AI Max for Search is now switched on automatically for many Google Ads Search campaigns, and auto-apply recommendations can change keywords and bids without anyone on your team touching the account. For a healthcare practice, those two defaults decide who sees your ads, which searches you pay for, and whether you stay inside Google’s health advertising policies. This 10-point audit walks through each setting, where to find it in Google Ads, and why it matters more in healthcare than in retail.
We run this audit on every healthcare account we take over and after any Google announcement that changes defaults. It takes about an hour and needs no extra tools.
Why November 2026 is the time to check
Google announced the change on April 15, 2026: campaigns using Dynamic Search Ads, automatically created assets, and the campaign-level broad match setting would be upgraded to AI Max for Search. Campaigns using automatically created assets or campaign-level broad match have been auto-upgraded starting in September 2026. On June 11, 2026 Google extended the timeline for the Dynamic Search Ads sunset and auto-upgrade, which will begin in February 2027. After the upgrade, search term matching is on by default, which means your ads can serve on searches that no keyword in the account would have matched.
If nobody opened your account during that window, assume something changed. That is the premise of this audit.
The 10-point AI Max for Search audit
1. Confirm whether AI Max is really on
Where to click: open the campaign, go to Settings, and look for the AI Max for Search card. The card presents a toggle. In accounts we have reviewed, the settings card opens with the toggle already checked, so what you see there is the proposed state, not proof of the live state.
The reliable check is the search terms report. Google’s reporting page for AI Max says to add the “Source” column and filter the “Match type” column for “AI Max”; there is also a dedicated view in the Search terms dropdown, now called “Search terms and ad combinations” (formerly “Search terms and landing pages from AI Max”). If AI Max rows exist, AI Max has been serving. Google notes the match-type filter can under-count because it ignores “Other search terms”, so treat zero rows as a hint, not a verdict.
Why it matters in healthcare: keywordless matching can pull a clinic’s ad onto searches about conditions or services it does not offer, and spend budget on research-intent queries that never become patients.
2. Read the AI Max search terms, not just the totals
Where to click: Campaigns, then Insights and reports, then Search terms, then the AI Max view described above.
Sort by cost and read the top 100 terms. Look for three patterns: services you do not provide, locations you do not serve, and queries that signal a crisis rather than scheduling intent. Add campaign-level negatives for the first two. For the third, decide with clinical leadership what the ad should do; a paid ad is not a crisis resource.
3. Set brand, location and URL controls inside AI Max
Where to click: brand inclusions live at campaign and ad group level, brand exclusions at campaign level, locations of interest at ad group level, and URL exclusions at campaign level, per Google’s “How AI Max for Search campaigns works” page.
If you keep AI Max on, these controls keep it inside the lines. Exclude URLs that should never be landing pages: privacy policy, careers, staff bios, patient portal, and any form not meant for new-patient inquiries. Exclude competitor brands. Set locations of interest to the metro you serve.
4. Turn off individual AI Max features you cannot police
Where to click: search term matching can be toggled off in ad group settings; text customization and Final URL expansion can be turned off individually in campaign settings.
Text customization lets Google write headlines and descriptions from your landing page content. For a practice that has every ad line reviewed for claims, that is a compliance surface, not a convenience. Final URL expansion can send a click to a page compliance never saw. Turn off whichever you cannot review weekly.
5. Audit auto-apply recommendations and their history
Where to click: Campaigns, then Recommendations, then Auto-apply settings. The Manage tab shows what is checked. The History tab shows when each recommendation was first turned on, how many times it was applied in the past week, and when it was last applied. The user who opted in is visible in Change history.
Read the History tab before the Manage tab. We have seen accounts where the history showed large batches of keyword removals and a target ROAS change applied in a single week, none of it decided by the practice. Uncheck anything that changes bidding, budgets, keywords, or targeting; you can uncheck it in Manage or select Disable in History. Keep only the housekeeping items you would approve every time.
6. Check Display Expansion on Search campaigns
Where to click: campaign Settings, then Networks, then “View network settings”. The checkbox is “Include Google Display Network”.
Google is moving Display Expansion from the old “unspent Search budget” model to channel prioritization: since October 2026 you can set the Display Network to High or Low priority with an optional daily budget allocation cap, and starting in February 2027 Search campaigns with Display Expansion will automatically transition to channel prioritization. Either way the checkbox is the same. For healthcare, it moves ads from an intent channel to a browsing channel with tighter personalization limits and placements that are harder to review. Uncheck it unless you built the campaign for it.
7. Check search partners
Where to click: the same Networks panel, checkbox “Include Google search partners”.
Google’s page on search partners says ads can appear on partner search pages, site directories, product pages, and YouTube search and watch pages. In our reading of the interface, Google does not offer a partner-by-partner placement list or a per-site exclusion for search partners, so in practice the choice is the whole network or none. For most practices we turn it off and revisit when Search volume is capped.
8. Set location options to Presence, not Presence or interest
Where to click: campaign Settings, then Locations, then “Location options”.
Google’s default, “Presence or interest”, reaches people who are in your area or have shown interest in it. “Presence” limits ads to people likely to be located, or regularly located, in your targeted area. A clinic in one metro does not want to pay for someone two states away reading about it. Switch to Presence unless you serve travelers.
9. Audit audiences against the health personalization policy
Where to click: campaign or ad group Audiences, then check every segment’s type.
Google’s “Health in personalized advertising” policy allows Google’s predefined audiences, such as in-market and affinity segments, because sensitive signals are excluded from them. It does not allow advertiser-curated audiences for sensitive health content: Customer Match, your data segments, audience expansion, and lookalike segments are listed as not supported. Users under 18 are not eligible for personalized advertising of any kind. If a health campaign has a Customer Match list or a “your data” segment attached, remove it and ask counsel how it was built.
10. Confirm certification status for restricted services
Where to click: the account’s Policy manager, and the certification notices on any disapproved ad.
Google’s Healthcare and medicines policy restricts recovery-oriented drug and alcohol addiction services, including clinical treatment providers, sober living, lead generators, and crisis hotlines. Advertisers must apply and be approved, per location or group of locations. In the United States and Canada, that path runs through LegitScript’s Addiction Treatment Certification before Google’s own application. If a behavioral health account shows disapprovals labelled as missing certification, the fix is paperwork, not ad copy.
What to do after the audit
Log every change with the date and the person who made it. Rerun the search terms check two weeks after any AI Max change and review the auto-apply History tab monthly. Then make sure the conversions the account optimizes toward are real leads, which is next week’s post.
For the paid search rules that apply before any of these settings, see our compliance-first guide to healthcare paid search and our overview of HIPAA-aware marketing. To connect the audit to the numbers leadership reads, see healthcare marketing KPIs.
FAQ
Is AI Max a new campaign type?
No. Google describes it as a set of features inside an existing Search campaign: search term matching, text customization, and Final URL expansion. You can turn the features off individually.
How do I know if Google turned on AI Max in my account?
Open the search terms report, add the “Source” column, and filter Match type for “AI Max”, or open the “Search terms and ad combinations” view. If AI Max rows appear, it has been serving. The settings card alone is not reliable.
Can I use remarketing or Customer Match for healthcare ads?
Google’s Health in personalized advertising policy lists Customer Match, your data segments, audience expansion, and lookalike segments as not supported for sensitive health content. Google’s predefined audiences are allowed. When in doubt, ask counsel before uploading any list.
What is the difference between Presence and Presence or interest?
Presence or interest, the default, reaches people in your area and people who have shown interest in it. Presence limits ads to people likely to be located, or regularly located, in your targeted area.
Want a second set of eyes?
We audit healthcare Google Ads accounts as part of our healthcare paid media work. To run these 10 checks with us on a screen share, book a call.
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