Some lawmakers are concerned about access to behavioral care in Medicare Advantage.
In an Oct. 18 hearing on Medicare Advantage open enrollment, Sen. Debbie Stabenow, a Michigan Democrat, said disparities between mental healthcare and physical healthcare still persist, despite federal parity requirements.
"We know that there's so many barriers put up under Medicare Advantage plans — prior authorizations, required referrals and so on," Ms. Stabenow said.
Christina Reeg, program director of the Ohio Senior Health Insurance Information Program, said it is important for Medicare recipients to understand how mental health providers fit into a MA plan's network before they enroll.
"Where a lot of consumers miss this education piece is knowing if there's a prior authorization situation where they have to have a relationship with their primary care physician as a gateway to that specialty care," she said.
Many Medicare Advantage plans have narrow networks for psychiatrists, containing less than 25% of providers in a market, when compared to Medicaid managed care and ACA plans, a study published in the July issue of Health Affairs found.
Lawmakers have also raised concerns about behavioral "ghost networks" in Medicare Advantage. Ghost networks refer to providers listed as in network on an insurers' website but are no longer in network, accepting new patients or in business.
"I still am so concerned, in general, that we look at mental health and addiction services as somehow specialty care. Healthcare above the neck should be the same as healthcare below the neck," Ms. Stabenow said.