Medicare Advantage Offers Better Access to Behavioral Healthcare Than FFS

Medicare Advantage plans may better equipped to provide behavioral healthcare services to Medicare beneficiaries than fee-for-service Medicare, a Better Medicare Alliance report found.

The research for the report was conducted by ATI Advisory.

“The COVID-19 pandemic has opened up long overdue conversations on behavioral health care needs. This research shows how Medicare Advantage is rising to the task and innovating to serve the more than one-third of beneficiaries who report a behavioral health condition. As a result, Medicare Advantage beneficiaries with a behavioral health condition are more likely to have a usual source of care and a single provider who knows all their medications than similar beneficiaries in fee-for-service Medicare,” said Mary Beth Donahue, president and chief executive officer of the Better Medicare Alliance.

“With continued bipartisan policy support in Washington, the Medicare Advantage community can do even more. As lawmakers consider future behavioral health reforms, this data brief offers helpful insights to inform their efforts.”

The need for behavioral and mental healthcare coverage in Medicare is clear, particularly in Medicare Advantage plans. More Medicare Advantage beneficiaries have mental health conditions than fee-for-service Medicare beneficiaries.

Thirty-one percent of Medicare Advantage beneficiaries have depression compared to 29 percent of beneficiaries in fee-for-service Medicare with depression. Eighteen percent of Medicare Advantage beneficiaries have cognitive impairment, as opposed to 17 percent of fee-for-service Medicare beneficiaries. And 14 percent of Medicare Advantage beneficiaries have serious mental illnesses compared to 13 percent of fee-for-service Medicare enrollees.

“Behavioral health care services are an essential component of whole-person, wraparound care for which Medicare Advantage is known. With a beneficiary population that is more likely to report a behavioral health condition than fee-for-service Medicare, Medicare Advantage has a unique responsibility in this area,” said Pamela Greenberg, president and chief executive officer of the Association for Behavioral Health and Wellness (ABHW). "Interestingly, ATI Advisory’s research shows that Medicare Advantage plans are indeed stepping up with solutions that identify unmet behavioral health needs and connect beneficiaries to the right care and support."

Black and Latino Medicare beneficiaries with mental health conditions face a particularly stark reality due to lower rates of diagnosis and social determinants of health barriers.

Across Medicare Advantage and traditional Medicare, a little more than half of Black beneficiaries with depressive symptoms have been diagnosed with depression. Three-quarters of Latino beneficiaries and 70 percent of Black beneficiaries who have behavioral health conditions live on less than 150 percent of the federal poverty level, while 45 percent and 48 percent of Latino and Black beneficiaries with behavioral health conditions face food insecurity, respectively.

In contrast, 70 percent of White beneficiaries with depressive symptoms have received a diagnosis, four in ten live under 150 percent of the federal poverty level, and less than a quarter of them face food insecurity.

“These findings indicate the need for diverse and innovative approaches to addressing mental health, given the strong overlap between mental health and other structural and social determinants of health,” explained Laura Benzing, lead data analyst for the study at ATI Advisory.

However, Medicare Advantage plans may be well-prepared to handle the scope of beneficiaries’ behavioral and mental healthcare needs.

Medicare Advantage beneficiaries can have access to a broader range of behavioral healthcare benefits than fee-for-service Medicare counterparts due to the Medicare Advantage supplemental benefits or care model. For example, Medicare Advantage plans may provide access to activity therapy, extra preventive care, support groups, digital solutions, and non-medical supports. All of these are benefits that fee-for-service Medicare does not cover.

The report also named three systemic barriers to access to behavioral healthcare that Medicare Advantage plans address: a low supply of behavioral healthcare providers, care coordination challenges, and treatment-focused culture that fails to incorporate the preventive care mentality into behavioral and mental healthcare.

Medicare Advantage plans have a unique ability to respond to these challenges through care coordination, care management, and more frequent screenings, the researchers stated.

For example, 94 percent of beneficiaries in Medicare Advantage plans have a usual source of care, compared of 91 percent of beneficiaries in fee-for-service Medicare. Having a usual source of care can be important for identifying members' mental and behavioral health conditions and connecting them to providers who will serve those needs. Over half of individuals who do not have a usual source of care do not get connected to mental healthcare services.

Additionally, 97 percent of Medicare Advantage beneficiaries have one provider who is aware of all of their medications, compared to 96 percent of fee-for-service Medicare beneficiaries. This is crucial for seniors who have faced a rising rate of drug-related deaths in recent years. 

The report concluded with policy measures that lawmakers could enact in order to support Medicare beneficiaries’ access to behavioral healthcare services. For example, lawmakers could increase the fee schedule for behavioral healthcare services in Medicare to help resolve the workforce shortage.

While Medicare Advantage may be well-equipped to address members’ mental and behavioral healthcare needs, the member experience may tell a different story. Medicare Advantage members reported that coverage for mental health and substance use disorder services was insufficient in a separate report.

Over three-quarters of Americans agree that health insurers have a significant responsibility for ensuring access to mental healthcare services, according to another report.