Medicare Advantage enrollees have less access to in-network psychiatrists than members of Medicaid managed care and Affordable Care Act plans, a new study found.
The Health Affairs study, published Wednesday, was conducted by researchers at Oregon Health and Science University, Johns Hopkins University and the University of Pittsburgh. It analyzed 2019 data from multiple data sources of mental health provider networks for Medicare Advantage, Medicaid managed care and ACA markets.
The researchers discovered that nearly two-thirds of Medicare Advantage psychiatrist networks, or 64.6%, were narrow in 2019. Narrow meant that the network included fewer than 25% of the psychiatrists in the network’s service area. Comparatively, about 43.1% of Medicaid managed care networks were narrow and 39.5% of ACA Marketplaces were narrow. More than half of the counties analyzed did not have any psychiatrists participating in Medicare Advantage.
The narrow networks in Medicare Advantage is “surprising, given the attention in both research and policy that is given to mental health care access in Medicaid in particular,” the researchers said. “There is relatively little empirical evidence on mental health care access and quality in MA.”
The analysis did not find any similar differences in network breadth in primary care and other physician specialties between the three markets like it did for psychiatry. However, it did find that psychiatrist networks were narrower than primary care and specialist physicians across all three insurance types.
There are several reasons for psychiatrists not participating in insurance networks in general, including a workforce shortage, low reimbursement, administrative delays and a high demand for services. In addition, many provider directories are inaccurate, meaning that the findings are actually an overestimate of provider networks, the researchers said.
When it comes to Medicare Advantage specifically, federal mental health parity rules (which require health plans to cover mental health similarly to medical services) don’t apply to Medicare — whether it is traditional Medicare or Medicare Advantage, the report stated.
While there are state and federal efforts to improve mental health access, more needs to be done, the researchers declared.
“Given our findings of narrow psychiatrist networks across insurance markets, broader efforts to increase mental health providers’ acceptance of insurance are urgently needed,” the report said. “Ongoing state and federal efforts, including increasing behavioral health care reimbursement, reducing administrative burdens and payment delays, and extending the behavioral health workforce across a range of provider types, will be important to monitor, evaluate, and replicate where effective.”
The analysis comes at a time when the Medicare Advantage population is rapidly growing. Medicare Advantage enrollees now account for just over half of all Medicare beneficiaries: of the 59.82 million people with Medicare Part A and Part B coverage in January, 30.19 million were enrolled in Medicare Advantage plans. About one in four older adults have a mental disorder.
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