Health care benefits typically span a wide range of services and coverage details. But rather than presenting these elements in a unified, accessible format, they’re often siloed across multiple platforms. For instance, plan information, reimbursement forms, in-network provider searches, and approved product lists might all be found not just on different pages, but on entirely separate websites. Each may have its own login requirements, interfaces and navigation quirks, turning what should be a straightforward task into a confusing scavenger hunt.

To complicate matters further, different companies may administer various parts of a single patient’s benefits package. As a result, there’s no one-size-fits-all contact center where someone can call with questions about everything from deductible balances to prescription coverage. Patients with multiple or complex needs must spend precious time hunting down the right number to call — and then hoping they get the right answers.

This fragmented experience not only frustrates patients, but also hampers benefits advisors who are trying to help them. When patients can’t access or understand their benefits, it becomes equally difficult for the advisor to guide them effectively. Instead of being able to focus on providing insight and value, advisors get bogged down in piecing together data from multiple sources just to give a basic answer.

The result? Patients who don’t get the full value of their health care benefits and who also often give up on trying to understand them altogether.

AI technology as a difference-maker

This is where new technology can come in and make a measurable difference for both advisors and patients.

AI-powered communication tools can add clarity and cohesion to what has long been an opaque and fragmented system. By integrating intelligent systems into benefits management platforms, advisors are better equipped to provide timely, personalized support — and patients receive a smoother, more intuitive experience.

Here are a few specific areas where AI is already proving its value:

Predictive eligibility and risk stratification:Advanced AI models can identify changes in a patient’s eligibility or flag potential high-cost claims before they occur. This allows benefits advisors to intervene early, offering preventative recommendations and steering patients toward cost-effective, quality care. The result is not only cost savings but improved patient outcomes.

Decision support:Large language models (LLMs) trained on plan documents, regulatory updates, and carrier data can surface the most relevant information in real time during client interactions. Instead of digging through multiple portals or spreadsheets, advisors can focus on strategic guidance, making the conversation more helpful and efficient for everyone involved.

Claims transparency:For patients, AI can simplify one of the most confusing parts of health care: the claims process. Intelligent systems can track reimbursement timelines, flag anomalies and provide clear explanations of what’s covered and why. No more clicking through a dozen pages or calling five different phone numbers just to figure out what’s going on with a claim.

Perhaps most importantly, AI extends advisor capacity with always-available virtual assistants. These 24/7 tools can answer common questions, guide patients through form submissions, and direct them to the right resources without needing to wait on hold. This frees up human advisors to focus on higher-value work like helping patients make smarter decisions about their health.

A simpler, smarter future

Health care benefits are one of the things in life that shouldn’t be nearly as confusing as they are — viewed right up there with navigating the DMV or scrolling to the bottom of a recipe page in desperate search of measurements. But, thankfully, there’s real and scalable technology available to fix it.

AI-powered communication tools offer an immediate opportunity for health insurers, benefits advisors, and employers to rebuild trust and improve patient experiences. By simplifying access, surfacing better information faster, and offering intelligent support when and where it’s needed most, AI is poised to transform how we understand and use healthcare benefits — and that transformation can’t come soon enough.