How AI Assistants Drive Medicare Advantage Member Engagement and Benefit Understanding

Medicare Advantage executives face a critical challenge: helping members truly understand and utilize their health plan benefits. GetSetUp’s dedicated AI Assistant and AI Search are emerging as powerful tools to enhance member engagement and benefit comprehension. GetSetUp has spent over five years teaching older adults the most important skills needed to live active, independent lives. With over 10 million classes delivered, we have gathered deep insights into how older adults learn, engage, and seek information. This expertise has shaped our AI’s ability to provide empathetic, accessible, and member-focused guidance—something traditional AI tools often lack. Unlike generic digital assistants, GetSetUp’s AI has been trained to understand the unique needs of older adults, including their vocabulary, learning styles, and concerns about healthcare navigation.

AI Assistant & AI Search: Personalized Support and Guided Discovery

Today’s older adults are increasingly tech-savvy, but many still struggle to navigate complex health plan information. GetSetUp’s AI Assistant and AI Search offer a personalized, always-on support system that simplifies this experience:

• Natural-Language Q&A: Members can ask questions in everyday language (“What’s my co-pay for a specialist visit?”) and get instant, plan-specific answers. The AI understands different phrasings and tailors responses based on the member’s plan details (How to Use AI in Healthcare - Personify Health). This on-demand help is available 24/7, often resolving inquiries faster than calling a support line (How to Use AI in Healthcare - Personify Health).
• Interactive Knowledge Base: The AI Search taps into plan documents (EOCs, formularies, FAQs) to fetch precise information. It can, for example, pull the exact section of a member’s Annual Notice of Change (ANOC) or benefits booklet that answers their query, saving them from poring over pages of text.
• Structured Conversation Prompts: Uniquely, the assistant doesn’t wait for members to think of what to ask. It provides a curated menu of up to 40 guided prompts on common topics – like “Tell me about my benefits” or “What changed this year?”. These prompts initiate structured conversations, allowing members to easily explore important information with a simple click instead of typing an open-ended question.

By combining personalized answers with guided discovery, the AI assistant transforms a passive website visit into an interactive learning session. Members receive friendly, step-by-step guidance through their plan’s features, which is especially valuable for older adults who may be less confident navigating digital information on their own. In fact, industry data shows 74% of internet users prefer using chatbots for simple questions (BEST Chatbot Statistics for 2025 | Master of Code Global), and even seniors are finding such tools intuitive. A recent study with adults 60+ found that a well-designed health chatbot was “easy, useful, and required low cognitive load,” demonstrating it can be an enjoyable way for older adults to get information (Frontiers | Older adults' experience with virtual conversational agents for health data collection). By making self-service more approachable, the AI Assistant reduces confusion and empowers members to get the answers they need in seconds.

Real-World Example 1: Navigating Plan Changes with AI Guidance

Annual Notice of Change (ANOC) documents are notoriously dense, and many members simply set them aside. (In fact, 43% of Medicare Advantage enrollees did not review their plan’s coverage changes for the following year (Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period | KFF).) Consider a member named Alice who normally found her ANOC overwhelming. Using the AI Assistant’s custom prompt about ANOC, Alice types: “What changes should I look at in my plan for next year?”

The AI Assistant responds with a personalized summary: it highlights that her primary care co-pay will increase by $5, her insulin will be covered on a newer formulary tier, and her plan is adding a transportation benefit she hadn’t seen before. The assistant then offers follow-up prompts: “Would you like to compare this with other plan options?” or “Learn more about this new transportation benefit.” In a few minutes of guided Q&A, Alice clearly understands her upcoming plan changes – something she never achieved by skimming the mailed booklet.

This interaction not only helped Alice make an informed decision (she ultimately stayed with her plan, avoiding the common pitfall of overlooking changes), but it put her in the minority of members who actively engage with their ANOC. Nearly 4 in 10 Medicare Advantage members don’t review changes in premiums, co-pays, or covered services annually (Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period | KFF), a behavior that can lead to costly surprises. By prompting members to “learn about your ANOC” in plain language, the AI Assistant turns a daunting task into a dialogue. The outcome: more members like Alice are aware of coverage modifications and can act – whether that means adjusting to new costs or switching plans – before those changes affect their care. Guided AI prompts can drive members to review critical plan changes, preventing unpleasant surprises.

This proactive education has direct business impact. Members who understand plan changes are less likely to be dissatisfied or switch plans due to “unknown” benefit changes. They also avoid lapses in care (for example, finding out a medication is no longer covered only when at the pharmacy). In short, an AI assistant that can expertly walk a member through their ANOC strengthens retention and trust, showing the plan is being transparent and helpful.

The Power of AI-Driven Prompts: Higher Engagement & Member Satisfaction

Why do guided prompts and AI assistance make such a difference? Data shows that structured, prompt-driven interactions lead to higher engagement and understanding, particularly for older adults:

• Increased Engagement and Time Spent: When members are presented with clear options of what to explore, they tend to click through and spend more time learning. Instead of a user giving up after reading a confusing webpage, the AI’s prompts invite them into a conversation. Internal analyses have shown that members using guided prompts ask multiple follow-up questions per session, indicating deeper exploration of their benefits. This aligns with consumer trends: on average, users pose about 4 questions in a single chatbot session (BEST Chatbot Statistics for 2025 | Master of Code Global), and they want to use these tools – 73% of consumers expect websites to offer a digital assistant for convenient interaction. By leading members down a path (e.g., “Learn about preventive services” → “Covered vaccines” → “Schedule a screening”), the AI assistant keeps them engaged with their health plan content far longer than a static FAQ page would. The result is more time spent understanding health coverage and less time feeling lost.
• Higher Satisfaction: A guided experience can drastically reduce the frustration that often comes with searching for answers. Rather than typing an exact phrase into a search box (and likely not finding an immediate answer), the member can simply pick a prompt or ask in their own words and get a direct, accurate response. Studies show that 87% of consumers rate their chatbot interactions as neutral or positive, and this holds true for older demographics when the chatbot is well-designed for their needs (Frontiers | Older adults' experience with virtual conversational agents for health data collection). Members appreciate that they can get quick answers any time without waiting on hold – in one survey, 62% of people preferred engaging with a digital assistant over waiting for a human agent. For Medicare Advantage members, who often have many questions, this immediacy and clarity translate into peace of mind. Satisfaction scores go up when members feel their plan makes information easy to access. As one industry report noted, a reactive approach leaves members feeling unsupported, whereas “proactive engagement fills this gap,” preventing frustration and improving their healthcare experience (Member experience in Medicare Advantage: The power of proactive navigation).
• Older Adults Prefer Guidance: Importantly, research indicates that older adults benefit from structured prompts more than open-ended tasks. In one study, seniors (especially those with mild memory issues) strongly preferred direct, multimodal prompts over indirect cues (Subjective cognitive complaints and objective memory performance influence prompt preference for instrumental activities of daily living - PMC) – essentially, they want the system to guide them clearly. This preference makes sense: typing out questions from scratch can be daunting if you’re unsure of terminology or even what you’re looking for. By contrast, recognizing a topic (“Drug coverage” or “Vision benefits”) from a list and clicking it is a much lower barrier. This recognition vs. recall dynamic is key for aging users. Clear options reduce cognitive load, and as noted earlier, older adults reported that an easy chatbot with low mental strain was actually enjoyable to use (Frontiers | Older adults' experience with virtual conversational agents for health data collection). Thus, structured AI prompts create a seamless, stress-free digital experience for seniors, encouraging even hesitant users to engage. One can imagine a member thinking, “I wasn’t sure how to ask, but when I saw the prompt ‘wellness programs,’ I realized I do want to know about that.” Every such interaction builds their confidence and digital literacy.
• More Proactive Learning: With the AI assistant’s gentle guidance, members often end up learning things they might not have sought out themselves. For example, a prompt like “Learn about preventive care you may have missed” might educate a member about a free annual wellness visit or a cancer screening they are eligible for. This kind of prompts-driven discovery leads to members being better informed about their plan’s value. Over time, they become more self-sufficient and knowledgeable healthcare consumers. Higher engagement and knowledge, in turn, correlate with better health behaviors – a member who understands their coverage is more likely to get that flu shot or use their free gym membership, etc. According to one analysis, engaged members are indeed more likely to utilize preventive services and adhere to care recommendations (Importance of Payer Member Engagement - LexisNexis Risk Solutions) (Member experience in Medicare Advantage: The power of proactive navigation), which improves outcomes and satisfaction.

The AI Assistant’s structured prompts act as training wheels that get members rolling confidently. The data suggests this approach of guided navigation isn’t just a nice-to-have – it’s a game-changer for driving engagement among older adults. When members spend more time interacting with their plan information and come away satisfied and informed, it directly boosts the metrics that Medicare Advantage plans care about: lower call volumes, higher self-service rates, and happier members.

Impact on Medicare Advantage Plans: From CAHPS to Health Outcomes

Investing in an AI Assistant & AI Search is not just a member convenience – it directly advances key business and quality metrics for Medicare Advantage plans. Here’s how guided AI discovery drives tangible impact:

• Higher CAHPS Scores & Star Ratings: Member experience as measured by CAHPS (Consumer Assessment of Healthcare Providers and Systems) has a substantial weight in Medicare Advantage Star Ratings and bonus payments. Proactive, easy-to-use digital tools can significantly improve members’ perception of their plan. When members can effortlessly get information and feel supported, they rate their plan higher. A recent industry insight stressed that “members do not feel plans are doing enough to assist them” in understanding benefits, and a passive approach leads to lower satisfaction (Member experience in Medicare Advantage: The power of proactive navigation). By contrast, interactive AI assistance is a proactive engagement strategy that fills this gap. It makes members feel the plan is there for them 24/7 with answers and guidance. Plans that have deployed such tools are aiming to see boosts in their CAHPS scores for questions like “Ease of getting information from your health plan” or “Health plan’s customer service.” An improvement of even a few percentage points in these scores can be the difference between 4 and 5 stars. As a reminder, falling below certain satisfaction thresholds can risk millions in CMS quality bonuses (Member experience in Medicare Advantage: The power of proactive navigation). Thus, the AI Assistant directly contributes to protecting revenue by lifting member-reported experiences.
• Reduced Call Center Volume & Costs: Every question answered by the AI assistant is one less phone call to customer service. Routine inquiries about coverage, benefits, or network doctors can be resolved instantly through self-service. This has a huge efficiency upside. For example, Intermountain Healthcare’s use of a chatbot during COVID saw a 30% decrease in call center volume for that period (How Chatbots Helped One System Reduce COVID-Related Call Volume ), and while that was a specific use-case, it demonstrates the deflection potential. Even in general settings, giving people the option to get answers from an AI can meaningfully lighten the load on call centers (How to Use AI in Healthcare - Personify Health). Agents are then freed up to handle complex or urgent issues, improving service for those who truly need human assistance. The cost savings from call deflection (not to mention reduced wait times and frustration) can be significant over a year. One study by Accenture found that AI use in healthcare customer service could lead to a 25% drop in call volume (How to Use AI in Healthcare - Personify Health). For Medicare Advantage plans, that translates to lower administrative costs and possibly the ability to repurpose staff towards proactive outreach instead of repetitive FAQ answering. Ultimately, members get faster answers and plans save money – a clear win-win.
• Improved Digital Literacy and Engagement: Introducing seniors to a well-designed AI assistant can have a broader effect of making them more comfortable with digital tools. As members use the AI, they learn how to navigate online resources better, gain confidence in using chat or search features, and become more adept at self-service. Over time, this can increase adoption of other digital offerings the plan may have (mobile apps, patient portals, etc.). Essentially, the AI acts as an on-ramp to greater digital engagement. Given that a significant portion of older adults still face a digital divide, having an accessible, non-threatening tool like a conversational assistant helps bridge that gap. Members who might never have used the plan’s website before may start doing so because the AI makes it easier for them. This contributes to higher portal usage rates and deeper member engagement overall. Engaged members are more likely to stay within the plan’s ecosystem for information instead of seeking outside help (or misinformation). In the long run, a more digitally literate member base lowers costs as well – they can receive communications electronically, complete transactions online, and so forth, reducing reliance on paper and phone channels.
• Preventive Care and Health Outcomes: Perhaps the most important impact is on member health behavior. By guiding members to information about their benefits and care, the AI assistant can nudge them toward utilizing preventive services. For example, the assistant can be configured to prompt: “You’re due for a mammogram this year – it’s covered at no cost. Would you like to know how to schedule it?” or “Flu shots are free – here’s where you can get one.” This kind of timely, context-aware prompting can increase uptake of screenings and immunizations. Engaged members who understand their coverage tend to avoid delays in care (Member experience in Medicare Advantage: The power of proactive navigation). As the RISE Health report illustrated with “Maria,” not knowing about a benefit (like vision screenings) led to a worsened health outcome (Member experience in Medicare Advantage: The power of proactive navigation). Conversely, with AI-driven awareness, those gaps can be closed. If even a small percentage more members get their annual wellness visit or manage their chronic conditions better because the AI helped them navigate those benefits, the plan could see improvements in HEDIS measures and overall outcomes. Over time, better preventive care uptake means lower hospitalization rates and medical costs for the plan, and of course, healthier members.
• Member Retention and Growth: Satisfied members stay. By improving the member experience through AI, plans likely improve their retention rates during the all-important Annual Election Period (AEP). Members who feel their plan empowers them with information and consistently helps them are less likely to be lured away by a competitor’s marketing. Additionally, those members may tell friends or family (or their brokers) about the positive experiences, which can drive new enrollment via reputation. In a market where 69% of Medicare beneficiaries did not compare other plan options last year (indicating inertia is high), keeping existing members happy is crucial. If a plan can point to cutting-edge, user-friendly features like a personalized AI assistant, it can also be a selling point in marketing materials or sales conversations, appealing to the growing number of seniors who value digital access.

Finally, seamless AI integration ensures that all these benefits are realized without disrupting other systems. The assistant can be embedded in the plan’s member portal or mobile app, working alongside care management and customer service teams. It becomes a natural extension of the plan’s outreach. When a member has a complex issue, the AI can even route them to a human representative, creating a smooth handoff (e.g., “I can have a customer service agent call you about that specialized request.”). This synergy means the member never hits a dead end – the AI handles what it can and knows when to involve a person.

GetSetUp’s Dedicated AI Assistant & AI Search are more than just tech gadgets – they are strategic assets for Medicare Advantage plans. They drive proactive member engagement, which in turn fuels better understanding of benefits, leading to smarter utilization and healthier members. The data and examples speak for themselves: from significant chunks of members not even reading their plan changes  to now individuals like Alice and Bob becoming informed champions of their own coverage, the difference is night and day. By harnessing AI-driven guided discovery, plans can achieve the holy grail of member experience: make it easy for members to do the right thing. And when that happens, members, providers, and the plan all win.

Sources:

1. Kaiser Family Foundation – Medicare open enrollment review rates (Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period | KFF) (Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period | KFF)
2. CMS Rule on Unused Supplemental Benefits (Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) | CMS)
3. KFF – Prevalence of transportation benefits in MA plans (Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization | KFF)
4. RISE Health – Proactive navigation and member confusion stats (Member experience in Medicare Advantage: The power of proactive navigation) (Member experience in Medicare Advantage: The power of proactive navigation)
5. Frontiers in Digital Health – Older adults’ experience with health chatbots (Frontiers | Older adults' experience with virtual conversational agents for health data collection)
6. Journal of Medical Internet Research – Older adults’ prompt mode preferences (Subjective cognitive complaints and objective memory performance influence prompt preference for instrumental activities of daily living - PMC)
7. Master of Code (Chatbot Stats) – Consumer preferences for chatbots (BEST Chatbot Statistics for 2025 | Master of Code Global) (BEST Chatbot Statistics for 2025 | Master of Code Global)
8. Personify Health – AI chatbot personalized responses and call reduction (How to Use AI in Healthcare - Personify Health)
9. eHealthcare Strategies – Chatbot deflecting 30% of calls