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AI Tools for Health Insurance Specialists
AI tools that help health insurance specialists research plan options, verify drug coverage, compare benefits, track healthcare regulations, and educate clients on their coverage choices.
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Aetna MA-PD (5 stars)
$0 premium · $5,900 MOOP · Part D included · strong cardiology network
UnitedHealthcare MA-PD
$0 premium · $6,700 MOOP · OTC benefit $50/qtr · broad network
Humana MA-PD
$0 premium · $5,200 MOOP · gym benefit included
Diabetes Coverage
All 3 cover Ozempic at Tier 3 · prior auth required for Mounjaro
Recommendation
Aetna for established cardiologist access · Humana for lowest MOOP risk
Health plan cost comparison
Model total annual cost of care for different plan options based on a client's expected utilization. Compare premiums, deductibles, copays, and out-of-pocket maximums to find the right fit.
Compare total cost of care for a client who visits a primary care doctor 4 times, a specialist 2 times, and fills 3 prescriptions monthly. Plan A: $350/mo premium, $1,500 deductible. Plan B: $180/mo premium, $4,500 deductible with HSA.
Scenario analysis: Plan A total annual cost (moderate use): $6,840 (premium + estimated out-of-pocket). Plan B with HSA: $5,460 (premium + OOP, assuming max HSA contribution offsets tax). Plan B better if client can fund HSA; Plan A better if high utilization year expected. Break-even at 6 specialist visits.
ToolRouter calculate
Plan A (PPO $350/mo)
Plan B (HDHP+HSA $180/mo)
Drug coverage and formulary research
Look up FDA drug information, formulary tier status, generic alternatives, and prior authorization requirements for medications clients need. Help clients understand coverage before they enroll.
My client takes Eliquis, Jardiance, and Humira daily. Look up the FDA drug information, typical Part D formulary tier placement, and whether generics exist for each.
Eliquis: Tier 3 most plans, no generic available (patent through 2028). Jardiance: Tier 3, generic empagliflozin available in some formularies. Humira: Tier 5 (specialty), biosimilars (Hadlima, Hyrimoz) now on Tier 3–4 in many plans. Annual cost difference with biosimilar switch: ~$4,200–$8,000.
ToolRouter get_drug_info
Eliquis
Tier 3 most plans · no generic (patent 2028) · ~$4,800/yr
Jardiance
Tier 3 · generic empagliflozin available at Tier 2 in some formularies
Humira
Tier 5 specialty · biosimilars (Hadlima, Hyrimoz) now Tier 3–4
Biosimilar Savings
Humira → biosimilar switch saves ~$4,200–$8,000/yr
Medicare enrollment research
Research Medicare enrollment windows, plan types, Part D penalty rules, and supplement vs. Medicare Advantage trade-offs. Help clients approaching 65 make well-informed Medicare decisions.
My client is turning 65 in 3 months and still has employer coverage through a company with 8 employees. Explain their Medicare enrollment obligations and late enrollment penalty risk.
Critical: with employer group of fewer than 20 employees, employer plan is secondary to Medicare. Client must enroll in Medicare Part A and B at 65 to avoid late enrollment penalties (10% premium surcharge per year delayed, permanent). Initial Enrollment Period opens 3 months before 65th birthday. Action needed immediately.
ToolRouter research
CRITICAL
Employer <20 employees = Medicare is PRIMARY — must enroll at 65
Late Enrollment Penalty
10% Part B surcharge per year delayed — PERMANENT
Initial Enrollment Period
Opens 3 months before 65th birthday — act immediately
Action Required
Enroll Part A and B within IEP to avoid penalty
ACA and regulatory update monitoring
Track CMS rule changes, ACA marketplace updates, subsidy changes, and state insurance department bulletins that affect plan availability, premiums, and client eligibility.
Summarize the major ACA marketplace changes for 2026 open enrollment, including subsidy rule changes and new plan requirements.
Key 2026 ACA changes: Enhanced APTC subsidies extended through IRA provisions. New standardized plan designs required in 12 additional states. Mental health parity enforcement rules strengthened — all plans must cover mental health and SUD at parity with medical. Silver plan CSR changes in 8 states.
ToolRouter search_actions
ChangeStatusEffective
Enhanced APTC subsidies extended (IRA)ConfirmedJan 2026
Standardized plans required in 12 more statesFinal RuleJan 2026
Mental health parity enforcement strengthenedFinal RuleJan 2026
Silver plan CSR changes — 8 statesPendingTBD
Source: CMS.gov · Final Rule Oct 2025
Clinical trial research for uninsured treatments
Help clients with complex conditions find clinical trials that may provide access to cutting-edge treatments, often at no cost. Research trial eligibility and locations.
Find recruiting clinical trials for a 58-year-old with early-stage non-small cell lung cancer in the Los Angeles, CA area. She is interested in immunotherapy trials.
Found 14 recruiting trials in LA County: 6 immunotherapy trials at UCLA, Cedars-Sinai, and City of Hope. Top match: Phase III pembrolizumab combination trial at UCLA (NCT04851458) — pays travel, no cost for treatment. 3 trials offer remote monitoring options. Eligibility criteria listed for each.
ToolRouter search_trials
Phase III · UCLA (NCT04851458)
Pembrolizumab combo · pays travel · no treatment cost
Phase II · Cedars-Sinai
Novel checkpoint inhibitor · recruiting early-stage NSCLC
Phase III · City of Hope
Atezolizumab + chemo · remote monitoring option
Eligibility
Early-stage NSCLC · no prior immunotherapy · ages 40–75
Group benefits benchmarking
Research employer group health plan trends, contribution strategies, and benefit design benchmarks for small to mid-size employers. Help business owners design competitive benefits packages.
What are the current benchmarks for employer health insurance contribution rates for small businesses (25–50 employees)? What percentage of premium do most employers cover?
Small employer benchmarks (2025): Average employer contribution 71% of single coverage premium, 44% of family. Median monthly employer contribution: $621 single, $1,432 family. Trend: 64% of small employers now offering HRA or HSA alongside HDHP to manage costs. ACA SHOP average premiums by state also compiled.
ToolRouter research
Employer Contribution (Single)
Average 71% of premium · median $621/month
Employer Contribution (Family)
Average 44% of premium · median $1,432/month
HDHP + HSA Trend
64% of small employers now offering HDHP + HRA/HSA
ACA SHOP
Average premiums compiled by state — available on request
Ready-to-use prompts
Medicare plan comparison
Research and compare Medicare Supplement (Medigap) Plan G and Plan N for a 66-year-old in good health in Florida. Include premium ranges, coverage differences, and which is better for different health use scenarios.
Drug formulary lookup
Look up FDA information and typical insurance formulary tier placement for Wegovy, Ozempic, and Mounjaro. Are these typically covered under commercial insurance or Medicare Part D?
HDHP vs PPO cost model
Calculate total annual cost of care for a family of 4 under two plans: Plan A (PPO, $720/month premium, $2,000 family deductible, $7,000 OOP max) vs Plan B (HDHP, $420/month, $5,000 deductible, $12,000 OOP max, HSA eligible). Assume average utilization.
ACA subsidy research
Research the 2026 ACA premium tax credit calculation for a family of 3 with a household income of $72,000 in Colorado. What silver plan premium would they pay after subsidy?
Medicare late enrollment penalties
Explain the Medicare Part B and Part D late enrollment penalties, how they are calculated, and what circumstances allow a Special Enrollment Period to avoid penalties.
Cancer clinical trials
Find recruiting clinical trials for Stage II breast cancer patients in the Chicago, IL metro area. Focus on trials offering novel targeted therapies or immunotherapy.
ACA regulatory updates
Summarize CMS rule changes affecting health insurance marketplace plans for the 2026 plan year, including essential health benefit requirements and network adequacy standards.
Group benefits benchmarks
Research benchmark contribution rates and plan design trends for employer-sponsored health insurance in the technology industry for companies with 50–200 employees.
Tools to power your best work
Deep ResearchAI research reports with citations
Drug InformationDrug info: recalls & side effects
Regulatory ActionsSEC, CFPB, FDIC & Federal Register
Financial CalculatorDCF, bonds, options & portfolios
Clinical TrialsClinical trials & drug safety data
NewsSearch and track news worldwide
Economic DataCensus, FRED, and labor stats
Places SearchFind restaurants, shops & venues worldwide
165+ tools.
One conversation.
Everything health insurance specialists need from AI, connected to the assistant you already use. No extra apps, no switching tabs.
Medicare enrollment consultation
Guide a client turning 65 through their Medicare options with complete research and cost modeling.
ACA open enrollment client review
Systematically review and update a client's ACA marketplace plan each year.
Small business group health design
Help a business owner design a competitive group health benefit program.
Frequently Asked Questions
How current is the drug information data?
Drug Info pulls from FDA labeling databases, which are updated continuously as manufacturers submit label changes. Formulary tier placement varies by insurance plan and changes annually — always verify with the specific plan's formulary for the current year before advising clients.
Can I use these tools to compare specific carrier plan benefits?
Deep Research can compile publicly available plan information, but carrier plan documents (Summary of Benefits and Coverage) are the authoritative source. Use Deep Research for market-level comparisons and research, then pull official plan documents from healthcare.gov or carrier websites for client presentations.
What is the best way to research Medicare Advantage plan quality ratings?
Deep Research can surface CMS Star Ratings, plan-level data from Medicare Plan Finder, and published plan quality research. Star Ratings are updated annually by CMS and are publicly available. Always direct clients to Medicare.gov Plan Finder for up-to-date plan availability in their zip code.
Can the clinical trials tool filter by insurance coverage?
Clinical Trials searches ClinicalTrials.gov and related databases by condition, location, and eligibility criteria. Coverage details vary by trial — most trials provide investigational treatment at no cost, but standard of care costs may still apply. Each trial listing includes sponsor contact information for coverage clarification.
How do I calculate HSA eligibility and contribution limits?
Tax Reference provides current IRS HSA contribution limits and eligibility rules. The Financial Calculator can model the tax savings benefit of HSA contributions at different income levels. Together they help demonstrate the true cost advantage of an HDHP/HSA combination.
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