The Future of Digital Health and Medicare Advantage: A Hopeful Outlook

Medicare Advantage enrollment has reached 34.1 million beneficiaries — 54% of all eligible Medicare recipients — with Medicare program payments to MA plans estimated at $494 billion in 2024 (MedPAC). As enrollment grows, health plans face pressure to differentiate through technology: better member experiences, more effective care management, and digital-first supplemental benefits. This article examines how MA plans use technology to design products, engage members, and deliver care.

Last updated: February 2026
By: Kevin Yamazaki, Partner, CEO at Sidebench

What Technology Do Medicare Advantage Plans Use for Product Design?

Medicare Advantage plans use specialised product design software to model benefits packages, calculate actuarial risk, and simulate member utilisation before filing with CMS. Digital platforms let sponsors design supplemental benefits based on social determinants of health data — a growing requirement as CMS expands allowable benefit categories.

Product Design Software Capabilities

Custom vs. Off-the-Shelf

Plans with standard product offerings may use commercial software. Plans with non-standard benefit designs — especially Special Supplemental Benefits for the Chronically Ill (SSBCI) — often require custom platforms that can model non-standard benefits and integrate with diverse vendors.

How Is Digital Health Improving Medicare Advantage Member Engagement?

Member engagement directly impacts Star Ratings, retention, and health outcomes. Digital platforms serve three audiences: members (self-service, benefits navigation, telehealth), care teams (population health dashboards), and administrators (claims analytics, CMS reporting).

Member-Facing Capabilities

The 65+ population is more digitally engaged than stereotypes suggest — 78% own smartphones according to Pew Research (January 2026). But design still needs to accommodate varying digital literacy levels.

Successful member platforms include:

• Self-service portal: Check benefits, find providers, track claims
• Telehealth integration: Virtual primary care, specialist consults
• Benefits navigation: AI-powered recommendations based on individual needs
• Care gap alerts: Proactive reminders for preventive care
• Supplemental benefits access: Book transportation, order OTC products, schedule meals

What Are the Benefits of Digital Transformation for Medicare Advantage?

Digital transformation in Medicare Advantage delivers measurable benefits across three dimensions: member experience, operational efficiency, and health outcomes.

Member Experience

Operational Efficiency

How Do Remote Monitoring and Wearables Fit Into Medicare Advantage?

Remote patient monitoring (RPM) uses connected devices — blood pressure cuffs, glucose monitors, pulse oximeters, scales — to collect patient data at home. Medicare reimburses RPM under CPT codes 99453-99458, making it economically viable for MA plans.

Wearables in Medicare Advantage

Unlike clinical RPM devices, consumer wearables (Apple Watch, Fitbit) generate data that’s harder to integrate into clinical workflows. That said, some plans use wearable data for:

• Fitness programs: Activity tracking for wellness incentives
• Fall detection: Apple Watch fall detection for high-risk members
• Sleep monitoring: Correlating sleep patterns with chronic disease outcomes

What Does a Successful Medicare Advantage Digital Platform Look Like?

A successful MA digital platform serves multiple stakeholders with appropriate interfaces while maintaining compliance and accessibility.

Critical Success Factors

1. Multi-channel access: Digital-first but not digital-only — phone support for members who prefer it
2. Real-time data: Benefits eligibility and care gaps updated in near-real-time
3. Personalisation: Recommendations based on individual member data
4. Integration depth: Connected to claims, clinical, and vendor systems
5. Compliance: HIPAA, CMS data requirements, state regulations
6. Accessibility: WCAG 2.1 compliance, large text options, screen reader support

What Challenges Do Medicare Advantage Plans Face With Technology?

Despite the benefits, technology implementation in Medicare Advantage faces significant obstacles that require careful planning and experienced partners.

Challenge 1: Legacy Claims Systems

Most health plans run on claims adjudication systems designed in the 1990s. These can’t support real-time adjudication or modern API integration without significant middleware investment.

Challenge 2: Member Data Fragmentation

Member data lives across claims, clinical, demographic, and SDOH sources. Creating a unified member view requires data integration that most plans haven’t achieved.

Challenge 3: Annual Regulatory Changes

CMS changes MA rules annually. Technology platforms must accommodate V28 risk model changes, Star Ratings methodology updates, and supplemental benefits expansions — on the CMS timeline, not yours.

Challenge 4: Digital Literacy Variation

While 78% of 65+ beneficiaries own smartphones (Pew Research, 2026), engagement levels vary dramatically. Platforms must support all digital literacy levels.

Challenge 5: Vendor Ecosystem Complexity

Supplemental benefits require integration with diverse vendors: transportation, meals, OTC catalogues, fitness centers. Each integration adds complexity.

What Supplemental Benefits Can Medicare Advantage Plans Offer?

CMS has dramatically expanded allowable supplemental benefits, creating differentiation opportunities for tech-driven delivery.

Comparison Tables

MA Digital Health Capabilities

Build vs. Buy for Health Plan Technology

FAQ

What is Medicare Advantage product design software?

Product design software helps health plans model benefits packages, calculate premiums, assess risk, and prepare CMS filings. These platforms simulate how different benefit configurations affect member utilisation, plan costs, and quality scores.

How are Medicare Advantage plans using digital health?

Plans deploy member-facing portals for benefits navigation, telehealth for virtual primary care, remote monitoring for chronic conditions, AI-powered care gap identification, and digital supplemental benefits like meal delivery and transportation booking.

What supplemental benefits can Medicare Advantage plans offer?

CMS allows dental, vision, hearing, fitness programs, transportation, over-the-counter products, meal delivery, in-home support, and Special Supplemental Benefits for the Chronically Ill (SSBCI) — all beyond original Medicare coverage.

How does remote monitoring work in Medicare Advantage?

Connected devices (blood pressure cuffs, glucose monitors, pulse oximeters) collect patient data at home. Data transmits to care teams who monitor for concerning trends. CMS reimburses RPM codes 99453-99458.

What is the future of digital health in Medicare?

AI-driven personalised care plans, expanded telehealth access, social determinants integration into care delivery, predictive analytics for population health, and digital-first member experiences matching consumer expectations.

How do Medicare Advantage plans measure quality?

CMS Star Ratings (1-5) measure staying healthy, managing chronic conditions, member experience, access, and customer service. Higher ratings earn bonus payments. Digital health tools directly impact several measures through care gap closure.

What challenges do health plans face with technology?

Legacy claims systems, fragmented member data, annual CMS regulatory changes, varying digital literacy among 65+ members, and supporting both digital and non-digital journeys simultaneously.

How much does it cost to build a Medicare Advantage digital platform?

Custom platforms cost $200K-$1M+ depending on scope. Member portals with telehealth sit at the lower end; full population health platforms with claims analytics sit higher. Factor in long-term licensing costs of alternatives when comparing.

What is population health management technology?

PHM technology aggregates clinical, claims, and social determinants data to identify at-risk individuals, close care gaps, coordinate interventions, and measure outcomes. For MA, PHM directly supports Star Ratings and risk adjustment accuracy.

How do health plans choose a technology development partner?

Key criteria: CMS regulatory experience, HIPAA compliance expertise, health plan client track record, integration capability with existing claims/member systems, understanding of 65+ digital literacy needs, and measurable outcomes from previous implementations.

Sidebench Perspective

Building Technology for Medicare Advantage?

Sidebench has experience scaling health plan platforms to 90,000+ members. See how we build for HIPAA or explore our partner evaluation framework.

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Cited Data Sources

1. Medicare Advantage Enrollment (KFF 2025) — KFF: Medicare Advantage Enrollment Update and Key Trends
2. CMS Star Ratings Fact Sheet — CMS: 2025 MA and Part D Star Ratings
3. MedPAC MA Payments ($494B) — MedPAC: Medicare Advantage Data Book Section 9
4. Pew Research: Smartphone Ownership 65+ (78%) — Pew Research: Internet Use, Smartphone Ownership (Jan 2026)
5. CMS RPM Reimbursement (CPT 99453-99458) — CMS Physician Fee Schedule
6. SSBCI Benefits — CMS: SSBCI
7. IEHP Case Study (1K to 90K users, 2M transactions) — Sidebench approved proof point