Massive Open Online Courses (MOOCs) have revolutionized education by reaching a diverse global audience. Despite their vast reach, the inclusivity and accessibility of MOOCs for learners with disabilities remain significant concerns. This paper provides an overview of a literature spanning eleven years (2012–2024), evaluating the advancements and ongoing challenges in the design of MOOCs with respect to accessibility. Our findings indicate that the major barriers to accessibility in MOOCs are largely due to the awareness, training, and knowledge gap in ICT accessibility and inclusive practices for course designers. Through the application of Universal Design for Learning (UDL) principles and the integration of Artificial Intelligence (AI) technologies, this paper demonstrates how MOOCs can be more accessible and inclusive. Specifically, the use of AI can automate the creation of universally accessible education materials catering to diverse learner needs, in line with accessibility standards and UDL principles. Moreover, engaging learners with disabilities in the design and evaluation processes is crucial for genuine inclusivity. This study provides actionable recommendations for MOOC designers and emphasizes the need for a collaborative approach to overcome the accessibility challenges in online education. By prioritizing accessibility, MOOCs can truly fulfill their potential as a transformative educational tool for all learners, regardless of their different abilities.