People with private Medicare coverage may not get the mental health services they need because they can’t find a psychiatrist within their plan’s network, according to New study.
More than half of the counties the researchers studied did not have a single psychiatrist participating in the Medicare Advantage plan, the private sector counterpart to traditional Medicare. about 30 million people, Just over half Of all federal program participants, enrolled in these private plans.
Researchers found, in an article published Wednesday in the Journal of Health Affairs, that nearly two-thirds of the plans reviewed were parochial, with less than a quarter of available psychiatrists in the plan’s network. According to the study, networks provided under Obamacare or Medicaid managed care were not restricted and included about 40 percent of available psychiatrists.
“Limited networks represent an additional frustrating barrier in mental health services even when there are, on paper, a sufficient number of providers in a geographic area,” the researchers write.
The pandemic has helped expose the widespread need for mental health services among older Americans, many of whom struggle with loneliness, the loss of a loved one, or poor health. While one in four people enrolled in Medicare suffers from a mental illness such as depression, anxiety, or schizophrenia, half or fewer are receiving treatment, according to a recent report. analysis of mental health coverage by the Commonwealth Fund, a non-profit group.
“We need systems in place so people can easily find and cost the care they need,” said Gretchen Jacobson, vice president for Medicare for the Commonwealth. “It is not clear that people are able to do that.”
The difficulty of finding a psychiatrist is not limited to Medicare Advantage policyholders, in part because of the increased demand. The dearth of psychiatrists, especially those willing to accept insurance, makes it difficult for plans to find providers. Many psychiatrists also choose not to see patients in a conventional medical care setting, according to the Modern report.
said Beth McGuinty, chair of health policy and economics at Weill Cornell Medical College and author of the Commonwealth Report. “It’s getting worse here.”
Because going off the grid is costly, many people will delay or skip treatment, said Dr. Jen M. Chu, one of the study’s authors and a primary care physician at Oregon Health & Science University. She said her patients often have a hard time finding help.
“I was referring them abroad, but they couldn’t access any mental health providers,” said Dr. Chu. She said one of her patients called more than a dozen providers before getting an appointment.
Insurance companies say their goal is to provide a wide range of mental health services. “Everyone deserves access to effective, affordable, and equitable mental health support,” Kristen Gro, a spokeswoman for AHIP, a trade group that represents insurance companies, said in an email.
But Ms. Grou criticized the Health Affairs study for not comparing plans with traditional Medicare and not examining other types of mental health services available to patients that could be provided by other doctors or by telehealth. “In essence, this study uses a very narrow definition of a mental health clinician to establish a pre-existing thesis about the Medicare advantage,” she said.
More broadly, regulators and lawmakers have expressed concerns that people on private Medicare plans may not get the services they are entitled to under the federal program. Critics have long complained about inadequate access to mental health services.
Sen. Ron Wyden, the Oregon Democrat who leads the Senate Finance Committee Listening session in May about so-called “phantom networks” of mental health providers, in which many physicians listed in Medicare Advantage plan directories don’t actually accept patients. His staff secretly surveyed shoppers and only managed to get them an appointment 18 percent of the time.
Dr. Chu said the Health Affairs study may have overestimated the availability of psychiatrists because it only looked at providers listed in the plan’s directory. “It would probably paint a rosier picture,” she said.
Dr. Robert Trestman, president of the Council on Health Care Systems and Financing, said the American Psychiatric Association and testified at the Senate hearing. “Many of the challenges and frustrations with Medicare Advantage plans are underscored,” he said.
The researchers said some insurance companies pay psychiatrists less under their Medicare Advantage plans than traditional Medicare pays for the same services. 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 provided.