CMS Plans AI Agents to Help Medicare Beneficiaries Navigate Care

CMS Administrator Dr. Mehmet Oz said the agency aims to introduce AI-powered tools that can guide seniors through healthcare decisions and simplify how they interact with Medicare services.

The Centers for Medicare & Medicaid Services (CMS) is exploring the deployment of artificial intelligence agents to help Medicare beneficiaries navigate healthcare services, including finding physicians and selecting Medicare Advantage plans, agency officials said during a discussion at the HIMSS Global Health Conference & Exhibition.

CMS Administrator Dr. Mehmet Oz said the agency aims to introduce AI-powered tools that can guide seniors through healthcare decisions and simplify how they interact with Medicare services.

“The fundamental problem right now is that other sectors of the U.S. economy have advanced and been deflationary with their use of technology,” Oz said during the panel. “Healthcare has remained inflationary.”

According to Oz, the agency hopes to make AI agents available to Medicare beneficiaries before the end of the current administration. These tools would act autonomously to assist users in tasks such as identifying physicians or evaluating Medicare Advantage coverage options.

However, trust in artificial intelligence among older adults remains a significant barrier. A survey published by Kaiser Family Foundation found that only 31% of Medicare enrollees aged 65 and older trust AI “a great deal” or “a fair amount” to access medical records and provide personalized health advice.

“No one has gotten to them with the use case of why it’ll transform their life for the better,” Oz said.

The proposed tools are part of the CMS Health Tech Ecosystem initiative, which seeks to expand digital health capabilities and improve healthcare data exchange through collaborations with technology companies. Amy Gleason, acting administrator of the U.S. DOGE Service and senior advisor to CMS, said the initiative also aims to expand access to conversational AI systems that can help patients understand healthcare information and navigate care decisions.

Technology companies participating in the ecosystem have begun introducing health-focused AI tools. OpenAI launched a consumer health chatbot earlier this year, while Microsoft recently announced a healthcare-focused assistant called Copilot Health.

Experts note that AI chatbots may also present risks if they provide incorrect or misleading medical guidance. Research published last month examining OpenAI’s consumer health chatbot found that the system sometimes undertriaged cases, failing to direct users to emergency care for serious conditions.

CMS officials acknowledged such risks but said the technology could still play a role in improving patient access to healthcare information.

In addition to patient-facing tools, the agency is already applying AI to administrative functions such as fraud detection. Kimberly Brandt, CMS chief operating officer and deputy administrator, said the agency is using algorithms trained on historical enforcement cases to identify potentially fraudulent providers enrolling in Medicare.

The agency has also taken recent enforcement actions tied to suspected fraud, including halting $259 million in Medicaid payments to providers in Minnesota and imposing a six-month moratorium on Medicare enrollment for certain durable medical equipment suppliers.

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