Softheon Medicare

Are you ready to gain the Medicare Advantage?

Support our seniors and the aging population by offering a simple and intuitive Medicare eCommerce platform. With Softheon Medicare, your consumers are provided a no wrong door approach to enrolling in coverage and managing associated payments going forward.

Why Softheon?

Partner with experts in government insurance

No Wrong Door

Engagement with your members doesn’t stop at 65. Keep your members engaged through a no wrong door eCommerce platform.

Built-in Compliance

Softheon’s Medicare Cloud offers government-grade compliance to keep your Medicare data secure.

Customer Experience

Simplicity and ease of use are of utmost importance for our Medicare solution. Our platform is WCAG compliant for enhanced accessibility.

Consumer Experience

Plan Shopping & Decision Support

Our platform takes a no wrong door approach to health insurance shopping. With a conversational interface, the platform is intuitive for users of all ages and takes the guesswork out of health insurance by guiding them through the shopping experience. PCP selection and drug lookup are both included to assist with confirming in-network, and coverage options and cost calculators help the consumer determine the best plan based on potential tax credits or Health Reimbursement Arrangements (HRAs). Our platform not only offers Affordable Care Act plans but also Medicare-related plans, dental, vision, and other ancillary products.


  • - Plan Shopping
  • - Decision Support
  • - Provider & Pharmacy Lookup
  • - Ancillary Products
  • - Brand Management
  • - Broker Portal & Support Tools

Eligibility & Enrollment

Configurable business rules

Determine eligibility for Medicare products in real-time through a series of screener questions. Upon completing an enrollment application, Softheon Medicare features a configurable back-end workflow for additional verification and processing.


  • - Back-end enrollment processing
  • - Termination, Cancellation & Delinquency management & processing
  • - Member identifier matching logic
  • - Automated business rules including exception handling



We offer a full-suite PCI DSS 3.1 payment/banking platform that connects with all major card brands and other payment channels (cash, money orders, etc.), including Fiserv and MoneyGram, to support our issuers. As a designated Payment Facilitator, we can also quickly and conveniently process payments without any third-party involvement. Members can manage their digital wallets to support single and reoccurring payments.


  • - Digital wallet functionality
  • - Credit & debit cards, including: Visa, MasterCard, American Express, and Discover
  • - ACH & e-Check
  • - Lockbox processing
  • - One-time and recurring payments
  • - Voice payments through IVR



Softheon finance allows you to track subsidies, member discounts/incentives, and track/pay agent and broker commissions with fully integrated accounting functions. Additionally, managing general ledger and month/year-end closing has never been easier with a full suite of financial reports.


  • - A/R management
  • - Agent/Broker commissions
  • - Financial Reporting
  • - Member loyalty programs & incentives

Payload Management

EDI Gateway

Softheon Payload Management allows you to integrate with the Federally Facilitated Marketplace (FFM), all major State-Based Marketplaces (SBMs), and your claims administration platform without changing your existing infrastructure. We facilitate data exchanges through secure, real-time APIs, as well as standard and ad-hoc file types, including EDI 834, 820, 837, XML, CSV, etc.


  • - EDI processing
  • - SNIP validation
  • - Secure File Transfer
  • - Real-time APIs
  • - Claims administration integration
  • - Data integrity & Normalization

Product & Pricing

Plan Management & Rating

Build and manage your Medicare product repository through Softheon Product & Pricing. Softheon Medicare utilizes APIs to pull in plan data, including associated plan documents.


  • - Product Repository
  • - Plan document storage
  • - Rate Verification
  • - Service area management
  • - Ancillary products

Data Intelligence & Governance

Softheon’s data intelligence suite offers intuitive state-of-the-art tools for all members of the health plan from the C-Suite to the individual contributor. Users can analyze data in near-real-time reviewing transaction trends, member demographics, geography, financial information, and cost comparisons.


  • - Enterprise Data Management & Warehouse Transformation & Monitoring
  • - Compliance Reporting
  • - Reconciliation
  • - Analytics Tools
  • - Referential Integrity

Join Softheon

Trusted by over 55 Health Insurance Issuers

Have more questions?

Check out our FAQ for more details on our solutions.