People with private Medicare coverage may not be getting the mental health services they need because they can’t find a psychiatrist in 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 equivalent to traditional Medicare. About 30 million people, a little more than half of all participants in the federal program, are enrolled in these private plans.
The researchers, in an article published Wednesday in the journal Health Affairs, found that of the plans reviewed, nearly two-thirds were narrow, with less than a quarter of available psychiatrists in the plan’s network. The networks offered under 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 to mental health services even when, on paper, there are a sufficient number of providers in a geographic region,” the researchers wrote.
The pandemic has helped reveal 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 declining health. While about one in four people enrolled in Medicare has a mental illness such as 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 pay for the care they need,” said Gretchen Jacobson, vice president of Medicare at Commonwealth. “It’s not clear that people are capable of doing that.”
The difficulty in finding a psychiatrist is not unique to Medicare Advantage policyholders, in part due to increased demand. The shortage of psychiatrists, especially those willing to accept insurance, makes it difficult for plans to find providers. Many psychiatrists also chose not to see patients under traditional Medicare, according to a recent report.
“Part of what’s happening is we have this big problem of a shortage of psychiatrists and mental health providers,” said Beth McGinty, the head of the division of health policy and economics at Weill Cornell Medicine and an author of the Commonwealth. a report “It’s exacerbated here.”
Because going out of network is expensive, many people will delay or skip treatment, said Dr. Jane M. Zhu, one of the study’s authors and an Oregon Health and Science physician. She said her own patients often had difficulty finding help.
“I referred them, but they just couldn’t 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 broad array of mental health services. “Everyone deserves access to effective, affordable and equitable mental health support,” Kristine Grow, 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 to traditional Medicare and for not examining other types of mental health services available to patients that would be provided by other clinicians or through telehealth. “Basically, this study uses a very narrow definition of a mental health clinic to prove a pre-existing Medicare Advantage thesis,” she said.
More broadly, regulators and lawmakers have expressed 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 of inadequate access to mental health services.
Senator Ron Wyden, the Oregon Democrat who heads the Senate Finance Committee, held out hearing in May about so-called “phantom networks” of mental health providers, in which many of the clinicians listed in the Medicare Advantage plans’ directories do not actually see patients. His staff did a secret shopping survey and could get an appointment only 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 probably paints a rosier picture,” she said.
Doctors may not want to participate in Medicare Advantage plans because of the low fees paid by the insurers, coupled with all the required paperwork, said Dr. Robert Trestman, who is the president of the Council on Health Systems and Financing for the Americans. Psychiatric Association and testified at the Senate hearing. “Many of the challenges and frustrations are highlighted 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 also may have an incentive to contract with a smaller group of doctors to have more control over the cost and care delivered, the researchers said.