It's crunch time for Medicare open enrollment. Can AI help you pick a plan?

MW It's crunch time for Medicare open enrollment. Can AI help you pick a plan?

By Robert Powell

What AI gets right - and wrong - when navigating Medicare

Most Medicare experts will tell you to start your search to select a Medicare Advantage plan and/or Part D prescription-drug plan and/or a Medigap plan by using Medicare's plan-comparison tool.

And despite that tool's limitations, it's good advice.

The problem is, searching for plans is the easy part. Selecting the best plan is ultimately the hardest, if not impossible, part.

Picking the right Medicare plan is crucial. Quality healthcare is increasingly important, as is having a plan that suits your budget and needs - especially for seniors who are living on a fixed income. However, plan details, doctors and drug coverage can change from year to year, and sticking with the same plan can end up shortchanging the beneficiary.

The first step is to approach the process with structure. "It is essential to develop a straightforward game plan to navigate the Medicare search process," said Katy Votava, president of Goodcare.com and author of "Making the Most of Medicare." She added that "everything starts with two good lists: one of your care providers, and one with the exact name and dose of your medications."

Read: Medicare fraud spikes during open enrollment. Here's how to protect yourself.

Check your medication list in your MyMedicare.gov account, or create an account if you don't already have one. "Following these steps saves time and reduces errors," Votava said.

To begin my search - and the first step in this two-part experiment - I went to Medicare's comparison site and clicked "Find plans now."

That takes you to a screen where you're asked to select the type of plan you want: Medicare Advantage, or Plan C; a Medicare prescription-drug plan, or Part D; or a Medigap policy.

In my case, I selected Medicare Advantage, which is what roughly half of the 70 million or so Medicare beneficiaries choose.

Next, you're asked to enter all your providers. The tool is gracious enough to remind you that not all providers are in-network with all Medicare Advantage plans. Add the providers who are most important to you, and your plan search results will show if they're in the network of the plans you're considering.

That was indeed the case, I later learned: Not all the physicians I use were in-network for the plans the tool identified for me.

The tool will also remind you: "Always check with your provider to make sure they participate in the plan you want to join. Providers can change which plans they accept at any time. If a provider has multiple office locations, plans might only cover the provider at some of the locations."

After you enter your providers, you're taken to a screen where you're offered the ability to select a "must-have" provider to narrow your search results and get a list limited to plans they participate in.

I did that, and it yielded a list of 34 - yes, 34 - plans, which most choice-architecture experts would say is far too many options for the average person.

Now, the good news is that I, along with every other Medicare beneficiary who uses Medicare's plan-comparison tool, is then able to search for plans based on any number of criteria: plan type (HMO or PPO); plan benefits (vision, dental, hearing, transportation, fitness benefits); insurance carrier; drug coverage (includes drug coverage or doesn't include drug coverage); and star ratings (no rating to five stars).

In my case, I searched for PPO plans that included drug coverage and had a four- or five-star rating - and that narrowed my choices to six plans.

This is where things become a bit complicated.

In two of the plans, not all of my doctors were in-network. And going out of network in 2026 would have pushed my out-of-pocket costs to $13,900.

In the other four plans, I encountered this instruction: "Contact the plan for provider information." Exactly what I did not want: more work.

I also learned that despite the new $2,100 cap on prescription drugs, my estimated total drug and premium cost could be as high as $5,585.40 per year. The reason: The cap applies only to covered drugs. I also had to understand the difference between an in-network pharmacy and a "preferred" in-network pharmacy.

Read: Watch out for these potential traps when signing up for Medicare

The hard part: Comparing plans

Now the truly hard part was comparing six plans. The tool lets you compare three plans at a time, and even that was overwhelming. There were more than 34 rows of information across three columns, and I cannot imagine my 90-year-old self having the patience or ability to sort through it.

So instead of booking an appointment with a health-insurance agent or a State Health Insurance Assistance Program $(SHIP)$ counselor, which likely would have been the smarter choice, I tried an experiment.

I took screenshots of all the rows and columns, uploaded them into ChatGPT, and asked the AI to review my options and pick the best Medicare Advantage plan for me.

It analyzed monthly premiums, health deductibles, drug deductibles, maximum out-of-pocket costs, star ratings, and whether the plans included drug coverage - a comprehensive list of items to evaluate.

Here's what ChatGPT had to say after analyzing just three plans:

-- "Medicare PPO Blue Essentials is the best overall value. It balances reasonable premiums with excellent coverage, lower out-of-pocket exposure, and added benefits (dental, vision, hearing) that Tufts lacks."

-- "If you rarely need care and want no premium, Tufts is fine."

-- "If you use more medical or dental services, Blue Essentials gives you more protection and value."

Can AI make Medicare plan comparisons easier?

At first blush, ChatGPT provided a useful first cut even though, for this exercise, I only analyzed three of the six plans that met my criteria. It did, after all, suggest which plan offered the best overall value.

But was ChatGPT's analysis accurate? And was the recommendation the best one?

To find out, I asked Marcia Mantell, author of "Creating Your Medicare Recipe: Your guide to enrolling on time and without penalties," for her thoughts.

What AI got right - and wrong

Mantell said she could not determine whether the AI's evaluation was accurate without seeing the full documents - but, for the sake of the exercise, she would assume it was, as long as I had uploaded the full plan documents and included my physicians, specialists and preferred hospital system, and added in my exact prescriptions.

Verifying physician participation is essential. "It's especially important to confirm before any analysis if your primary care physician (PCP) is accepting the plans in the comparison group," Mantell said. "Many, many PCPs are no longer accepting a preferred provider organization (PPO) or the PPO is no longer offering in-network status to lots of physician groups."

Provider databases often contain errors, and you would need to preclear your choices with your key doctors, Mantell advised.

On whether ChatGPT picked the best plan, Mantell said the analysis was sensible if the right plans were included. "If we assume the three choices compared in your document are all correct, the analysis was fair and unbiased. It looked at the key facts (premiums, out-of-pocket [costs], drugs, number [of] days to pay for a hospital stay, etc.)," she said.

Mantell added that the AI's take on supplemental benefits was noteworthy. It did a good job flagging when a plan might offer more value for people who use a lot of dental or vision care - but, she noted, that usefulness depends on whether your providers actually accept the plan.

She also commented on the AI's assessment of extra benefits. "It was also interesting to see how it considered the 'extra goodies' and gave a good perspective of, 'If you use more dental/vision, this plan provides more value,'" she said. "Well, it might provide more value, but only if your dentist takes the plan!"

But Mantell cautioned that the AI's comparison did not fully reflect how plans work in real life. "While the comparison of the three plans is pretty thorough, it definitely has not considered the real-world use of the plan," she said. "Who is really accepting it? Can you take full advantage of all the bits offered? Did you choose the correct pharmacy (preferred, in-network) when selecting the plan?"

AI can be helpful in certain situations. "If you are just looking to compare three random plans offered in your zip code, AI can be a really good option to sort through the 250 pages of the evidence of coverage, or EOC," Mantell said.

The comparison tool is not designed to let users compare all components of Part C plans, so she suggested AI could create more realistic benefit comparisons, such as a detailed table to compare more of the puzzle pieces of healthcare for older Americans. Some examples include physical-therapy limits, acupuncture rules, podiatry and other commonly used services.

AI could be helpful in narrowing large plan lists. "In states where the consumers have 45 or 60 different options, I think AI could be really valuable in comparing eight or 10 as a first cut, then the consumer could further refine for their doctors, drugs and facilities," Mantell said.

Should AI replace professional advice?

When it comes to whether AI could replace professional advice, Mantell was definitive. "Supplement, yes," she said. "Replace, no."

Even with AI, consumers still need to verify coverage, including calling each doctor or medical facility.

The limitations should be spelled out clearly. Mantell advised listing the exact plan documents and prescriptions used in the comparison, noting that outcomes can shift dramatically depending on the drugs included.