Consumers turn to AI to shop for health plans during ACA open enrollment

Nearly half of healthcare consumers are turning to AI to review their health plan options, as concerns about cost and healthcare navigation loom large, according to a survey of more than 1,000 adult patients from eHealth.

November heralds the start of open enrollment season, with consumers shopping on the Affordable Care Act Marketplaces now able to select their insurance plans for 2027. At the same time, a plurality of folks covered by employer-sponsored health plans are gearing up to select which plan -- if they're given options -- they want from their employer.

This process can be difficult, with adult consumers saying it's hard to understand health plan benefit design. Indeed, 84% told the surveyors they feel like the health insurance system was intentionally designed to be confusing. Another 57% said open enrollment season is stressful, and 53% said it's as bad or worse than completing their federal taxes.

Health plan complexity stifles consumer shopping habits. Ideally, healthcare consumers would use the publicly available data on premiums, deductibles and other coverage details to compare plans to get the best value for their medical needs. But understanding those details can be so difficult that 71% of consumers choose to simply enroll in the same plan year after year. This keeps consumers from enrolling in another plan with better value if one is available.

But the cost of insurance is slated to increase next year, and that could push more consumers to shop around.

A June 2026 preliminary look at the ACA Marketplace showed that premiums in some states could rise by double digits. In the employer benefits space, analysts expect a jump of at least 9% in 2027, a cost employers will likely have to partially pass on to workers.

ACA Marketplace enrollees are feeling the pinch, with 68% saying they're worried they won't be able to afford a plan in 2027, while a third said their current plan is unaffordable.

Consumers must be able to navigate the ACA Marketplaces to find the best-value plan for their medical needs. And now, they're turning to a key tool to help them with their research: AI.

According to eHealth, 48% of American healthcare consumers have already used AI to help them review their insurance plan options. AI has the potential to help consumers compare plans, consider the nuances of certain benefits based on their medical needs and parse through dense medical jargon to get plain-language explanations of benefits.

That doesn't mean consumers will over-rely on AI. The survey showed that most consumers don't think AI can replace their doctor, and two-thirds have received incorrect medical advice from AI. A sizeable 82% think medical claims denied by AI must receive a second review from a human.

Still, health insurance companies and provider organizations should both be aware of how consumers use AI to find and select healthcare.

In September 2026, Accenture published data revealing that 62% of young members are using AI, not care navigators, to choose a health plan. Accenture said payers need to repair the trust they have with their younger members to drive engagement.

At the same time, payers and providers alike must update their online presence to ensure they are visible in AI. Because AI draws on online information, incorrect coverage details or outdated office locations could keep a payer or provider from being surfaced when consumers ask for a health plan or doctor recommendation.

Experts recommend payers and providers continue to use the same online practices they adopted when visibility on Google search became popular. Conducting regular content and reputation audits will ensure that information is accurate and up to date.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.