Medicare, Medicaid, CMS, coverage

Medicare, Medicaid, CMS, coverage

About 64 million Americans will be enrolled in Medicare by 2021, according to the Centers for Medicare & Medicaid Services. But about 70% of people on Medicare don’t compare their plans during open enrollment, Kaiser Family Foundation found. The process is confusing and slow, making it difficult for seniors to enroll, said Dave Francis, CEO of the insurance company Healthpilot.

“The way people get insurance today is stuck in 1975,” Francis said. “They either have to have someone come to their house and sit at the kitchen table across from them and offer them a small selection of plans from a small selection of insurance companies. Or they’re on the phone with someone who’s very sales-oriented, and they’re getting a lot of information thrown at them over the phone.”

Based in Nashville Healthpilot, which acts as an insurance broker and was founded in 2021, is trying to simplify this process through its AI-driven platform. Users can go to its website and enter their location, doctors, prescriptions, pharmacies and the benefits they want. Healthpilot’s AI will then provide the plan from the insurance carrier it thinks best meets that person’s needs. Users can then sign up from the website if they feel comfortable with the proposed plan. It also provides a number to call if the user has questions and wants to speak directly to a person.

Healthpilot’s AI uses data from anonymized medical records of about 2 million patients, Francis said. It takes the customer’s information and compares it to a group of similar patients to determine what the customer’s health usage will look like.

“Based on that prospective customer’s usage profile — knowing who their doctors are, what medications they take, what pharmacy they go to — allows us to go into their specific regional market and say, ‘This is the best plan for you . ‘”

The company also contacts each year to confirm whether consumers are still on the best plan for them, Francis said.

“We have all your information so we can help you every year and reach out to you and say, ‘Hey, you’re still in the best plan for you. You don’t have to worry about anything, just renew.” … Or “Hey, we see you’re seeing a new doctor or taking a new drug and that Humana plan you were on last year isn’t right for you now, but here’s another plan of Humana that works best for you,” Francis said.

For its services, Healthpilot then receives a commission from the insurance companies that enroll its users. The first year someone signs up, the startup gets about a $500 commission and then $250 to $300 each year when the customer renews the plan, Francis said. Users do not have to pay for Healthpilot services.

To help customers get the word out about their company, Healthpilot works with financial advisory firms such as UBS, BlackRock and Charles Schwab. These businesses send an email link to their pensioner customers and direct them to the Healthpilot website. In return, the company tells the financial advisor what Medicare plan the customer has chosen so it can be included in their financial plan. Healthpilot has worked with about 20,000 retirees through that process, Francis said.

Other insurance brokerage companies include GoHealth, Select Quote and AmeriLife. But Francis said Healthpilot differentiates itself from traditional brokers by digitizing the process and using an AI platform to compare plans.

Francis added that the company hopes to go beyond insurance in the future, such as helping consumers with annual health screenings, medications and nutrition.

“Eventually, [wellness] it starts with health insurance, but there’s so much more because we’ve established that relationship with the customer, we can communicate with them and engage with them,” he said.

Photo: Vadzim Kushniarou, Getty Images

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