AI-Powered Assistance and Health Equity in Medicare Advantage

Addressing Disparities Through AI-Driven Member Support

For Medicare Advantage plans, health equity remains a persistent challenge. Social determinants of health (SDOH) such as transportation access, digital literacy, food insecurity, and language barriers continue to affect how members engage with their benefits and care. While plans have expanded coverage and support services, many beneficiaries remain unaware of available resources or struggle to navigate them effectively.

GetSetUp’s Dedicated AI Assistant & AI Search offers a potential solution by using AI-driven engagement to provide culturally relevant, accessible, and proactive support. By integrating this technology, Medicare Advantage plans can reduce disparities in health literacy, improve preventive care participation, and increase benefit utilization ensuring members receive the right information when they need it. GetSetUp has spent over four 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.

Navigating Benefits: How AI Can Improve Access to Care

For example, Martha, 72, lives in a predominantly Spanish-speaking community in Texas. She has been enrolled in Medicare Advantage for several years but was unaware that her plan covered transportation to medical appointments. When she logged into her health plan’s portal, the AI Assistant greeted her with a customized prompt: “Do you need help getting to your next doctor’s visit?”

Martha typed a question in Spanish. "¿Cómo puedo llegar al médico?”

With one click, Martha discovered that she was eligible for free Uber rides to her medical appointments. The AI Assistant provided instructions in Spanish on how to schedule a ride through her plan’s transportation partner. Previously, Martha had been missing follow-up visits due to a lack of reliable transportation. With AI-driven guidance, she was able to schedule an appointment for the next week potentially preventing a worsening health condition that could have led to an emergency visit.

The Role of AI in Addressing Health Equity Challenges

Accessing and understanding health benefits remains a hurdle for many Medicare Advantage members, particularly those in underserved communities. AI-driven assistance helps close this gap by:

📌 Improving Awareness of Benefits – AI prompts highlight underutilized services like food delivery, transportation, and in-home care that members may not know they qualify for.

📌 Reducing Language Barriers – AI-powered multi-language support ensures that non-English speakers receive the same level of information and assistance.

📌 Simplifying Health Navigation – Guided AI conversations make it easier for members to schedule preventive screenings, wellness visits, and routine care.

📌 Encouraging Digital Engagement – Older adults often prefer structured prompts over free-text searches, making AI-guided experiences more user-friendly and effective.

Scaling AI to Meet Health Equity Goals

Medicare Advantage plans can customize AI-driven assistance to meet the needs of their most vulnerable members:

🎯 40+ Customizable Prompts – Plans can prioritize engagement on SDOH-related benefits, ensuring members receive relevant guidance.

🎯 Culturally Responsive AI – Multi-language capabilities and culturally sensitive prompts create a more inclusive member experience.

🎯 Seamless Integration – AI tools can be embedded into member portals and mobile apps, ensuring consistent, accessible support.

🎯 Personalized Health Equity Strategies – AI analytics provide insight into member engagement trends, helping plans refine outreach efforts.

Shifting from Reactive to Proactive Member Support

Medicare Advantage plans have an opportunity to go beyond traditional outreach models and adopt AI-driven, proactive engagement strategies. By embedding AI-powered support into digital platforms, plans can reduce disparities, improve access to care, and empower members to take full advantage of their benefits.

AI technology alone is not a complete solution for addressing health inequities, but when integrated with peer-to-peer led programming, targeted, culturally relevant outreach, it can be a powerful tool in narrowing gaps in care and improving member outcomes.

For Medicare Advantage plans looking to enhance health equity, AI-driven engagement offers a scalable, data-informed approach to breaking down barriers to care.