Spike in Number of Medicare Advantage Plans Offering Special Services to Beneficiaries with Behavioral Conditions

The number of Medicare Advantage (MA) plans offering special benefits to beneficiaries with behavioral health issues has spiked dramatically in the past year, according to a new analysis from the actuarial consulting firm Milliman.  

Specifically, the report, which was commissioned by the Better Medicare Alliance (BMA), shows that 135 MA plans are using Special Supplemental Benefits for the Chronically Ill (SSBCI) for behavioral health diagnoses such as anxiety, depression or substance use disorder (SUD). In the year prior, only five plans nationwide provided reduced cost-sharing and/or additional benefits related to behavioral health.

That spike represents a 27-fold increase between 2020 and 2021, with COVID-19 and the impact it’s had on the nation’s mental health leading the charge.

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“This analysis provides unique insight into the ways that Medicare Advantage continues to innovate and enhance benefit offerings, even in the face of the extraordinary circumstances presented by the COVID-19 pandemic,” Allyson Y. Schwartz, President and CEO of the Better Medicare Alliance, said in a statement. “In 2021, benefits like vision, hearing, fitness and dental care that remain unavailable in Traditional Medicare became nearly universal in Medicare Advantage.”

Like vision and hearing benefits, many behavioral health benefits are unavailable to beneficiaries with traditional Medicare. Unlike the rest of the U.S. health care system, the program is not bound by the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2018.

In fact, Medicare has a 190-day lifetime limit on inpatient mental health care and a very low number of participating psychiatrists. Plus, it has little in the way of addiction benefits, despite the fact that the Medicare population has the fastest-growing prevalence of opioid use disorder (OUD) in the U.S.

Meanwhile, Medicare Advantage — a type of health insurance that provides Medicare benefits through private health insurers — is bound by MHPAEA. Plus, MA plans give beneficiaries perks in the form of both traditional supplemental benefits, which are primarily health-related benefits unavailable in normal Medicare, and SSBCI, which are non-primarily health-related benefits for certain chronically ill beneficiaries.

Behavioral health isn’t the only receiving increased MA attention. Overall, supplemental benefits grew in 36 out of 41 categories for 2021. That includes growth in 15 out of 17 traditional supplemental benefit categories, 4 out of 5 expanded supplemental benefit categories and 17 out of 19 SSBCI categories.

“More than 500 Medicare Advantage plans provide reduced cost-sharing, expanded benefits, or some combination of the two in order to help meet the needs of over 2.2 million beneficiaries,” Schwartz said. “Diabetics, those facing behavioral health challenges, and beneficiaries with congestive heart failure and COPD are among those most helped by this important flexibility.”

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