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 & 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. This is for market research purposes only and is not a solicitation for proposals. Responses are due by March 31, 2026.
Scope of Interest
CMS is interested in solutions that can provide:
- Personalized, claims-informed plan recommendations.
- Real-time conversational AI support (chatbots, virtual assistants).
- Predictive analytics for plan matching.
- Accessible decision support tools and translation of complex information.
- Call center automation and AI-powered call quality assurance.
- Generation of insights on beneficiary preferences and operational improvements.
- Seamless experiences across Medicare.gov, Plan Finder, and 1-800-MEDICARE.
Information Requested from Vendors
Respondents should provide details on:
- 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.
Contract & Timeline
- Type: Request for Information (RFI) / Sources Sought
- Set-Aside: None specified (market research stage)
- Response Due: March 31, 2026, 02:00 PM EDT
- Published: February 17, 2026
Submission Details
Responses must be submitted in PDF Format via email to aaron.blackshire@cms.hhs.gov and matthew.wendel@cms.hhs.gov. Narrative responses, including supplemental attachments, are limited to 20 pages.
Important Notes
This RFI is for information gathering only and does not commit CMS to a future solicitation or contract. Responses will inform market research and future procurement development. CMS will not reimburse costs associated with RFI responses.