Platform Feature
AI Plan Intelligence
MedicareCopilot uses a 12-factor AI scoring engine with natural language processing (NLP) to analyze every available Medicare plan against a client's medications, providers, budget, and health needs — then ranks the best options with plain-language explanations you can use in the appointment.
How It Works
From client intake to ranked recommendation — in under 60 seconds. Here's what happens behind the scenes when you run a plan comparison.
Enter client details
Add the client's medications, preferred providers, pharmacy, budget range, and any health conditions or coverage priorities.
AI scores every plan
The engine evaluates every available MAPD, PDP, Supplement, and Ancillary plan across 12 weighted factors using carrier-accurate data from ConnectureDRX.
NLP analyzes benefits
Natural language processing reads plan documents to surface specific benefits — transportation, meal delivery, OTC allowances — that keyword search alone would miss.
Ranked results with talking points
You get a ranked shortlist with plain-language explanations for why each plan scored the way it did — ready to present to the client during the appointment.
12-Factor Plan Scoring
Every plan is scored across 12 weighted factors that reflect what actually matters to Medicare beneficiaries — not just premium price.
Monthly premium
Total monthly cost including Part B give-back credits where applicable.
Drug coverage
Formulary tier placement, copay amounts, and coverage gap costs for the client's specific medications.
Provider network
Whether the client's preferred doctors, specialists, and facilities are in-network.
Pharmacy access
Preferred pharmacy status, mail-order options, and 90-day fill availability.
Max out-of-pocket
Annual maximum out-of-pocket exposure for in-network and out-of-network services.
Star rating
CMS quality star ratings reflecting plan performance in health outcomes, member experience, and complaints.
Vision benefits
Coverage for routine eye exams, eyeglasses, contact lenses, and annual allowances.
Dental benefits
Preventive, comprehensive, and major dental coverage including annual benefit maximums.
Hearing benefits
Hearing exam coverage, hearing aid allowances, and fitting and follow-up visit benefits.
Supplemental benefits
OTC allowances, meal delivery, transportation assistance, fitness programs, and telehealth access.
Transportation
Non-emergency medical transportation trips, ride limits, and covered destinations.
Specialist & hospital costs
Copays for specialist visits, inpatient hospital stays, and outpatient surgery costs.
NLP Benefit Analysis
Plan documents are dense. A single Summary of Benefits can run 50+ pages. MedicareCopilot's natural language processing reads these documents and extracts the specific details that matter to each client.
Instead of agents manually scanning PDFs for a transportation benefit or a grocery delivery allowance, the AI surfaces it automatically — and explains it in plain language the client can understand.
Reads full Summary of Benefits and Evidence of Coverage documents
Surfaces supplemental benefits that keyword search misses
Generates plain-language explanations for client conversations
Compares current plan vs. alternatives side by side
Identifies C-SNP and D-SNP eligibility based on health conditions
Powered by ConnectureDRX Plan Data
MedicareCopilot's AI runs on carrier-accurate plan, formulary, and provider network data from ConnectureDRX — the same data source used by major carriers and CMS. Every recommendation is grounded in verified, up-to-date plan information — not scraped or estimated data.
MAPD
Medicare Advantage with prescription drug plans
PDP
Standalone Part D prescription drug plans
MedSupp
Medicare Supplement (Medigap) plans
What You See After Running a Comparison
Every plan comparison gives you actionable output — not raw data. Here's what you get for each client.
Ranked plan list
Plans ordered by overall score, with the best match at the top. Each plan shows the composite score across all 12 factors so you can see exactly why it ranked where it did.
Side-by-side comparison
Compare two or more plans head to head across every scoring factor. See where each plan excels and where it falls short — including drug costs, provider coverage, and supplemental benefits.
Plain-language talking points
AI-generated explanations written in language your client will understand. Use them during appointments to explain why a specific plan is the best fit — without reading from a carrier brochure.
Saved to client record
Every comparison is automatically saved to the client's CRM record — inputs used, plans scored, and the recommendation presented. See CRM & Client Management for how records are organized.
Frequently Asked Questions About AI Plan Intelligence
See the AI in Action
Watch a live plan comparison or schedule a demo to see how MedicareCopilot's AI finds the best plan for your client in under 60 seconds.