AI-powered clarity for answers that matter most in Medicare
The Broker Assistant delivers instant answers on costs, coverage, and care, empowering brokers to guide members with confidence. Its success informed enhancements now being developed for the clinician-facing Clover Assistant, extending clarity across the care journey.
What this technology unlocks at scale
The success of the Broker Assistant prototype established a clear path for broader AI adoption at Clover Health. Early signals show that when instant, trustworthy answers are available at every touchpoint, the entire enrollment and care journey becomes more aligned, efficient, and human.
Hours saved annually
If rolled out to 300–400 active brokers, the assistant could free more than 20,000 hours each year by reducing manual research and back-and-forth clarification.
More time for patients
Cutting lookup time for physicians by 25 to 40 percent shifts minutes back to the patient conversation, strengthening trust and care quality.
Fewer support calls
Targeting a core broker workflow positions Clover to achieve meaningful reductions in call volume and handle time, exceeding typical early-AI benchmarks reported across the industry.
Fragmented information creates friction in Medicare conversations
Medicare decisions are complex, scattered across formularies, provider files, benefit documents, and internal knowledge sources. Brokers often rely on escalation paths, manual searches, or outdated PDFs when members ask critical questions about medications, doctors, or costs.
This slows conversations, breaks trust, and forces brokers into the role of middleman instead of trusted advisor.
What brokers were up against:
Multiple systems needed to answer a single member question
Coverage rules and pricing varying across county, plan and drug tier
High-stakes questions requiring fast, accurate responses
A regulatory environment where incorrect guidance carries real risk
From a simple prototype to a tool that transforms every Medicare conversation
What began as an experiment in natural language understanding quickly revealed something bigger. The real opportunity was not only helping members find answers but empowering the people who guide them. Brokers shape nearly every enrollment decision, and when they gain instant clarity, everything about the conversation improves.
For brokers
When brokers get instant clarity, members feel it. Questions are answered without delay, guidance feels more personal, and choosing a plan becomes a smoother, more confident experience.
Beyond brokers
The prototype’s success sparked enhancements for Clover Health’s clinician tools, extending the same trusted information into physician visits so everyone involved in care stays aligned, informed and fully supported.
How the Broker Assistant delivers answers brokers can rely on
Medication Cost & Coverage
Instant clarity on prescriptions, including accurate pricing, rules, restrictions, and retail or mail-order options in seconds.
Provider Lookup
Find the right doctor - existing or new - with one question. Confirm network status, validate location, and view visit costs instantly.
Service & Procedure Costs
Clear pricing for routine or unexpected care. No jargon, no spreadsheets; just straight answers.
Plan Benefits & Extras
From OTC allowances to supplemental perks, members get a full picture of their plan’s extras in moments.
When everyone stays informed, the whole journey improves
When answers surface instantly and consistently, brokers, members, and physicians stay aligned. The entire enrollment journey becomes clearer, faster, and more human.
Confident guidance without delay
No more escalations or waiting on siloed data. Brokers stay present with members and lead each conversation with clarity.
Decisions that feel informed and personal
Accurate costs, coverage rules, and provider details give members confidence in choices that shape their health and financial wellbeing.
Real-time coverage insight at point of care
The same medication and visit cost clarity is now being used to help physicians guide treatment decisions that fit each patient’s needs and budget.
What makes the Broker Assistant work
The Broker Assistant is powered by an AI architecture designed to handle the real complexity of Medicare decisions. It interprets natural questions, retrieves information from multiple internal sources, and synthesizes the results into clear, trustworthy answers.
Speed without compromise
Answers arrive in seconds, not minutes or hours of searching.
Accuracy you can trust
Built on current Clover data with validation checks at every step.
Clarity in plain language
Complex Medicare rules explained simply, without jargon or confusion.
Sources always visible
See where each answer comes from and how it was determined.
Early Impact
Early insights from Clover Health teams showed how the Broker Assistant immediately elevated the pace and quality of enrollment conversations.
"The tool excels at delivering clearer benefit information and providing accurate copayments for confident responses."
"We now have a roadmap for broker pilots and metrics, such as time savings and member satisfaction."
"I see the value in fewer back-and-forth calls and more self-service—not just shaving seconds off a workflow, but making the whole experience smoother.”
What it means for the people navigating care
Healthcare choices shape the quality of our daily lives. Yet these decisions are often made under stress, with incomplete information, with limited time - and a lot of back-and-forth.
By giving people and their trusted advisors instant clarity, we reduce friction and restore confidence. Members feel grounded. Brokers feel equipped. Physicians feel aligned.
And ultimately, it protects what matters most: a person’s health, dignity, and peace of mind.
Created by Clover Health in collaboration with BlueLabel.
Prototype design, development, and experimentation conducted by BlueLabel’s AI innovation team.