Will AI replace Medicare agents? Industry groups weigh in

Will artificial intelligence replace Medicare agents in getting people enrolled in coverage?

Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, has publicly floated the idea of using AI as a decision-support and navigation tool for Medicare beneficiaries. He proposed using AI to help consumers understand their Medicare options, compare Medicare Advantage plans and providers, and navigate their enrollment choices.

But although no rule has been issued on the use of AI in Medicare enrollment, associations representing health agents are paying close attention to the possibility.

Health Agents for America launched a letter-writing campaign in late March to call on CMS to ensure that access to live, licensed professionals remains a priority; that AI supports and not replaces human interaction, and that safeguards are in place to protect seniors from confusion and errors.

“We absolutely think that Dr. Oz needs to hear from seniors and agents and brokers, because I think in Washington, they decide that this is a good idea without talking to human beings about how this is really going to work,” said Ronnell Nolan, HAFA president and CEO. “We decided the best thing to do is to go directly to the horse’s mouth, go to Dr. Oz and let him know our thoughts – what we think is good, what we think is bad.”

Using AI to enroll people in Medicare “only hurts the American senior,” Nolan said. “Why not take what we already have and make it better? Because until the carriers do a better job, until CMS does a better job, it won’t be effective at all. Could a bot replace Dr. Oz? I’m going to say no – the same way I’m going to say a bot cannot replace agents and brokers.”

NAIFA: AI has its place

At the National Association of Insurance and Financial Advisors, Carroll Golden believes AI has a place in the Medicare enrollment process, but won’t take the place of an advisor. Golden is executive director of NAIFA's Centers of Excellence.

“I think that in Medicare, there are some repetitive things that AI is good at and belongs there,” she said. “But I think seniors probably will be hesitant to give their personal information to a machine. So for that reason, we need to ask where AI plays a role. Can AI assess our risk tolerance? Can it evaluate your health conditions or your financial situation? Is it familiar with your family dynamics? Does it know whether your house will accommodate your needs as you age?"

Golden described the agent as “the anchor” who can help older Americans sift through their Medicare options and choose the best one for their needs.

NAIFA’s Medicare Collective compiled basic tenets of what a good agent looks like, Golden said. “They took the position papers to say, ‘What is happening is not good but how can we help? How can we improve it?’”

The Medicare Collective has met with CMS twice, she said, explaining how Medicare agents enroll clients but also serve them after they have signed up for coverage.

“They’re approaching CMS, not as ‘you're the bad guys and we're the good guys,’ but as ‘we're all in this together, they're our seniors, and we have to do it right.’”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].