Most Medicare Advantage plans fall short on substance abuse disorder coverage

The news: While overall satisfaction with Medicare Advantage (MA) plans has increased this year, most MA members say they don’t have enough mental health and substance abuse disorder services, per J.D. Power’s 2022 US Medicare Advantage Study.

• Only 27% of members say they have enough coverage for substance use disorder services.
• By comparison, most (91%) say they have enough coverage for routine diagnostics and preventative services (89%).

The problem: The substance abuse crisis could get much worse over the next few years.

Seventy-five percent of doctors say they are already concerned about the misuse of opioids, according to a 2021 Quest Diagnostics report surveying 500 primary care doctors.

• Opioid-related deaths will likely increase in the next few years due to the increased mixing of synthetic opioids like fentanyl, per a new Northwestern Medicine analysis.

The bigger picture: The substance abuse crisis means insurance coverage will be need-to-have for MA members.

That’s because substance abuse in seniors could also worsen their health outcomes. Older adults are more likely to experience lung problems, heart problems, and memory issues. Drugs can worsen these conditions and exacerbate the already negative effects of substance abuse, per the NIH.

What’s next? We could see major MA plans tapping established digital health entrants like Bicycle Health and Pear Therapeutics to appease demand for substance use disorder services.

Virtual opioid use disorder platform Bicycle Health, for example, covers MA plans in California, Michigan, Virginia, and Washington. Its roster already includes legacy insurers like UnitedHealthcare and Aetna, according to its site.

• Humana has yet to partner with Bicycle Health. It wouldn’t be a stretch to see them pair up as the substance abuse disorder crisis intensifies.