New Medicare Advantage Plans Tailored To Fit Culture And Lifestyle


As seniors increasingly favor Medicare Advantage, three companies in Southern California are leading the way by developing innovative plans tailored to cultural and ethnic communities, complete with specialized services and practitioners fluent in native languages.

Clever Care Health Plan, headquartered in Huntington Beach, and Alignment Health, based in nearby Orange, have introduced plans tailored for Asian Americans. These plans offer additional benefits like coverage for Eastern medicines and therapies such as cupping and tui na massage. Alignment Health has also designed a plan specifically for Latinos, while SCAN Health Plan, located in Long Beach, offers a product tailored to the LGBTQ+ community. Remarkably, all these plans have been launched since 2020.

While many Medicare Advantage providers customize their advertising for different communities, these three companies stand out as pioneers, being among the first in the nation to create plans with provider networks and benefits tailored to specific cultural groups. Medicare Advantage, known for its cost-effectiveness compared to traditional Medicare, usually requires patients to utilize in-network providers.

“This fits me better,” said Clever Care member Tam Pham, 78. She is a Vietnamese American coming from Westminster, California. She spoke to KFF Health News with the help of an interpreter and she shared how much she appreciates the dental care and herbal supplement benefits that come with her plan. More importantly, this also provided her with access to a Vietnamese-speaking doctor.

“I can always get help when I call, without an interpreter,” she said.

Supporters of these culturally tailored initiatives argue that they can provide patients with trusted healthcare professionals who comprehend their distinct backgrounds and communicate in their native languages. Additionally, these plans can offer specialized products and services tailored to meet the specific needs of diverse communities. For instance, Asian Americans might require coverage for traditional Eastern treatments, whereas LGBTQ+ patients could prioritize HIV prevention or management.

However, experts in health policy point out that Medicare Advantage, while profitable for insurers, may not consistently benefit patients. This is due to the limited provider options available to them. Critics argue that introducing targeted plans might not address this issue effectively. Moreover, there are concerns that such an approach could potentially become a new avenue for discrimination.

“It’s strange to think about commodifying and profiting off people’s racial and ethnic identities,” said Naomi Zewde, an assistant professor at the UCLA Fielding School of Public Health. “We should do so with care and proceed carefully, so as not to be exploitive.”

Nevertheless, there is substantial evidence supporting the idea that patients can experience significant benefits from receiving care tailored to their race, ethnicity, or sexual orientation.

A study published in JAMA Network Open in November 2020, which analyzed nearly 118,000 patient surveys, emphasized the importance of a strong connection between physicians and patients. The study revealed that patients who shared the same racial or ethnic background as their physicians were more likely to give higher ratings to the latter. Additionally, a 2022 survey conducted by the pharmaceutical company Sanofi, involving 11,500 individuals worldwide, highlighted the enduring mistrust marginalized groups, including ethnic minorities, LGBTQ+ individuals, and people with disabilities, have in healthcare systems.

Clever Care, founded by Korean American health care executive Myong Lee, had a goal from the start to create Medicare Advantage plans for underserved Asian communities, said Peter Winston. He is the senior vice president and general manager of community and provider development at the company. “When we started enrollments, we realized there is no one ‘Asian,’ but there is Korean, Chinese, Vietnamese, Filipino, and Japanese,” Winston detailed.

The company offers distinct customer service lines based on different languages and provides members the freedom to choose how and where they utilize their allowances for benefits such as fitness programs.

According to Winston, the program started with 500 members in January 2021 and has since grown to 14,000, although it remains relatively small compared to more established plans. The benefits related to herbal supplements differ depending on the plan, but there are over 200 products commonly used by Asian clients available. These plans offer coverage of several hundred dollars per quarter for eligible products.

Sachin Jain, a physician and the CEO of SCAN Group, said its LGBTQ+ plan is also able to cater to 600 members.

“This is a group of people who, for much of their lives, lived in the shadows,” Jain added. “There is an opportunity for us as a company to help affirm them, to provide them with a special set of benefits that address unmet needs.”

SCAN encountered its own set of bias issues, with instances of hate speech posted by some employees and a long-time provider opting out of the program, according to Jain.

Alignment Health provides specialized plans for different communities. One such plan caters to Asian Americans in six California counties, offering benefits such as traditional wellness services, a grocery allowance for Asian stores, nonemergency medical transportation, and even pet care for members who have to be away from home due to hospital procedures or emergencies. Additionally, Alignment offers a plan called el Único, targeted at Latinos in parts of Arizona, Nevada, Texas, Florida, and California. In California, it is an HMO co-branded with Rite Aid, available in six counties, while in Florida and Nevada, it operates as a special needs plan for Medicare beneficiaries who also qualify for Medicaid. All of these plans come with a network of Spanish-speaking providers.

Todd Macaluso, Alignment’s Chief Growth Officer, did not disclose specific numbers but mentioned that membership in Harmony, the plan tailored for Asian Americans, and el Único in California has seen an 80% year-over-year growth since 2021. Macaluso emphasized that Alignment’s marketing efforts go beyond merely enrolling customers; they involve outreach to places where potential members shop or socialize.

“Being present there means we can see what works, what’s needed, and build it out. The Medicare-eligible population in Fresno looks very different from one in Ventura.”

“Just having materials in the same language is important, as is identifying the caller and routing them properly,” Macaluso added.

Recent research conducted for Better Medicare Alliance, a nonprofit funded by health insurers, indicates that when it comes to choosing Medicare Advantage plans, Blacks, Latinos, and Asians are significantly more inclined than white beneficiaries to opt for these plans. It’s important to note that Latino people can belong to any race or combination of races. However, the extent to which this preference will lead to the development of specialized networks remains unclear. While major insurers often tailor their Medicare Advantage marketing strategies to specific racial or ethnic communities, these plans typically do not offer any distinctive features for these groups.

Utibe Essien, an assistant professor of medicine at UCLA, highlighted the historical underrepresentation of the Black community and pointed out that the scarcity of Black physicians could pose challenges in creating targeted offerings for this population. Similarly, in many areas of the country, there might not be a sufficiently high concentration of specific ethnic or racial groups to support the establishment of dedicated networks.

Still, all three companies are optimistic about expanding this to groups that haven’t always been treated fairly by their own health care system. “If you treat them with respect, and bring care to them the way they expect it, they will come,” Winston said.