

The problem is what happens after the member reads it — nothing.

A plain-text SMS typically asks a member to log in to a portal to read a notification and then take a secondary action based on what you need them to do. It puts a lot of work on the member to navigate next steps, and most members don’t get past the first step. Or, health plans that are more advanced in their SMS workflows may step members through a process where members reply with a number to select an option. Either way, it's clunky and full of opportunities for friction and confusion.

It’s why outreach open rates are high, but it’s not reflecting in your gap improvement rates. If text outreach is going to influence HEDIS and Star Ratings performance, Medicare and Medicaid plans need to reevaluate.

RCS (Rich Communication Services) is designed to close the measure-level gap by creating more user-friendly texting experiences.  

SMS vs. RCS comparison for health plans

RCS business messaging is the new standard that’s replacing traditional SMS for companies conducting consumer, member or patient outreach. It works through the same native messaging apps your members already use — no downloads, no logins, no new technology for members to learn or payers to support.

What changes is the experience it delivers. Where SMS delivers a line of text and a link, RCS delivers a branded, app-like interactive experience that can step members through a conversation or process.  

Here’s a side-by-side look at what that means in practice.

Why RCS should matter to payers

1. Adoption is high

Adoption for RCS messaging among consumer brands is already high. In May 2025, Google announced more than one billion RCS messages are sent every day across Android and iPhone users, and it’s safe to assume that number is only growing.  

Members are increasingly expecting their healthcare providers and services to operate like the shoppable experiences they have with other brands that are mobile-friendly and up-front.  

Translation: health plans expecting members to take extra steps or jump through hoops are being ignored.

2. Cost savings opportunities

The resource investment to get a member to their provider's office typically includes high-cost phone outreach to members and providers, and mailed letters. These channels are not only a burden on the plan and often hard to measure, but expensive to produce and scale. Conventional outreach to schedule a provider visit typically runs around $23 per member, combining phone calls and mailers. That cost adds up across a population, especially when the call-to-action requires a member to go do something separate from the communication.

RCS leveraged in outreach that enables scheduling right there, while you have the member's attention, runs approximately $5.82 when bundled with rewards and reminder communications. For plans that's a 75% cost reduction per outreach. Multiplied by a whole population, that's measurable savings and performance improvement.

How RCS can impact clinical gap closure for health plans

RCS addresses the friction member’s experience just to schedule an appointment with their provider, jumping between text messages, online portals, Google searches and phone calls with frustrating hold times and phone trees.  

The mechanism is straightforward. When a member receives an RCS message from their recognized health plan name — with a “Schedule Now” button that opens directly into provider matching and appointment availability — the conversion from outreach to action happens in a short text exchange. There’s no link to copy, no number to call, no friction to absorb. All the member has to do is tap a button to proceed.  

For payers, this experience improvement can mean significant improvement in gap closure and risk adjustment accuracy. For Medicare Advantage plans, that can translate to a meaningful Star Ratings boost.

Not all members can receive RCS and that’s OK

RCS requires a device with RCS support which includes iPhones with iOS 18.1+ and Android phones with OS 5.0+. As of early 2025, 68% of iPhones in use supported RCS. Android has supported RCS natively for years, and nearly all Android users now have OS 5.0+.  

Most of a plan’s member population can receive RCS messages today.

Inevitably there are members who either have older smartphones or no smartphone at all. For these members, nothing breaks. The platform automatically detects whether a member’s device supports RCS. If it does, they get the rich experience. If it doesn’t, the message falls back to SMS automatically. This requires no segmentation and no additional configuration on behalf of the plan to administer.  

Your outreach reaches everyone. The members who can receive RCS get a better experience. The members who can’t receive RCS get the same SMS they would have received anyway.

RCS becomes the default that makes the upgrade zero-risk for member reach.  

What this looks like in a real member journey  

Healthmine offers RCS through QRM Connect™, a provider matching and appointment scheduling platform. QRM Connect enables members to get notified they’re due for a provider visit, find a provider and choose appointment windows that work for their schedule. A conversational AI agent initiates the call to the provider’s office, navigating hold times and phone trees, to schedule the appointment.  

Compare the path for SMS and RCS experiences.  

SMS and RCS compliance considerations: PHI, HIPAA and TCPA

RCS operates within the same regulatory framework your team already manages for SMS and, in several ways, it's a more defensible channel. Under HIPAA, neither SMS nor RCS should be used as a vehicle for transmitting protected health information (PHI) directly. The rule is the same for both: keep PHI out of the message body, use generalized outreach language for condition-specific campaigns, and route members to secure, authenticated environments when clinical detail is required. That's not a new constraint — it's the same approach health plans are already applying to their SMS programs today.  

What RCS adds is a stronger trust layer, which is critical for government programs like Medicare and Medicaid. Verified sender profiles that display a health plan's name, logo, and a verified business profile substantially reduce the phishing and spoofing risk that makes unbranded SMS a liability for member-facing communications. A member who receives a text from a recognized, verified sender is far less likely to mistake it for fraud, and far more likely to engage with a secure link embedded in it.  

For TCPA compliance, RCS doesn't change consent requirements, but it does make opt-out management cleaner. Interactive unsubscribe buttons built directly into the message thread give members a clear, frictionless way to opt out — and, where supported, the event-level analytics RCS provides create a more complete audit trail for demonstrating that consent was honored.  

Because RCS delivery depends on device and carrier support, SMS workflows remain necessary in parallel for members who are on unsupported devices for RCS. For organizations that have already built compliant SMS workflows, the transition to RCS is not a compliance rebuild. It's an upgrade to a channel that is, by design, harder to spoof and easier to document.

See the RCS experience

Find out how RCS can re-ignite your existing member engagement initiatives in a channel your members already prefer. Get in touch and we’ll show you QRM Connect in real time, including a live call with the AI agent scheduling appointments. See how frictionless gap closure can be for your plan and your members. Contact us.    

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