CMS pushes AI tools to help U.S. seniors navigate Medicare
NEVADA, UNITED STATES — The Centers for Medicare & Medicaid Services is moving to deploy artificial intelligence (AI) tools to help millions of older Americans navigate Medicare, a shift that could reshape how patients access care while placing new operational demands on providers, Healthcare Dive reports.
Speaking at the HIMSS Conference, CMS officials said the agency aims to introduce AI “agents” that can guide beneficiaries in selecting doctors and comparing Medicare Advantage plans.
The effort is part of a broader strategy to modernize healthcare delivery and rein in costs that continue to outpace other sectors of the United States economy.
“The fundamental problem right now is that other sectors of the U.S. economy have advanced and been deflationary with their use of technology,” CMS Administrator Mehmet Oz said. “Healthcare has remained inflationary.”
AI-driven navigation raises stakes for providers
For hospitals, health systems and clinics, the rollout of patient-facing AI could significantly alter referral patterns, patient acquisition strategies and digital engagement models.
As AI tools increasingly influence how seniors choose providers, organizations may need to ensure their data, quality metrics and service offerings are accurately reflected across digital platforms.
CMS said the technology is intended not only to improve patient experience but also to reduce administrative friction. However, uptake may be slow. Only 31% of Medicare beneficiaries aged 65 and older trust AI to handle medical-related tasks, according to a survey by KFF.
“No one has gotten to them with the use case of why it’ll transform their life for the better,” Oz said. “It seems like a tool that we use to market to them, or help hospitals deal with issues, but not necessarily their issues.”
To address this, CMS is expanding its Health Tech Ecosystem initiative, which promotes data-sharing partnerships and digital tools, including conversational AI. Technology companies such as OpenAI and Microsoft have already introduced healthcare-focused assistants aligned with this vision.
Operational shifts, outsourcing opportunities emerge
While AI could streamline front-end navigation, it may also create new back-end complexities for providers. Ensuring accurate data integration, monitoring AI-driven patient flows and managing increased digital inquiries could strain already burdened administrative teams.
This opens the door for healthcare organizations to rethink workforce strategies, including leveraging outsourced support for revenue cycle management (RCM), patient engagement and IT operations. Third-party partners may play a growing role in maintaining data quality and supporting AI-enabled workflows without significantly increasing internal costs.
At the same time, risks remain. AI chatbots can generate misleading advice, with recent research showing some tools failed to escalate serious conditions appropriately. Still, CMS officials argue the technology will improve over time.
“The same will happen with AI, and they’re the dumbest today that they’ll ever be,” said Amy Gleason, a CMS advisor. “So I think we need to embrace this and help people understand how much this can help them.”
Beyond patient navigation, CMS is also expanding AI use in fraud detection. “We wanted to use AI to really help us be able to find out where the problems are,” said Kimberly Brandt, the agency’s deputy administrator.
