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Medicare Advantage lacking for mental health coverage

Photo: LucaLorenzelli/Getty Images

Overall buyer satisfaction with Medicare Advantage plans has elevated this 12 months, thanks largely to enhancements in billing and funds, value and supplier selection. But in line with the brand new J.D. Power 2022 U.S. Medicare Advantage Study, some regarding traits are brewing beneath the floor of these constructive numbers. 

Most notably, a majority of Medicare Advantage plan members are saying they do not have sufficient coverage for mental health and substance use dysfunction providers.

Data from the Commonwealth Fund and the National Library of Medicine exhibits an estimated 1.7 million Medicare beneficiaries residing with a identified substance use dysfunction, and about one in 4 beneficiaries residing with a mental health situation.

Older adults particularly, the examine discovered, have been affected by the loneliness and isolation which have solely elevated all through the COVID-19 pandemic. For some health plans, coverage may be improved, whereas others might have a chance to coach prospects about mental health advantages, as many beneficiaries could also be unaware of the coverage and drugs which are obtainable.


Overall, member satisfaction with Medicare Advantage plans is on the rise. Customer satisfaction clocked in at 809 on a 1,000-point scale, which is up three factors from 2021 and up 15 factors in the course of the previous 5 years.

Despite that, simply 38% of MA plan members say they’ve sufficient coverage for mental health therapy, down from 39% a 12 months in the past. Just 27% of members say they’ve sufficient coverage for substance use dysfunction providers. 

These numbers examine with 91% of members who say they’ve sufficient coverage for routine diagnostics and 89% who say they’ve sufficient coverage for preventive and wellness providers.

Telehealth utilization, in the meantime, is on the decline. Just 24% of MA plan members used telehealth in the course of the previous 12 months, down from 35% in 2021. Among those that have used the know-how, nonetheless, 48% say they’re very seemingly to make use of it once more, a rise of 5 proportion factors from final 12 months.

Health plan portals nonetheless present some promise, however breaking inertia is proving tough. A powerful majority (82%) of MA members are registered for their health plan’s member portal – up 4 proportion factors from a 12 months in the past – however 14% have registered for the portal and by no means logged in. Overall buyer satisfaction scores are 72 factors larger (823) when prospects register and log in to the portal than once they do neither (751).

Kaiser Foundation Health Plan ranks highest in Medicare Advantage plan total satisfaction, with a rating of 844. Humana (824) ranks second and Highmark (811) ranks third.


The Centers for Medicare and Medicaid Services is trying for methods to make Medicare Advantage better. The company launched a Request for Information in July searching for public touch upon the favored providing, and is searching for enter on methods to make it extra equitable, inexpensive and sustainable.

As enrollment within the Medicare Advantage program grows, so do issues and uncertainty over the earnings suppliers are reaping and whether or not “overpayment” is a matter. A report from the Brookings Institution signifies the 5 main insurers – UnitedHealthcare, Humana, Aetna, Kaiser Permanente and Elevance Health (previously Anthem) – are padding their backside traces by disguising earnings as prices. 

The report factors out that insurers are ready to do that as a result of earnings accrued via associated companies will not be regulated by medical loss ratio necessities.

Medicare Advantage plan funds are anticipated to get an 8.5% revenue increase for 2023. This is a rise over the 7.98% proposed within the February advance discover. The 2023 progress charge is ready at 4.88%.

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