THIS TIME ON CODE WACK!
Privatized Medicare now covers more than half of older adults nationwide. But how do Medicare Advantage plans’ lower star ratings, narrow networks, and “paper benefits” hit seniors of color hardest-and why are hospitals dropping these plans, leaving patients scrambling for care?
Our guest is Dr. Belinda McIntosh, an Atlanta-based psychiatrist with more than 20 years of experience, Physicians for a National Health Program board member, and co-author of the PNHP report No Real Choices: How Medicare Advantage Fails Seniors of Color. This is part two of a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
Medicare Advantage plans that enroll more Black, Hispanic, and Asian seniors tend to have lower star ratings. What does that mean for patients? And what does lower quality look like when you’re sick, older, or disabled?
“ … the star rating system is something that CMS [Centers for Medicare and Medicaid Services] … developed … so that patients could be able to see the differences between plans as they’re choosing them. A plan with a high star rating versus a plan with a low star rating will differ in factors such as how long it takes to process a prior authorization, as well as the quality of care. So how often are people getting the care that’s considered standard for chronic conditions like diabetes, high blood pressure, or their cardiovascular issues? How long do people stay in the plan, or are people switching out of this plan often? How robust is the network? So a lot of these things will factor into a plan’s star quality rating. And the thing is, if the plan has a high star rating, they get a bonus from CMS.
“And so … plans that are in areas with, you know, kind of less healthcare spending because they’re healthier communities, which often… means wealthier communities, … they have less healthcare spending overall, and they will get bonus dollars from CMS and they can then pass those bonus dollars on to their enrollees in terms of … supplemental benefits or lower premiums and, and other kinds of advantages.
“And when that happens, this continually boosts their star rating. And so there’s this compounding effect where that then continues to shunt CMS dollars towards wealthier, whiter communities. The structural inequities are so built into the system.” – Dr. Belinda McIntosh
Medicare Advantage ads love to talk about dental, vision and hearing benefits … supplemental benefits. The report calls many of these ‘paper benefits.’ What happens when seniors actually try to use these paper benefits?
“… First they find out there’s a waiting period, they can’t go yet. You have to have a plan for this long. Then … they find out how narrow the network is, and they may have to leave town altogether to find a provider in their network or worse – not be able to find one. Again, this is an average; some people can get their dental benefits with Medicare Advantage, but many people face these issues.
“So the narrow network means they may actually end up having to see someone out of network, in which case they end up paying out-of-pocket anyway, and they don’t actually get the benefit of the supplemental benefit.
“The other thing that happens is if they do see a provider who’s in-network, they have a deductible to pay, they have to hit that amount first, and then there’s an annual cap on their benefits. So if their dental work costs $2,000, but their cap on benefits for the year is $1,000, that’s coming out of their pocket for that.
“And then there are exclusions, and as I’ve mentioned, waiting periods. So when you take all of those barriers to care into consideration, this has been studied, and the amount of money that a Medicare Advantage plan with supplemental benefits saves over a traditional Medicare plan for getting dental benefits, on average, it’s $23 a year. And it’s just ridiculous to think that you could have a plan that actually has supplemental benefits in Medicare Advantage and only save $23 over Traditional Medicare, which has zero supplemental benefits.
“That’s what we mean by paper benefit. It plays out for vision and hearing as well….”– Dr. Belinda McIntosh
So if policymakers were truly serious about health equity, what is the first thing they should change about Medicare right now, and how would that immediately improve the lives of seniors of color?
“They could institute a low cap on out-of-pocket expenses or limit out-of-pocket expenses completely. Traditional Medicare does not have an out-of-pocket maximum, which is why there’s significant financial exposure for people who don’t get Medigap. So that would change things significantly. A lot of people would choose traditional Medicare if there were a cap on costs.
“I am a part of Physicians for a National Health Program, and we advocate for single-payer health care. So what I’d like to see is zero out-of-pocket costs in traditional Medicare, but even if legislators just introduced a lower out-of-pocket maximum, like a thousand dollars, they would put traditional Medicare on the same level as these Medicare Advantage plans so that people do not go broke because they don’t have a Medigap plan.
“… The second thing that policymakers can do right away is … provide the supplemental benefits. If Traditional Medicare matched the supplemental benefits that were advertised, and to some extent provided in Medicare Advantage, that would go a very long way to even-ing the playing field.
“And the good news is there’s a lot of money already in our system that’s being used on Medicare Advantage overpayments. So something like $140 billion of overpayments are leaving CMS every year because of the fraud and tactics that the Medicare Advantage companies use to get more CMS dollars out of caring for patients who they up-code as sicker. If we were to reign in those overpayments, $140 billion a year could be redeployed and would absolutely cover putting a coverage cap on traditional Medicare spending, put supplemental benefits for everyone in traditional Medicare so that we’re not giving Medicare advantage plans, which are private insurance companies that are profiting from healthcare, a leg up in this... ”
“… I would go a step further and say that a single payer system where the delivery of care is also more standardized would make a huge difference because we know that in our system here, if you go to this hospital versus that hospital, you may have a different choice or a different outcome. A single payer healthcare system helps us to deliver care in an equitable fashion to, to everyone. And no matter their cost, no matter their race or ethnicity, no matter the zip code they live in, there’s no difference in what star rating their plan has versus another person. And so it’s really the only answer we have.” – Dr. Belinda McIntosh
Helpful Links
Physicians for a National Health Program
No Real Choices: How Medicare Advantage Fails Seniors of Color, PNHP
Support Traditional Medicare by Leveling the Playing Field with Medicare Advantage, Center for Medicare Advocacy
The Great Medicare Advantage Marketing Scam, The American Prospect
New interactive tool explores billions in excess payments to Medicare Advantage plans, Brown University School of Public Health
Kaiser’s $556M Medicare Advantage whistleblower lawsuit: 10 things to know, Becker’s ASC Review
Episode Transcript
Read the full episode transcript.
Guest Biography: Belinda McIntosh, MD
Dr. Belinda McIntosh received her medical degree from Emory University School of Medicine and has been in practice for more than 20 years, specializing in Psychiatry in Atlanta, GA.
Her clinical and research interests are in psychotic disorders and community mental health. In 2021, she shepherded a resolution through the Atlanta City Council in support of Medicare for All.
Dr. McIntosh is a Board member of Physicians for a National Health Program (PNHP). She is a co-author on a 2025 report published by PNHP entitled, “No Real Choices: How Medicare Advantage Fails Seniors of Color.”
Host Biography: Brenda Gazzar
Brenda Gazzar, the host and co-producer of Code WACK!, has produced over 300 weekly podcast episodes, topping 400,000 downloads. A skilled interviewer and storyteller, Brenda brings nuance, curiosity, and clarity to every conversation.
Brenda has worked as a multilingual and award-winning reporter with more than two decades of experience in California and the Middle East.
Her work has been published by Reuters, Ms. Magazine, USA Today, Los Angeles Daily News, the Orange County Register, The Wrap, The Jerusalem Post, Cairo Times and numerous other publications. She speaks Spanish, Hebrew, and moderate Arabic and is the recipient of national, state and regional awards.
Brenda also enjoys being a life coach, helping people align with their purpose so they feel fulfilled while achieving their boldest dreams.
Brenda’s work is grounded in a belief that systemic change and personal growth go hand in hand — and she’s here for both.
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Keywords:
Medicare Advantage, Medicare for All, privatized Medicare, health equity, seniors health, healthcare disparities, racial disparities in healthcare, seniors of color, healthcare access, healthcare inequality, medical debt, prior authorization, narrow provider networks, Medigap, Medicare Part G, The Gap Trap, healthcare policy, health insurance reform, single payer healthcare, Physicians for a National Health Program, PNHP report, healthcare justice, aging and healthcare, seniors rights, public health, structural racism in healthcare, healthcare costs, Code WACK! podcast
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