Making Medicare Advantage Plans for the LGBTQ+ Community

December 12, 2022 - For generations, the LGBTQ+ community has faced discrimination in the healthcare system. Seniors in the LGBTQ+ community, in particular, have faced a lifetime of inequity and many now enter some of the most healthcare-intensive years of their lives without a strong support system.

But efforts have been underway to create a more equitable system for members of this patient population, including creating health plans that better serve the need of LGBTQ+ individuals.

Sachin Jain, MD, president and chief executive officer of SCAN Health Plan, and Jill Selby, senior vice president of product development, marketing, and market expansion at SCAN Health Plan, shared insights from building SCAN Health Plan’s Affirm, a Medicare Advantage plan designed for LGBTQ+ members.

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The payer’s leaders looked at the historical discrimination and ostracization of the LGBTQ+ community as well as the unique healthcare needs and decided to design a health plan that accommodated LGBTQ+ seniors.

“We took those statistics and basically said, ‘okay, how are we going to tackle these in a product and plan design?’ So, we were thoughtful about putting things on paper that weren’t shiny objects, but really were meaningful to the LGBTQ+ community, and made them feel like, ‘hey, this is a product that speaks to me and is going to meet the needs that I have, as someone in the healthcare space trying to get equitable access to care,’” Selby told Healthcare Strategies.

Selby highlighted four key differences between a typical Medicare Advantage plan and a plan designed for the LGBTQ+ community.

First, recognizing the high rates of mental and behavioral healthcare needs among members of the LGBTQ+ community, the health plan prioritized offering behavioral healthcare services. The plan allows members to access virtual care for behavioral health needs without requiring a primary care referral.

Second, a Medicare Advantage plan that is well-tailored to the LGBTQ+ community will include support services. For example, in the Affirm plan, SCAN Health Plan offers companionship services where a senior can have a visitor who might go to the movies or play board games with them.

Third, a Medicare Advantage plan for the LGBTQ+ community may reimburse for legal services for members.

“If someone does have an individual in their life, a relationship that has not been committed legally, we want them to get the right legal documents in place so that their loved one can make healthcare decisions on their behalf when they are unable to,” said Selby.

The final difference that Selby noted was that an LGBTQ+ health plan might lower the cost of drugs that see high utilization in the LGBTQ+ community. For example, the Affirm plan places drugs for HIV and hormone replacement medications on a lower tier to reduce the out-of-pocket costs for these treatments.

“What I'm hoping is that we are going to be a trendsetter here and that other companies will look at what we're doing and say, not only is there a great business opportunity here, but there's also an opportunity to truly serve and affirm a generation of older adults who, honestly, came of age at a time where they needed to be ashamed about who they are,” Jain told Healthcare Strategies.

“And here we are today saying, ‘you don't have to be ashamed of who you are. In fact, we have things that are built specifically for you, that are oriented around addressing your specific needs.”