Medicare benefit plans offer few psychiatrists
People with private Medicare coverage may not get the mental health care they need because they can’t 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 counterpart of traditional Medicare in the private sector. about 30 million people, just over half of all federal program participants are enrolled in these private plans.
The researchers found in a paper published Wednesday in the journal Health Affairs that of plans reviewed, nearly two-thirds were narrow, with less than a quarter of available psychiatrists in a plan’s network. The networks offered under an Obamacare plan or Medicaid-administered care were not as restrictive, covering about 40 percent of available psychiatrists, according to the study.
The more limited “networks present a frustrating additional barrier in mental health care even when, on paper, there are enough providers in a geographic region,” the researchers wrote.
The pandemic helped expose a widespread need for mental health care among older Americans, many of whom struggle with loneliness, the loss of a loved one or their own deteriorating health. While about one in four people who enroll in Medicare have a mental health condition such as depression, anxiety or schizophrenia, an estimated half or fewer receive treatment, according to a recent survey. analysis of mental health care by the Commonwealth Fund, a non-profit organization.
“We need systems 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 humans are capable of that.”
The difficulty of 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 chosen not to see patients under traditional Medicare, according to one recent report.
“Part of what’s going on is we have this big problem of a shortage of psychiatrists and mental health providers,” said Beth McGinty, chief of the division of health policy and economics at Weill Cornell Medicine and the author of the Commonwealth report. “It’s gotten worse 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 a family physician at Oregon Health and Science University. She said her own patients often struggled to find help.
“I referred them, but they just couldn’t access mental health providers,” said Dr. Zhu. One of her patients called more than a dozen providers before getting an appointment, she said.
Insurers say their goal is to offer a wide variety of mental health services. “Everyone deserves access to effective, affordable and equitable mental health care,” Kristine Grow, a spokeswoman for AHIP, a trade group that represents 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. “Essentially, 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 legislators have raised concerns that people in 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 care.
Senator Ron Wyden, the Oregon Democrat who heads the Senate Finance Committee, stood his ground a hearing in May about so-called “ghost networks” of mental health providers, in which many of the clinicians listed in Medicare Advantage plans do not, in fact, accept patients. His staff conducted a secret customer survey and were only able to get an appointment 18 percent of the time.
The Health Affairs study may have exaggerated the availability of psychiatrists because it only looked at which providers were in the plan’s directory, said Dr. Zhu. “It probably paints a rosier picture,” she said.
Doctors may not be willing to participate in Medicare Advantage plans because of the low payments paid by the insurers, coupled with all the required paperwork, said Dr. Robert Trestman, chairman of the board on healthcare systems and funding for the American 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 may also provide an incentive to contract with a smaller group of doctors to have more control over costs and the care provided, the researchers said.