Imagine a future where all 70 million Americans enrolled in Medicare have access to a personal AI assistant that helps them navigate the health care system with clarity and confidence. Instead of sorting through plan documents or deciphering unfamiliar policy terms, beneficiaries receive personalized guidance to help them understand their options and choose the coverage that best fits their needs.
That future may not be far away, according to recent comments from Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, MD. In fact, CMS recently issued a request for information on how AI can be used to improve Medicare plan selection and enrollment.
It’s a timely and necessary conversation.
Turning 65 and becoming eligible for Medicare is a major milestone in your life. But for millions of eligible Medicare beneficiaries, the enrollment process remains complicated.
Most Medicare beneficiaries (75%) say choosing coverage is confusing. New enrollees are expected to quickly understand whether their doctor is in-network, copays, and the differences between Original Medicare, Medicare Advantage, Medicare Supplement, and Medicare Part D plans. This level of complexity alone should be reason enough to modernize.
Further complicating matters, in most areas of the country, beneficiaries can choose from more than 40 Medicare Advantage plans, multiple Part D prescription drug plans, and a variety of Medicare Supplement options. Plans may vary in provider networks, drug coverage, premiums, cost sharing, and supplemental benefits such as dental and hearing care. Add in strict registration periods and frequently changing rules, and the process can quickly become overwhelming, even for savvy consumers.
Amid all the complexity, one fact stands out. That means the Medicare enrollment experience needs to evolve, and AI can help accelerate that progress. To understand where AI can have the biggest impact, it’s helpful to look at how Medicare enrollment has changed.
From paper to digital platforms: The early evolution of Medicare enrollment
Before the Internet, Medicare enrollment was primarily paper-based. Beneficiaries relied on government handbooks, mailed pamphlets, in-person seminars, and lengthy phone calls with licensed insurance agents. Comparing options was a time-consuming process with limited transparency into premiums, costs, and coverage.
The dot-com era brought about the first major changes. For the first time, consumers can now compare health plans online. Digital tools have replaced mountains of paper and introduced real-time data into the decision-making process.
The next phase was mobile. As smartphones become more central to daily life, beneficiaries have come to expect easier access and faster answers. Research and enrollment are increasingly being conducted from home, with licensed insurance agents often assisting individuals with their choices by phone or chat.
Next chapter: AI
We are entering the next phase of modernization. AI has the potential to address complexity, a core challenge that has persisted at every stage of Medicare enrollment.
Today, AI-powered tools are already being used to help beneficiaries evaluate plans based on their preferred doctors, prescriptions, chronic conditions, and financial considerations. Rather than focusing solely on monthly premiums, these technologies can estimate potential total out-of-pocket costs, identify network limitations, and surface options that better meet an individual’s medical needs. For most people, it is impractical to perform this level of analysis on their own.
At the same time, Medicare planning decisions are very personal. When licensed insurance agents speak with beneficiaries, they often hear the same concerns. People worry about maintaining access to trusted doctors, misunderstanding plan differences, and facing unexpected medical costs. Many people don’t just want data, they want peace of mind.
This is where responsible use of AI becomes essential.
AI reduces wait times, streamlines administrative procedures, gathers the information you need, and improves plan comparisons. You can also increase transparency by explaining why a particular plan is recommended. Just as importantly, AI, when used responsibly, can help close persistent health disparities by making quality Medicare guidance more accessible to underserved communities and providing personalized support to beneficiaries who have traditionally faced the greatest barriers to navigating a complex health care system.
But AI shouldn’t work alone.
A licensed insurance agent provides judgment, accountability, and empathy. These can help beneficiaries understand trade-offs, interpret changes in their lives, and reconsider coverage decisions as their needs change. The most effective model is not one in which technology replaces people, but one in which technology supports professionals in providing better guidance.
As CMS considers how to use AI to optimize Medicare plan selection and expand access to coverage, it must focus on clear guardrails, transparency, and meaningful human oversight alongside innovation. If implemented carefully, Medicare enrollment can be made more personalized, more transparent, and less intimidating.
The opportunities before CMS are not just technical. It’s human. When used responsibly, AI can restore trust in a system that too many beneficiaries still feel disorganized and ensure that innovation serves the people Medicare was created to protect.
Dr. Jerome Adams is a distinguished professor at Purdue University and former Surgeon General of the United States Army. Derrick Duke is the CEO of eHealth, a leading private online health insurance marketplace. Adams is also a member of eHealth’s Public Policy Advisory Board.
