AI for member retention: Built for retail or real care?

Maria was 72 when she nearly gave up on her health plan. Her Annual Notice of Change arrived in the mail, packed with jargon she didn’t understand. She called the number on the back of her card and waited 37 minutes to talk to a human. When someone finally picked up, they read from a script and left her more confused than before.

Maria didn’t want to leave her plan. But she felt like she had no choice.

This is the moment when most health plans lose a member. Not because the premium has changed. Not because another plan offered more perks. But because the experience didn’t feel like care. It felt cold, scripted, and impersonal.

That’s the issue.

Most AI tools used by health plans were built for the retail world, where the goal is to sell quickly. That kind of thinking doesn’t translate when someone’s trying to understand if they can keep seeing their doctor or afford their medication. And in healthcare, that disconnect is costly- not just in dollars, but in trust, satisfaction, and outcomes.

Maria needed someone who could walk her through the change, help her understand her coverage, and reassure her that she wasn’t alone in figuring it out. Health plans need that too, if they want to build loyalty and trust. They need something designed for connection, built with empathy at its core.

That’s where Mia comes in.

Mia is the only AI-powered, voice-first member experience, retention, and engagement platform designed specifically for health plans.

How Mia helps members like Maria

1. Tackles member confusion and churn
   Maria didn’t leave because she wanted to, she left because no one helped her stay. She’s not alone. Voluntary disenrollment rates run as high as 15% for Medicare Advantage plans. Behind every one of those numbers is a story like hers- confusion, a lack of support, and the silent frustration that builds when members don’t feel heard. Mia identifies at-risk members early, then steps in with clear, timely communication that answers questions, eases anxiety, and helps them stay- not out of pressure or obligation, but because they feel supported, valued, and confident in their choice.
   

2. Makes coverage make sense
   Like many, Maria couldn’t make sense of the changes in her plan. She’s part of the 65% of Medicare members who say they don’t fully understand their coverage. And when members don’t understand, they don’t engage or worse, they leave. Mia makes it simple. It turns complex documents into plain language, so members know what’s covered and what’s not. It meets them where they are, in words they understand. Plans using Mia see a 40% boost in engagement and a 50% rise in satisfaction. When members understand their coverage, they build confidence in their decisions. They feel in control of their care and that sense of control is what keeps them from walking away.
   

3. Meets members in their moment of need
   When Maria finally reached out, it was too late to turn things around. She had waited, grown frustrated, and lost trust. But when members reach out to Mia, it’s a different experience. There’s no waiting, no repeating themselves, no struggle to be understood. Whether it’s 2 p.m. or 2 a.m., they get help in their language, at their pace and that moment of ease becomes a reason to stay. They feel seen, heard, and valued and in a system that often feels rushed or distant; that’s what stands out.
   

4. Built for compliance from the ground up  
   Maria’s call wasn’t just about coverage, it involved personal health questions, sensitive details, and the kind of information that must be protected. With Mia, every interaction is built on a foundation of trust. HIPAA, CMS, and GDPR standards are part of Mia’s core design. Mia redacts PHI, captures consent, and maintains detailed audit logs automatically. So, when a member reaches out, plans can respond with confidence- not just emotionally, but legally, ethically, and operationally too.

The bottom line

Most AI helps your call center sound smarter.
Mia helps your members feel seen.

If you lead member services, retention, or growth at a health plan- especially in Medicare Advantage, don’t settle for AI that speaks retail.

Choose the platform that knows what care sounds like.

That’s Mia.

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