Artificial intelligence is rapidly moving from concept to reality across the healthcare industry. Reports show that a full 70% of healthcare organizations are already using AI[1]—from claims processing and care management to member communications and engagement. And according to a report from McKinsey, AI could generate $200–$360 billion in annual value in U.S. healthcare[2], driven by improvements in clinical decision-making, operational efficiency, and patient engagement, and adoption is accelerating.
Some of the most promising use cases are emerging in Medicare and Medicaid populations. These programs serve patients who often face the greatest barriers to care—whether due to age, income, geography, or complexity of health needs. AI has the potential to address many of these challenges by delivering more personalized health information, improving access to care, and empowering patients to take a more proactive role in managing their health.
But as with any major technological shift, success will depend on more than just capability. While plans are investing heavily in AI, they must be just as thoughtful about how they engage members—building trust, driving adoption, and ensuring these innovations actually deliver meaningful value.
Why AI can uniquely benefit Medicare and Medicaid populations
For many Medicare and Medicaid members, the healthcare experience today looks very different from the ideal.
Access to care can be inconsistent. Provider availability is often limited. Interactions with the healthcare system can feel fragmented, reactive, and difficult to navigate. These challenges contribute to well-documented disparities in health outcomes across senior and lower-income populations.
At the core, many of these issues come down to time, access, and cost. Providers are stretched thin, often unable to spend the time needed to deliver proactive, personalized guidance. Health systems and payors operate under tight budget constraints, making it difficult to scale more tailored, high-touch care models across large populations.
This is exactly where AI can make a meaningful difference. By augmenting—not replacing—human providers, AI can help extend the reach of care teams, improve access to information, and enable more proactive health management. In particular, AI is well-positioned to improve preventive care and chronic disease management—areas that have an outsized impact on Medicare and Medicaid populations.
Reducing barriers to care
One of the most immediate opportunities for AI is reducing the barriers that prevent patients from accessing care in the first place. These barriers often include time constraints, geographic limitations, administrative complexity, and cost pressures.
AI-powered tools can help address each of these challenges. Virtual assistants and AI-driven chat tools can provide 24/7 access to basic health information, helping members get answers without waiting for appointments or navigating call centers. Intelligent systems also can help patients schedule appointments, understand benefits, and navigate prior authorization requirements—areas that are often confusing and time-consuming.
Rather than replacing human providers, these tools serve as an extension of care teams—helping ensure that patients can access the right information and support at the right time, while allowing clinicians to focus on higher-value interactions.
Smarter health monitoring and earlier intervention
AI is also transforming how health plans and providers monitor patient health. With the growing adoption of wearable devices and connected health technologies, patients are generating continuous streams of health data. AI can analyze this data in real time, identifying patterns and surfacing early warning signs that might otherwise go unnoticed.
For Medicare and Medicaid populations—where chronic conditions are more prevalent—this capability is especially powerful. AI-enabled monitoring can help detect changes in blood glucose levels, weight, heart rate, and other key indicators. These insights can trigger early interventions, helping to prevent complications, reduce hospitalizations, and improve overall outcomes.
In many cases, this also enables more effective remote care, allowing patients to receive support and guidance without needing to visit a provider in person.
Democratizing hyper-personalized healthcare
Historically, highly personalized healthcare has been difficult to deliver at scale. Providing tailored guidance based on each patient’s unique health history, lifestyle, and risk factors requires time and resources that most healthcare systems simply don’t have.
AI changes that equation. By analyzing large volumes of data—from medical records to behavioral patterns—AI can generate personalized insights and recommendations for individual patients. This can include everything from medication reminders and preventive care suggestions to lifestyle coaching and condition-specific guidance.
For Medicare and Medicaid members, this means access to a level of personalized support that was previously out of reach. Instead of one-size-fits-all communications, patients can receive information that is directly relevant to their circumstances—helping them better understand their health and make more informed decisions.
Empowering self-managed health
One of the most transformative aspects of AI is its ability to empower patients to take a more active role in their own health. By delivering timely, personalized insights, AI can help shift healthcare from a reactive model—where patients seek care after issues arise—to a more proactive, preventive approach.
Patients can receive reminders for screenings, alerts about potential health risks, and guidance to manage chronic conditions. Over time, this can help build healthier habits, improve adherence to treatment plans, and reduce the progression of disease.
For populations that have historically faced barriers to consistent care, this kind of empowerment can have a significant impact on long-term outcomes.
Expanding access to leading-edge medicine
AI also has the potential to improve access to the latest medical knowledge and treatment approaches. Healthcare providers constantly are balancing a growing body of research, new treatment options, and evolving clinical guidelines. Staying fully up to date can be challenging—especially in high-volume care environments.
AI tools can support providers by surfacing relevant research, identifying emerging best practices, and recommending evidence-based treatment options. This can help reduce reliance on status quo approaches and ensure that patients—regardless of geography or income—have access to more advanced and effective care options.
Why member trust matters as much as AI capability
Despite its potential, AI will only deliver value if members trust it enough to use it. We are already seeing this dynamic play out across industries. Organizations are investing heavily in AI tools, but adoption often lags because users are hesitant to rely on outputs they don’t fully understand or trust.
In healthcare, this challenge is even more pronounced. Just as even the best clinical recommendations are ineffective if patients don’t follow them, AI-driven insights will only matter if patients are willing to engage with them.
This is particularly relevant for Medicare and Medicaid populations. Older members often have lower comfort levels with new technologies, while both senior and lower-income populations may have lower trust in institutions and systems. At the same time, these groups often place a higher value on human relationships and personal interaction.
Without trust, even the most advanced AI capabilities will fall short of their potential.
Building trust through thoughtful member engagement
For health plans, building trust in AI requires a deliberate and strategic approach to member engagement.
First, plans need to clearly communicate how AI is being used—and, more importantly, how it benefits the member. Messaging should focus on outcomes such as improved access, faster answers, and more personalized support—not just efficiency or cost savings.
Second, engagement must be ongoing and tailored to the member. Trust and familiarity with AI vary widely across populations, so communication strategies must be flexible and multi-channel. Some members may prefer digital education through apps or portals, while others may require more traditional outreach through print or phone.
Finally, health plans must navigate a growing and evolving regulatory landscape. As regulatory bodies continue to define requirements around AI transparency and disclosure, health plans will need to ensure their communications meet these standards while still delivering clear, meaningful messages to members.
New disclosure requirements will add layers of complexity to this trust-building challenge. Regulators still are catching up, but we’ll soon see a growing wave of requirements around how health plans must disclose their AI utilization. Health plans will need to ensure their communications meet these standards while still delivering clear, meaningful messages to members.
And while building trust in AI will require a heavy lift at the outset, it will remain a critical, ongoing process. As AI continually plays a larger and more complex role in healthcare, health plans will continually need to tell a clear, compelling “how and why” story to members.
How Toppan Merrill can help
Bringing the promise of AI into healthcare is a trust problem as much as a technology problem. It requires the ability to engage members effectively, build trust, and deliver the right message through the right channel.
Toppan Merrill helps health plans navigate this complexity by combining deep expertise in healthcare communications with advanced omnichannel capabilities. We help design and execute member engagement strategies that educate members on new technologies, support regulatory compliance, and ensure communications reach each member in the way they prefer.
From traditional print and mail to digital channels and emerging AI-enabled experiences, Toppan Merrill provides the tools and expertise needed to deliver consistent, personalized, and effective member communications. The result: stronger member trust, higher engagement, and better outcomes—across every population you serve.
Learn more about Toppan Merrill Health Plans Member Communications
[1] https://www.nvidia.com/content/dam/en-zz/Solutions/lp/survey-report/healthcare-state-of-ai-report-2026-4559650-web.pdf
[2] https://www.mckinsey.com/industries/healthcare/our-insights/digital-transformation-health-systems-investment-priorities?utm
