What's Behind the Medicare Advantage Care Gap for California's Black Seniors

Medicare 1s a federal health insurance program for people 65 or older, and some people under 65 with certain disabilities or conditions.

Medicare Advantage 1s a localized Medicare option offering insurance services that vary by county or Zip Code. The cost of premiums, coverage, and benefits also differ by location.

Advocates say Medicare Advantage plans simplify health coverage for older adults, typically offering comprehensive plans with low or no premiums and deductibles. They also offer specialized care like dental, hearing exams, eye tests, transportation services - and sometimes even gym memberships.

But due to coverage gaps, many Black seniors still lack the care they need. These gaps often show up as difficulty seeing specialists, lower-rated plans, confusing rules, and limited access to Black physicians.

Unlike Original Medicare, Medicare Advantage-also known as Part C-is provided through private companies approved by Medicare and typically includes drug coverage (Part D). Medicare Part A covers hospital insurance and Medicare Part B covers medical insurance.

Although Medicare Advantage plans must follow federal rules, some seniors, like Joanne Craig, 76, have struggled to access full benefits through her Kaiser Permanente Senior Advantage plan. Still, she said the plan works for her overall.

"You have to stay on top of it. I haven't had problems with the insurance. I've had problems with the insurer representatives and medical professionals not treating you the way that you should under Medicare. They don't want to give you specialists, and they try to work around the system giving you the best service," said Craig.

"Тат a victim of cancer - breast, uterus - and 1 had to identify it because it was early stages and they kept saying there was nothing wrong," said Craig.

She said she wrote to Kaiser noting that, at her age, she shouldn't be struggling to get care. "To this day, the doctor has never acknowledged it. I just had to get other doctors. But somebody else might not be able to do that, write letters and do stuff," she added.

Complicating the information available on selecting which option to get or which services are provided, both Medicare and Medicare Advantage are currently evolving. For example, the out-of-pocket maximum payment is projected to increase by $100 next year for Medicare Advantage beneficiaries. The number of plans being offered are also shrinking and premium beneficiaries pay for outpatient services are likely to go up by an average of $15.

Although the end date for Medicare open enrollment was Dec. 7. people who qualify will be allowed to enroll or dis-enroll until March 31, 2026.

Medicare Advantage enrollment 1$ on the rise, but access isn't equal, according to a report, "Medicare Trends and Tactics in California," by Blooming Health, an Alpowered platform that connects organizations serving aging and underserved communities to resources.

"California's Medicareonly population includes nearly 5 million people, 13% of whom fall between 139-200% of the federal poverty level - too high for Medi-Cal but still financially vulnerable. Many people in this group often lack access to care. Race, income, geography, and

language continue to shape health outcomes. For example, Black Californians have the highest mortality rates from several cancers and are more likely to experience unmanaged chronic conditions," reported Blooming Health.

The report says closing these disparities requires better data collection, integration with communitybased organizations, and targeted investments in underserved areas.

Some cases of inadequate or denied care are driven by algorithms, said Christine Huberty, an attorney with the Center for Medicare Advocacy. During a recent STAT News Summit in San Francisco, she discussed UnitedHealth's 2024 phase-out of its NaviHealth brand, Which used an algorithm to predict how long patients should stay in medical facilities. The report

highlighted Megan Bent, whose mother won an appeal against UnitedHealth's denial of care for her father, who was recovering from brain surgery.

UnitedHealth has denied using artificial intelligence to automatically deny claims.

Jill Baker, 69, of South Los Angeles, shares a different experience. She said she was fortunate to find a good Medicare Advantage plan with UnitedHealth.

"They ve been pretty good. I've been able to keep my same doctor through the years," Baker sald. "That ensured continuity because they were familiar with my medical history."

Baker said her plan has also been good about referrals, including for a recent bone scan. She credits her background as a researcher for helping her make an informed decision.

"You hear those things, "Oh! It's the medical profession, but I've been pleasantly surprised by the care and the attention that they ve given me," she said. Advocates recommend that seniors research their options and seek guidance from navigators to understand Medicare Advantage plan differences.

"Many Black seniors try to manage their chronic illness, like high blood pressure or diabetes, because the health insurance that they have 1s not adequate or doesn't cover the medications and the visits they need," said Janette Robinson Flint, founder and executive director of Black Women for Wellness, an advocacy group for Black women and girls

"Medicare is such a good thing - lifesaving for many Black seniors. But others have not figured out how to use it, and the rules are so complicated," she said.

Seniors start receiving mail about Medicare Advantage plans after age 64 and must sign up within three months after their 65th birthday. But at that time, Flint said, they're inundated with so much information that selecting the right plan can be overwhelming.

"We need to uncomplicate the rules. It's a wonderful program, one that absolutely should not go away - and if it does, it's going to cost lives, for sure," said Robinson Flint