Medicare Advantage Plans Offer Few Psychiatrists

People with private Medicare coverage may not be getting the mental health services they need because they cannot find a psychiatrist within their plan’s network, according to a new study.

More than half of the counties the researchers studied did not have a single psychiatrist participating in a Medicare Advantage plan, the private-sector counterpart to traditional Medicare. Some 30 million people, just over half of all participants in the federal program, are enrolled in these private plans.

The researchers, in an article published on Wednesday in the journal Health Affairs, found that of the plans reviewed, nearly two-thirds were narrow, with fewer than a quarter of available psychiatrists in a plan’s network. The networks offered under either an Obamacare plan or Medicaid managed care were not as restrictive and included about 40 percent of the available psychiatrists, according to the study.

The more limited “networks present a frustrating additional barrier in mental health services even when, on paper, there are a sufficient number of providers in a geographic region,” the researchers wrote.

The pandemic helped expose a widespread need for mental health services among older Americans, many of whom are struggling with loneliness, the loss of a loved one or their own deteriorating health. While roughly one in four people enrolled in Medicare has a mental illness like depression, anxiety or schizophrenia, an estimated half or fewer receive treatment, according to a recent analysis of mental health coverage by the Commonwealth Fund, a nonprofit group.

“We need systems in place so people can easily find and afford the care they need,” said Gretchen Jacobson, vice president of Medicare at Commonwealth. “It’s not clear people are able to do so.”

The difficulty in finding a psychiatrist is not unique to Medicare Advantage policyholders, in part because of increased demand. The scarcity of psychiatrists, particularly those willing to accept insurance, makes it difficult for plans to find providers. Many psychiatrists have also opted out of seeing patients under traditional Medicare, according to a recent report.

“Part of what is going on is we have this big problem of a shortage of psychiatrists and mental health providers writ large,” said Beth McGinty, the chief of the division of health policy and economics at Weill Cornell Medicine and the author of the Commonwealth report. “It is exacerbated here.”

Because going out of network is costly, many people will delay or skip treatment, said Dr. Jane M. Zhu, one of the study’s authors and a primary care physician at Oregon Health and Science University. She said her own patients often had difficulty finding help.

“I was referring them out, but they could just not get access to any mental health providers,” Dr. Zhu said. One of her patients called more than a dozen providers before getting an appointment, she said.

Insurers say their goal is to provide a wide array of mental health services. “Everyone deserves access to effective, affordable and equitable mental health support,” Kristine Grow, a spokeswoman for AHIP, a trade group representing the insurers, said in an email.

But Ms. Grow criticized the Health Affairs study for not comparing the plans with traditional Medicare and for not examining other types of mental health services available to patients that would be provided by other clinicians or via telehealth. “In essence, this study uses a very narrow definition of mental health clinician to prove a pre-existing thesis about Medicare Advantage,” she said.

More broadly, regulators and lawmakers have voiced concerns that people in the private Medicare plans may not be getting the services they are entitled to under the federal program. Critics have long complained about inadequate access to mental health services.

Senator Ron Wyden, the Oregon Democrat who leads the Senate Finance Committee, held a hearing in May about so-called “ghost networks” of mental health providers, in which many of the clinicians listed in the Medicare Advantage plans’ directories are not, in fact, accepting patients. His staff conducted a secret shopper survey and could only obtain an appointment 18 percent of the time.

The Health Affairs study may have overstated the availability of psychiatrists because it only looked at which providers were listed in the plan’s directory, Dr. Zhu said. “It likely paints a rosier picture,” she said.

Doctors may be unwilling to participate in Medicare Advantage plans because of the low payments paid by the insurers, coupled with all of the required paperwork, said Dr. Robert Trestman, who is the chairman of the council on health care systems and financing for the American Psychiatric Association and testified at the Senate hearing. “Many of the challenges and frustrations are emphasized in the Medicare Advantage plans,” he said.

Some insurers pay psychiatrists less under their Medicare Advantage plans than traditional Medicare pays for the same services, the researchers said. The plans may also have an incentive to contract with a smaller group of doctors to have more control over the cost and care being delivered, the researchers said.