In 2024, 32.8 million U.S. adults received their health insurance coverage through a Medicare Advantage plan from a private insurance carrier. For each of these Medicare-eligible individuals—who are over 65 or live with disability—it’s vital to pick a plan that fits their unique healthcare needs and financial situation.
As a leading health insurance marketplace that’s served more than 10 million Medicare consumers, GoHealth strives to ensure everyone has the peace of mind that comes with reliable, affordable coverage. That’s why the company has rolled out a suite of technology solutions for easier shopping and enrollment.
GoHealth’s PlanFit technology makes finding the right plan a more efficient process, equipping licensed insurance agents to provide knowledgeable guidance and personalized recommendations in moments. This proprietary tool instantly hones in on the plan features that matter most to each individual so they can make the best choice for their needs.
“The complexities of the Medicare landscape demand continual innovation,” said GoHealth Chief Technology Officer Wayne Young. “PlanFit technology is one of the most powerful tools we have to expedite and simplify the consumer experience, empowering our agents to identify the best possible coverage in a rapidly evolving market.”
Here’s how PlanFit technology brings ease and efficiency to Medicare Advantage enrollment for both consumers and agents.
A High-Stakes Choice in a Complex Market
Medicare Advantage plans (also called Medicare Part C) substitute for health insurance coverage from the federally administered Original Medicare program (also called Medicare Part A and Part B). In 2025, the average enrollee could choose among 43 plans offered by private insurance carriers in their ZIP code.
All these plans must at least match the hospital and medical coverage provided by Original Medicare. However, once you delve into the details, there’s a wide range of differences.
- Costs: Some plans charge monthly premiums on top of the standard Medicare Part B premium. Deductibles, coinsurance, and copays vary by plan.
- Out-of-pocket maximum: Unlike Original Medicare, Medicare Advantage plans are required to set a limit on annual out-of-pocket costs. Federal rules establish the highest possible maximum, but the precise amount depends on the plan.
- Provider networks: To get the most out of their benefits, people on Medicare Advantage plans must visit doctors, hospitals, and pharmacies that are in their provider network. Each plan has its own network of local providers.
- Additional benefits: Plans may feature an array of benefits that aren’t included in Original Medicare, such as Medicare Part D prescription drug coverage, dental, vision, and hearing. The level of coverage and associated costs depend on the plan.
Even when consumers weigh their options carefully and find a plan that works for them, that’s not the end of the story. Every year, economic conditions and regulations can bring changes to the Medicare Advantage market that affect costs and benefits. New plans may become available in a certain ZIP code while others exit.
In 2024 for example, the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers these public insurance programs, announced decreases in payments to Medicare Advantage plan carriers. The insurance companies discontinued certain plans and more than 1.8 million consumers needed to change their coverage or go back to Original Medicare.
For consumers, navigating this complex market on their own is often confusing and frustrating. That’s where PlanFit technology and a licensed insurance agent come in.
From Dozens of Options to One
GoHealth’s PlanFit technology allows licensed insurance agents to connect consumers with the best plan for their needs quickly.
“PlanFit cuts through the noise to find the plans that are most likely to be the right fit,” Lead Machine Learning Engineer Sanjay Sharma explained. “It’s a much faster and more natural way to sort through options.”
The PlanFit platform makes recommendations based on analytics from millions of consumer interactions, narrowing down dozens of possibilities to the top five. These suggestions account for data from individual plans, the market, and the consumer preferences expressed in a needs assessment. That means agents can quickly drill down on individual needs in categories like monthly costs, coverage for a prescription medication, or a provider network that includes their preferred doctor.
During the 2024 Annual Enrollment Period (Oct. 15-Dec. 7), 66% of the more than 481,000 people who joined plans through GoHealth mentioned at least one prescription medication they took regularly. Over 81% gave the name of a doctor they wanted to see. Just these two pieces of information are often sufficient to rule out many of the available plans so the platform can provide finely tuned recommendations.
The rankings include Special Needs Plans (SNPs), Medicare Advantage plans created for specific populations. SNPs must offer Part D prescription drug coverage as well as coordinated healthcare services, and they can also feature a range of additional benefits. Based on their personal situations and local plan availability, consumers may be able to enroll in a:
- Dual Eligible Special Needs Plan (D-SNP): For Medicare enrollees with low incomes who qualify for the Medicaid programs in their states.
- Chronic Condition Special Needs Plan (C-SNP): For people with a certain type of chronic condition such as heart disease, diabetes, or kidney disease.
- Institutional Special Needs Plan (I-SNP): For individuals who need the level of care provided in a facility like a nursing home, skilled nursing facility, or psychiatric hospital.
PlanFit helps to determine whether a SNP is the right choice, including in cases where someone qualifies for more than one of these plan types. For 78% of eligible enrollees, a C-SNP appeared in their top three PlanFit recommendations.
GoHealth’s goal is to not just enroll consumers in one of these plans, but to ensure they have coverage that will serve them well throughout the coming year. 62% of the enrollees who used GoHealth signed up for a plan ranked in the top three, and those who do are more likely to stay on their new plan for at least the next 90 days.
“90-day retention tracks with the PlanFit rank,” Sharma said. “As we make improvements to our model, plan submissions from the top three or the top five become more common.”
GoHealth incentivizes agents to always provide the best advice based on a PlanFit analysis, whether that means a consumer switches to a new plan or sticks with the coverage they already have. The agent explains consumers’ options but never pressures them.
The Value of a PlanFit CheckUp
The PlanFit platform integrates with other GoHealth technology and processes to bring consumers the information they need to make the best choices for their healthcare. For example, PlanGPT employs a large language model to quickly summarize details from plan documentation, answering in-depth questions about up to three plans at a time. Bringing together multiple advanced, proprietary tools empowers agents to guide consumers through their options with speed and accuracy.
GoHealth encourages consumers to take advantage of these resources not just once, but every year. There may be new plans available in their area, and their existing coverage can go through changes: Doctors sometimes leave a plan’s provider network, the costs of a prescription may go up, or the coverage available for a specific benefit may be reduced.
PlanFit technology makes it easier for consumers to keep up with these changes. A yearly PlanFit CheckUp during the Annual Enrollment Period is a simple, efficient way to find out whether their current plan is still the best one for their needs.
“PlanFit has not only sped up the enrollment process but transformed the consumer experience,” GoHealth Vice President of Operations and Strategy Connor Sea said. “This tool is integral to meeting our commitment to leverage best-in-class technology to deliver peace of mind for Medicare enrollees.”
Sources
Medicare Advantage in 2024: Enrollment Update and Key Trends. KFF.
Medicare Advantage 2025 Spotlight: A First Look at Plan Offerings. KFF.
Changes in store for Medicare Advantage as open enrollment starts. CNN.
