Medicare gives people 65 and older greater access to doctors and health insurance. But this state-run program didn’t wipe out racial and ethnic disparities in medical care. Members of marginalized communities still bear a greater burden when it comes to illnesses and economic challenges.
“Medicare has helped tremendously to level the playing field, but there are still some holes,” says Muriel Jean-Jacques, MD, associate vice chair for diversity, equity, and inclusion in the Department of Medicine at Northwestern University Feinberg School of Medicine. “And that stems beyond insurance coverage or cost.”
But there are steps you can take to get good medical care. Here’s how to advocate for yourself if you’re a person of color on Medicare.
Ask for Help Paying for Medical Care
Many older people of color live with long-term or serious medical conditions. But compared to some other races and ethnicities, Black or Hispanic people are less likely to have savings or supplemental insurance coverage to pay out-of-pocket costs to treat those health problems.
And while many older people live on fixed budgets, people of color often face greater economic challenges and other barriers due to racism.
But if you have financial problems, Jean-Jacques says, there’s no reason to hide that from your doctor. Your care team can help you find ways to cover your costs without interrupting your health care.
“This is important because many people go years skimping on their medication and not taking it for several months or taking half-doses,” she says, “when actually they’re eligible for some support programs that would allow them to continue access to their medication and to do so more affordably.”
Ask to speak with a social worker or health advocate at your hospital or doctor’s office. They may be able to point you toward national or local programs that can help.
Here are some things they might suggest:
Prescription assistance. Many older people buy Medicare Part D to pay for their medication. But that’s not your only option, and sometimes it’s not the most affordable one. That’s why Jean-Jacques urges older people to ask their health care team about drug assistance programs.
You might be able to get help paying for your medications through:
Medicare’s Part D “Extra Help” low-income subsidyState assistance programsDrugmakersDrug discount cards
But Medicare recipients are not eligible for some of these programs, so be sure to ask questions.
Ask about extra health coverage. Many people choose to add on a private health insurance plan to lower out-of-pocket costs that aren’t covered by Medicare. But people of color are less likely to have certain types of backup insurance, including supplemental coverage (Medigap).
Tonya Moody, a Medicare and Medicaid expert with the managed care health plan AmeriHealth Caritas Pennsylvania, says people sometimes think traditional Medicare covers everything. “But they may have to add on a supplemental plan to help support the health care that they need,” she says.
Look into Medicaid. Some people are “dual eligible,” Moody says. That means you can get health care coverage through both Medicare and Medicaid. But this depends on how much money you bring in every month. Find out whether you qualify for low-income health coverage through HealthCare.gov or Medicaid.gov.
Learn More About How to Make Medicare Work for You
You might find it easier to advocate for yourself if you know more about your Medicare benefits. Your doctor may be able to answer some of your basic questions, “but I usually send them to our social work team first,” Jean-Jacques says.
If you don’t have a social worker on your medical team, contact your local State Health Insurance Assistance Program (SHIP) to talk about your health needs. A licensed Medicare broker approved by the National Council on Aging could be another resource.
Here are some questions to get you started:
Is my cane or wheelchair covered?How can I get meals paid for?Who can help me pay my rent and utilities?Can I get low- or no-cost transportation services? What kind of medical benefits does Medicare pay for?What are out-of-pocket costs? And how much might I have to pay each year?What supportive equipment can I get with my benefits?
You can also ask something like: What I really need is to get down a long hallway in order to fix meals and there’s no room for a motorized wheelchair. I think a walker would be better. Is that something I can get covered under Medicare?
But you don’t need to have every possible question in mind when you talk to a social worker or another type of benefits adviser. Your health care team should work with you to navigate “this way-too-complicated system,” Jean-Jacques says.
Find a Doctor You Trust
Many people feel more comfortable when they see a doctor of the same race or ethnicity, but that’s not always possible if you’re a person of color. “We still have a ways to go in terms of diversifying our workforce,” Jean-Jacques says.
There are ways to spot a compassionate provider, though. According to Jean-Jacques, the doctor or nurse should:
Say hello when they walk in.Call you by name and look you in the eye.Make you feel like a partner in your medical care.Give you clear advice about all your treatment options. Validate your symptoms.
Your doctor should fully grasp how your symptoms affect your daily life. “That’s one area where self-advocacy is very important,” Jean-Jacques says.
How to Advocate for Yourself
According to Abbe Udochi, a certified senior adviser and board member of the Aging Life Care Association, older people of color often feel dismissed and demeaned when they go to the doctor, especially Black women.
“They often feel as though they are not seen and are not heard,” she says, “as if society sees you as someone who has receded into the background.”
But there are ways to make the most of your medical appointments. Finding someone to go with you is a good first step.
A family member, friend, church member, or professional advocate like a geriatric care manager can provide another set of eyes and ears at your appointment, Udochi says. This can be a big help if you’re nervous, don’t feel well, or have more than one medical issue.
“As we age, it can be more challenging to speak up and to defend yourself,” she says. “And if you have vision problems, hearing problems, or mild cognitive decline, it can be hard to perceive all of the things that are happening around you. That’s when having support is a necessity.”
Also, pay attention to how well your provider pays attention to you, Udochi says. Is the doctor or nurse answering the question you asked or explaining things in a way you understand? Are they responding to your complaints of pain or other health issues adequately? If not, speak up.
Bias exists in many institutions. That’s why Udochi urges older people of color to speak up when they feel their provider isn’t taking their health concerns seriously. Your support person can also watch out for you and advocate on your behalf.
“Those preconceived notions about you or your condition should be corrected in the space with the physician,” she says. “But sometimes you need someone next to you to cue you or ask that extra question.”
Photo Credit: shapecharge / Getty Images
SOURCES:
Muriel Jean-Jacques, MD, associate vice chair for diversity, equity, and inclusion, Department of Medicine, and associate professor of medicine (general internal medicine), Northwestern University Feinberg School of Medicine, Evanston, IL.
Tonya Moody, vice president, AmeriHealth Caritas Pennsylvania Medicare VIP plans, Harrisburg, PA.
Abbe Udochi, certified senior adviser and CEO, Concierge Healthcare Consulting; board member, New York Aging Life Care Association, Rochelle, NY.
JAMA Internal Medicine: “Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years.”
Henry J. Kaiser Family Foundation (KFF): “Medicare and Minority Americans,” “Racial and Ethnic Health Inequities and Medicare.”
National Council on Aging: “Prescription Assistance for Older Adults,” “Medicare Part D: How to Get ‘Extra Help’ Paying for Prescriptions,” “What is a Medicare Broker and Why Should You Consider Talking to One?” “Get expert help understanding your Medicare Plan options.”
State Health Insurance Assistance Program (SHIP): “Local Medicare Help.”
HealthCare.gov: “Saving money on health insurance: Income levels & savings.”
Medicaid.gov: “Select Your State for Medicaid Eligibility or to Apply for Coverage.”
UW Medicine: “Blocking Bias: How to Speak Up For Your Health.”
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