In the November Retiree Advocate, readers learned about a recent study

by Physicians for a National Health Program (PNHP) called “No Real Choices.” The study shows how the Medicare Advantage (MA) system, which claims to increase equity in healthcare, fails to do so and instead disproportionately harms seniors of color. Of course, all seniors are affected by the high prices of Medigap policies which lead many to turn to Medicare

Advantage plans. MA plans frequently offer lower premiums and promise “extras,” like hearing, dental and vision benefits that are not covered by Original Medicare. But with for-profit MA plans, the costs, network of providers, and benefits can change suddenly, and beneficiaries may find they are unable to access the care they need because of limits on network providers or benefits. Meanwhile, the MA companies continue to overcharge the Medicare Trust Fund by billions each year.

The MA industry claims that it is improving racial equity in healthcare by providing MA plans as an alternative to Original Medicare. It’s true that MA plans are purchased by a racially diverse group of seniors, and MA companies often tout this fact in their advertising. Black seniors in particular, and seniors of color generally, are disproportionately enrolling in MA plans, compared with their white counterparts. But as PNHP points out, this diversity does not bring about equity. Far from it.

PNHP and Johns Hopkins University examined so-called “affinity plans,” MA plans which have a high enrollment of Black, Hispanic, and Asian beneficiaries. Those plans had lower “star” ratings from Medicare, indicating lower quality. The conclusion? “Taken together, the plans disproportionately serving Black, Hispanic, and Asian beneficiaries tend to be of lower quality and more restrictive, while plans disproportionately serving White beneficiaries tend to be of higher quality. Far from advancing equity, these patterns perpetuate disparities in access and outcomes.”

PNHP notes that higher enrollment in lower-rated plans is affected by the geographic availability of plans; counties with higher unmet social needs were found to have a lower likelihood of access to higher-rated plans. And higher-rated plans are rewarded by “bonuses” from CMS, which funnels additional resources to healthier, wealthier communities. So lower-income communities with lower-rated plans are essentially stuck with lower quality MA plans, and the cycle perpetuates itself.

Further, PNHP cites studies showing that MA enrollees of color experience worse outcomes than white MA enrollees in areas such as hospitalizations, mental health treatment, emergency department use, and outcomes in preventive care. The impacts on MA enrollees of color documented in this report – poorer outcomes, lack of access to care, closures of local hospitals in underserved communities, and yes, higher denial rates for prior authorizations – will not be a surprise to BIPOC (Black, Indigenous, People of Color) seniors. The problems associated with the MA system are amplified when it comes to marginalized communities. So what can we do?

We can have real choices that create true equity in healthcare. We must return to Medicare’s original promise of universal, equitable healthcare. Solutions identified by PNHP include: ending the “gap trap” by creating a reasonable cap on uncovered costs in Original Medicare, so that no one is forced into an MA plan because of the cost of a Medigap plan; adding missing benefits to Original Medicare (e.g., hearing and vision); and ending the overpayments to MA plans. PNHP notes that if the estimated $84-140 billion per year in overpayments to MA plans were recovered, we could easily afford to put a reasonable cap on uncovered costs in Original Medicare and add missing benefits, all comparable to what the MA plans offer.

PSARA continues to fight for real choices and true equity in healthcare. We thank all of you for being part of this effort.