AI Tools for Medicare Experience Modernization - Request for Information
Overview
Buyer
Place of Performance
NAICS
PSC
Set Aside
Original Source
Timeline
Qualification Details
Fit reasons
- NAICS alignment with historical contract wins in similar service areas.
- Scope strongly matches core technical capabilities and delivery model.
Risks
- Past performance thresholds may require one additional teaming partner.
- Potential clarification needed on staffing minimums before bid/no-bid.
Next steps
Validate eligibility requirements, assign capture owner, and schedule partner outreach to confirm teaming strategy before submission planning.
Quick Summary
The Centers for Medicare and Medicaid Services (CMS), under the Department of Health and Human Services, has issued a Request for Information (RFI) titled "AI Tools for Medicare Experience Modernization." This RFI seeks information on artificial intelligence (AI) and machine learning (ML) platforms and services to enhance the Medicare experience for beneficiaries across digital and voice channels. Responses are due by March 31, 2026.
Purpose & Scope
CMS is interested in solutions that can provide personalized plan recommendations, conversational AI support, predictive analytics, accessible decision support tools, and call center automation. The goal is to help Medicare beneficiaries make informed plan choices and maximize their coverage. Key areas of interest include personalized, claims-informed plan recommendations; real-time conversational AI support (chatbots, virtual assistants); predictive analytics for plan matching; translation of complex plan information; automation of routine call center inquiries; AI-powered call quality assurance; generation of insights on beneficiary preferences; and seamless experiences across Medicare.gov, Plan Finder, and 1-800-MEDICARE.
Information Requested from Vendors
Respondents are asked to provide details across several categories:
- Organizational Overview & Market Readiness: Company profile, deployment evidence, financial stability, industry experience.
- AI/ML Platform Capabilities: Core capabilities, experience with Medicare plan selection, NLP, predictive analytics, explainability, bias detection, call center AI.
- Medicare and Government Experience: Experience with Medicare/Medicaid, enrollment volume, understanding of Medicare structures and regulations, work with vulnerable populations.
- Technical Architecture and Integration: Cloud deployment, integration with CMS data, API standards, data security, scalability.
- Privacy, Security, and Compliance: HIPAA compliance, privacy-preserving techniques, FedRAMP status, FISMA experience, PHI/PII handling.
- Accessibility and Usability: Section 508/WCAG compliance, assistive technologies, multilingual support, plain language features.
- Model Development and Maintenance: Approach to training, validation, continuous improvement, monitoring, and handling model drift.
- Fairness, Bias, and Equity: Approach to testing for bias, ensuring equitable outcomes, and addressing health disparities.
- Claims-Informed Personalization & Data Integration: Leveraging Medicare claims data, consent mechanisms, privacy-enhancing technologies.
- Call Center Capabilities: Voice automation, AI call intelligence, CSR assist tools, agentic voice advisors.
- Implementation Approach: Methodology, timeline, training, data integration, risk mitigation.
- Cost and Pricing Structure: Pricing models, cost drivers, implementation and operational costs (Rough Order of Magnitude - ROM).
- References and Past Performance: Relevant projects, customer references, demonstrated outcomes.
Submission Details
Responses are due by March 31, 2026. Submissions should be in PDF format and emailed to aaron.blackshire@cms.hhs.gov and matthew.wendel@cms.hhs.gov. Narrative responses, including supplemental attachments, have a page limit of 20 pages.
Important Notes
This is an RFI only and not a solicitation for proposals. It does not commit CMS to award a contract now or in the future. Responses will inform market research and future procurement development. CMS will not reimburse costs associated with RFI responses.