Predictika · Humana-style Medicare Supplement and Part D quotes

An AI sales agent's Medicare Supplement quote, checked before it goes out

An AI sales agent prepares a quote for a Humana-style Medicare Supplement (Medigap) plan with a standalone Part D plan, in US dollars per month. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the enrollment, underwriting and pricing rules, compares the total the quote states with the computed one, and returns every finding together with the line-item premium. This is an illustrative model built from public Medicare rules with fictional rates; it is not Humana's internal rule set.

Scope: Humana-style Medicare Supplement (Medigap) plan letters plus a standalone Part D plan, for seven states, checked against enrollment, underwriting and pricing rules. See everything this validator covers

This validator checks a Medigap plus standalone Part D quote of the kind Humana sells: Medigap plan letters A, K, High Deductible G, N, G, C and F, and three Part D plans, in Florida, Texas, California, New York, Ohio, Arizona and Minnesota. It handles any quote built from these plans and states, not only the scenarios shown on this page. It does not cover Medicare Advantage, dental or vision plans, employer group retiree coverage, or other insurers' Medigap products.

  • Covered: plan eligibility — Plan C and F only for people first eligible before 2020, waiver states, Part B required, no Medigap while in Medicare Advantage unless the plan is being dropped, and under-65 availability by state.
  • Covered: enrollment protections — the 6-month open enrollment window, guaranteed-issue rights (63-day window, guaranteed-issue letters only), state birthday rules and continuous guaranteed issue in New York, then medical underwriting: approval needed, passed, or declined.
  • Covered: pricing — attained-age and community rating, gender and tobacco factors, the household discount where the state allows one, the Part D premium, Extra Help and the late-enrollment penalty, as line items that add up to a total per month.
  • Covered: stated total — the total per month the agent states is compared with the computed total.
  • Not covered — other states, Medicare Advantage, benefit design beyond the plan letters, real Humana rates, and underwriting questions themselves. Other areas can be added.
  • Labeled as assumptions — all rates, factors, the Part D premiums and the national base premium are invented illustrative values built from public Medicare rules, not Humana data.
The AI sales agentBuilds the Medigap and Part D quote from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

8 scenarios in 4 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
Which enrollment protection applies, and so whether underwriting is neededOnly with workarounds
Whether medical underwriting applies depends on the open-enrollment window, the type and age of a guaranteed-issue right, the state birthday rule and the rank of the current plan. A price book cannot hold that decision tree; it ends up in custom code or with an underwriter.		Every protection is evaluated on every call, and the finding says whether underwriting must approve and why.
Plan C and F closed to people first eligible in 2020 or laterOnly with care
A simple eligibility rule, but it has to be kept in step with the plan list and the applicant data on every quote.		Checked on every call against the applicant data and the plan catalog.
State rules: waiver states, under-65 availability, household discount, community ratingOnly with care
Each state differs, so rules multiply by state and plan. They work, but several together are easy to leave out of step with the price book.		State rules and state rating factors come from one catalog and are applied together, so a discount the state does not allow is blocked while the same quote without it passes.
Late-enrollment penalty and Extra Help arithmeticOnly with care
The penalty depends on months without drug coverage and the national base premium, and Extra Help changes the premium. Both are calculations across lines.		The premium, Extra Help and penalty are computed on every call and shown as line items that add up to the total.
Stated total that must match the computed oneOnly with workarounds
A validation rule can compare a stated figure with a calculated one only if the stated figure is a field on the quote, which it rarely is.		The total the agent states travels with the quote and is compared with the computed total on every call; a difference blocks the quote.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1A Medicare Supplement plan requires enrollment in Medicare Part B.
2A household discount was applied but New York does not allow one.
3Humana Medicare Supplement Plan F is sold only to people first eligible for Medicare before January 1 2020.
4Minnesota is a Medigap waiver state with its own standardized plans; the G letter plan is not sold there.
5No open enrollment, guaranteed-issue or birthday-rule protection applies and medical underwriting declined the applicant for Humana Medicare Supplement Plan F.
6Outside open enrollment (40 months after Part B) with no valid guaranteed-issue or birthday-rule protection for Humana Medicare Supplement Plan N; medical underwriting must approve.
7Stated total does not match: the agent stated $217.50 per month; the validator computes $226.90 per month.
8The applicant is 60 and Arizona does not require Medigap to be offered under age 65.
9The applicant is in a Medicare Advantage plan; Medigap cannot be sold unless the MA plan is being dropped.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. Plan availability: Plan F for a 2025 Medicare enrollee

    
The agent's request. Quote for a 66-year-old woman in Florida: Humana Medicare Supplement Plan F with the Humana Value Rx Plan. Total premium $258.90 per month. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Plan closed to newer Medicare enrollees. Humana Medicare Supplement Plan F is sold only to people first eligible for Medicare before January 1 2020.
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2. Plan availability: Plan G instead

    
The agent's request. Quote for a 66-year-old woman in Florida: Humana Medicare Supplement Plan G with the Humana Value Rx Plan. Total premium $199.68 per month. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Premium summary. Total $199.68 per month: Medigap premium $177.68; Humana Value Rx Plan $22.00.
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3. State rules: Household discount in New York

    
The agent's request. Quote for an 80-year-old man in New York: Humana Medicare Supplement Plan G with the Humana Value Rx Plan, household discount applied. Total premium $224.50 per month. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Household discount not allowed. A household discount was applied but New York does not allow one.
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4. State rules: Quote without the discount

    
The agent's request. Quote for an 80-year-old man in New York: Humana Medicare Supplement Plan G with the Humana Value Rx Plan. Total premium $224.50 per month. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Premium summary. Total $224.50 per month: Medigap premium $202.50; Humana Value Rx Plan $22.00.
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5. Underwriting: Plan F outside open enrollment

    
The agent's request. Quote for a 72-year-old man in Florida, 80 months after Part B started: Humana Medicare Supplement Plan F with the Humana Basic Rx Plan. Total premium $356.70 per month. It is ready to send.

    
Verdict: Needs approval.

    
    
      
  • Medical underwriting required. Outside open enrollment (80 months after Part B) with no valid guaranteed-issue or birthday-rule protection for Humana Medicare Supplement Plan F; medical underwriting must approve.
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  • Premium summary. Total $356.70 per month: Medigap premium $311.70; Humana Basic Rx Plan $45.00.
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6. Underwriting: Underwriting passed

    
The agent's request. Quote for a 72-year-old man in Florida, 80 months after Part B started and medical underwriting passed: Humana Medicare Supplement Plan F with the Humana Basic Rx Plan. Total premium $356.70 per month. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Premium summary. Total $356.70 per month: Medigap premium $311.70; Humana Basic Rx Plan $45.00.
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7. Stated total: Stated total is off

    
The agent's request. Quote for a 65-year-old woman in Florida, 4 months after Part B started: Humana Medicare Supplement Plan G with the Humana Basic Rx Plan and a late-enrollment penalty for 24 months without drug coverage. Total premium $217.50 per month. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Stated total does not match. Stated total does not match: the agent stated $217.50 per month; the validator computes $226.90 per month.
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8. Stated total: Total matches the validator

    
The agent's request. Quote for a 65-year-old woman in Florida, 4 months after Part B started: Humana Medicare Supplement Plan G with the Humana Basic Rx Plan and a late-enrollment penalty for 24 months without drug coverage. Total premium $226.90 per month. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Premium summary. Total $226.90 per month: Medigap premium $172.50; Humana Basic Rx Plan $45.00; late-enrollment penalty, 24 uncovered months $9.40.
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI sales agent prepares a quote for a Humana-style Medicare Supplement (Medigap) plan with a standalone Part D plan, in US dollars per month. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the enrollment, underwriting and pricing rules, compares the total the quote states with the computed one, and returns every finding together with the line-item premium. This is an illustrative model built from public Medicare rules with fictional rates; it is not Humana's internal rule set.
    2. 
      
  2. I will start with the first request by the agent.
    3. 
      
  3. The agent says. Quote for a 66-year-old woman in Florida: Humana Medicare Supplement Plan F with the Humana Value Rx Plan. Total premium $258.90 per month. The rest of the request is on screen.
    4. 
      
  4. Before it goes out, the agent calls the validator.
    5. 
      
  5. Blocked, with one finding, all in one answer. Humana Medicare Supplement Plan F is sold only to people first eligible for Medicare before January 1 2020.
    6. 
      
  6. The validator returned one blocking finding in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other.
    7. 
      
  7. What this shows: for plan C and F closed to people first eligible in 2020 or later, a rules-based CPQ is error-prone for this.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the medigap plan to Humana Medicare Supplement Plan G and the stated total per month to $199.68.
    10. 
      
  10. It calls the validator again.
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  11. This time the validator clears it.
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  12. The validator also returns the line-item quote, on screen.
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  13. The earlier finding is cleared, and the validator's total, $199.68, matches the quote.
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  14. One problem caught in one call, fixed in one pass, and a clean $199.68 quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    15.