Why I Don't Trust AI With Your Health Insurance

I've spent seven years as a licensed health insurance broker in Tustin, California, and I'm watching the system get worse — and the technology marketed to fix it making things harder for the people it's supposed to help. Open enrollment for 2026 just showed how broken things are: average premium payments for ACA Marketplace shoppers jumped 58%, from $113 to $178 a month, while effectuated enrollment could fall to roughly 17.5 million people from 22.3 million the year before (KFF).

Against that backdrop, every ad you see seems to offer the same answer: let an algorithm pick your plan. My thesis is blunt: health insurance is broken, and you should not trust AI to make the decision for you. This isn't an anti-technology rant. It's a warning grounded in what I see daily — AI tools that chase the cheapest premium while missing the medical reality of the person buying the plan, all at the exact moment when every dollar and every claim decision matters more than ever.

What's at stake if you get this wrong

A bad health insurance choice isn't a bad cell phone plan. It's a year of uncovered care, surprise bills, and denied treatments at the worst possible moment. The stakes went up, not down, in 2026. Beyond that 58% jump in what shoppers actually pay, the average Marketplace deductible grew by about $1,000 per person in 2026, pushing more enrollees toward higher-deductible plans as enhanced tax credits expired (KFF).

The result is a market where the "cheap" plan on paper is often the most expensive in practice. A low monthly premium can carry a deductible of $8,500 to $10,600, meaning you pay for nearly everything out of pocket before coverage kicks in — a trap AI-driven tools routinely steer people into by optimizing for the smallest number on the screen (StretchDollar). When a family's health history, ongoing medications, and planned procedures aren't on the front page of an algorithm's output, the cheapest option isn't a bargain — it's a liability.

The illusion of the easy button

Here's what AI tools don't understand: health insurance is a medical decision, not a pricing problem. An algorithm compares premiums, deductibles, and networks and returns the cheapest match in seconds. What it can't see is that you have a specialist you trust who isn't in that plan's network, a child with a condition that needs a specific medication, or a procedure you've already scheduled. I've never once had an algorithm ask about any of that.

The human oversight gap is real and documented. Researchers at Stanford note that a major worry is that "wrongful denials may be occurring as a result of a lack of meaningful human review of recommendations made by AI" (Stanford Report). Insurers themselves have embraced this fast: a 2024 survey by the National Association of Insurance Commissioners found 84% of 93 large health insurers used AI for some operational purpose (Stanford Report). The same machines deciding whether to approve your coverage are the ones being asked to pick the plan you'll live with all year — and they operate on efficiency, not empathy.

The real cost of "free" AI

Here's the part that surprises most people: working with a licensed broker like me costs you nothing. Insurance carriers pay my commission out of the premium — you pay the same amount whether you click "enroll" yourself or I help you. A human broker is genuinely free for the consumer, which flips the entire "AI saves you money" pitch on its head.

So what are you actually paying for the convenience of an algorithm? Consider what happens after enrollment, when the real costs surface. The machines approving or denying your care are a source of growing worry among the doctors who treat you: 61% of physicians worry that insurers' use of AI is increasing denial rates, with some tools accused of producing denials at rates up to 16 times higher than traditional review (Physicians Practice).

The honest case for AI

I want to be fair, because a one-sided attack on technology would be just as unhelpful as blind trust in it. AI genuinely does some things well: it can check coverage rules, extract patient data from records, and flag which appeals are most likely to succeed. Even my Stanford source concedes that Medicare Advantage plans approved more than 93% of prior authorization requests from 2019 to 2023, and that automating clearly allowable approvals could reduce delays (Stanford Report). Used as a tool with human oversight, AI has real potential.

But that's the key phrase: with human oversight. The problem isn't the technology — it's that efficiency-driven tools are handed the whole decision, and no one is checking the answer against your actual life. That's where a broker earns their keep, and it's not a checkbox you can automate away.

Why a human advocate still matters

Here's what I actually do for the families who sit across my desk in Tustin. I read the fine print on networks and formularies. I ask about your medications, your doctors, and the surgery you have planned for next spring. When a claim is denied — and in this system, claims get denied — I know who to call and what to say to get it overturned, often on appeal. That advocacy is the difference between a plan that exists on paper and coverage that works when you need it most.

I'm not saying a broker replaces your doctor or that good tools have no place. I'm saying that when the health insurance system is this broken — when the premiums shoppers actually pay have jumped sharply and deductibles keep climbing — the last thing you should hand your family's care to is an algorithm optimizing for the lowest number on a screen.

The good news is that this doesn't cost you anything, and it might save you a great deal. A licensed broker works for you for free — paid by the carriers, not by your pocket. Before you hit "enroll" on whatever tool recommends the cheapest plan, talk to a human who will actually read your medical history and fight for your coverage. Your health is too important to leave to an algorithm.