Buying health insurance can be a baffling experience. It is hard to know the true cost of health care under one plan versus another, because the higher monthly premiums of one plan may be more than offset by the higher out-of-pocket costs or narrower coverage of another plan (such as higher co-payments or deductibles, or narrower networks of covered doctors). For many people, buying insurance on state or federal insurance websites is just too expensive, because of federal mandates that increase the price of health insurance — insurers have to charge a higher price to cover pre-existing conditions of other people that you don’t have, and to cover costly elective procedures that most people won’t get, like sex changes (progressive government officials have issued regulations requiring many insurers to cover sex-change procedures, even though a sex change can cost over $100,000).
Even among people who can afford insurance, some people avoid buying insurance because of how confusing it is to decide which to buy — they can’t figure out which plan is best, and most are very expensive.
But now, artificial intelligence may help you figure out which plan to buy, even if you can’t do complicated algebra in your head to calculate the expected value of competing healthcare plans:
For all the frenzied speculation about how AI can transform health care, some companies are leveraging the technology for a decidedly simpler but still critical task: making shopping for health insurance less terrible.
Why it matters: Many Americans typically stick with their health plan year after year even when better and cheaper options are available, often because it’s too hard to predict how much care they’ll need or figure out if they can actually get a better deal.
- Companies are rolling out AI-powered tools aimed at making the shopping experience easier, and even brokers and agents selling health plans say they see the technology as a helpful aid, rather than an existential threat.
Context: The tools can be especially helpful for the tens of millions of people purchasing private Medicare Advantage plans or shopping for their own coverage on the Affordable Care Act marketplaces.
- While employees covered through their workplaces may just have a few plans to pick from, the average shopper on the ACA marketplaces during the current enrollment season has 100 plan options, with differing levels of cost and access to health care providers.
- The number of Medicare Advantage plans available to the average enrollee in recent years has more than doubled to 43, according to health policy research nonprofit KFF.
How it works: The AI tools generally gather basic information about an individual insurance shopper and their expected health needs and then use that data to churn out predictions for the best health plan options.
- Alight, a company providing cloud-based HR services, said 95% of the employers it serves used AI technology — including a virtual assistant feature — to help employees pick health benefits during fall open enrollment.
- The Big Plan, which launched last year for ACA open enrollment, bills itself as an “AI-driven health insurance matchmaker.” Its tool offers up the best three health plan options available to a customer based on several factors, including their income, prescriptions and preferred doctors.
- Healthpilot, an AI startup specializing in Medicare coverage, markets itself as removing the “commission bias” brokers may have to steer patients to certain health plans.
Health insurance brokers who work with companies and individuals say increasingly advanced AI could actually be helpful for business, even as workers in many industries worry the new tech could take their jobs.
- “AI is going to enable us to free up some of those tasks that could be routine and could be automated to allow us to be more personal” with clients, said Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professionals.
- The industry trade group is training internal staff on AI and in early 2024 will roll out an “app store” that will make these sorts of tools available to members.
One study looking at an AI-based decision tool in a Medicare Advantage marketplace found it saved consumers $278 on average and made the quality of brokers’ help less variable.
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