Some Medicare Users May Lack Crucial Mental Health Access, New Report Finds

Fact checked by Nick Blackmer

• Some Medicare Advantage Plan users are facing a scarcity of psychiatric options, a new report finds.

• More than 31 million U.S. adults are enrolled in some type of Medicare Advantage Plan.

• Experts note older adults are already a vulnerable population within the mental health space, and shedding light on a lack of care is crucial to spark important change.

Some Medicare users are facing a lack of psychiatric care coverage.

More than 31 million older adults in the United States are enrolled in Medicare Advantage (MA) Plans. These plans are offered by private companies that Medicare approves. Medicare then pays these private entities to cover a user’s Medicare benefits.

A new report has shed light on a potential disadvantage of these private Medicare alternatives—those enrolled might not be receiving certain mental health support given a scarcity of psychiatrists covered under in-network services.

The new research was published earlier this month. The research team looked at data examining psychiatrists’ “network breadth”—how many providers are in a given area and are “in-network” for a given plan—across Medicare Advantage, Medicaid managed care, and Affordable Care Act plan markets.

The researchers’ data showed that almost two-thirds of psychiatrist networks in Medicaid Advantage plans “contained fewer than 25 percent of providers in a network’s service area.” This is a stark contrast to Medicaid managed care and Affordable Care Act (popularly known as “Obamacare”) plan markets that contained about 40 percent of providers in a given network service area.

The research suggests that a relatively large proportion of Medicare-eligible older adults who are on these private plans might not be getting the mental health services they need with ease.

Study author Jane M. Zhu, MD, MPP, MSHP, a primary care physician and associate professor of medicine in the Division of General Internal Medicine at Oregon Health & Science University, told Health that given Medicaid “often receives a lot of research and policy attention for mental health access gaps,” it was “surprising to see narrower networks in Medicare Advantage.”

Medicare Lacks Psychiatric Care in General

As of the most recent Centers for Medicare and Medicaid Services (CMS) data, more than 31 million American adults are enrolled in some kind of Medicare Advantage Plan.

Zhu noted that Medicare Advantage programs “are managed care plans,” meaning that “they contract with sets of providers and facilities to deliver care to enrollees.” Traditional Medicare, by contrast, “does not use provider networks, meaning that any traditional Medicare enrollee can access any provider that accepts Medicare.”

Typically, someone enrolled in a Medicare Advantage Plan is usually willing to tolerate a more restrictive network for lower premiums.

While Zhu noted that “there are systemic issues” that affect all insurance markets and the mental health care supply, concerns over Medicare Advantage’s “narrower provider networks” is very real.

She said that while a lack of one resource is an issue, it’s possible that MA Plans emphasize different types of providers—like a broader network of primary care physicians or mental health nurses, for example, instead of psychiatrists.

Michael L. Barnett, MD, MS, an associate professor of Health Policy and Management at Harvard T. H. Chan School of Public Health, explained that access to mental health professionals through Medicare Fee-For-Service (FFS)—the traditional Medicare programs—hasn’t been very promising in general, separate from these numbers seen with the private programs.

He said that as recently as 2019, just 60% of psychiatrists were taking new Medicare patients at all, “which is not very good.”

“In general, psychiatry participation in Medicare FFS has been falling over time, and this paper suggests that the problems may be just as bad or worse in MA, though there is no direct comparison,” said Barnett, who is unaffiliated with the recent report.

The Mental Health Needs of Medicare Users

The mental health crisis, especially amidst the global COVID-19 pandemic, has been an active topic of conversation for the past few years.

In a 2022 piece, Joel Miller, Chair of the National Coalition on Mental Health and Aging, detailed that fewer than 50% of older adults with mental and/or substance use disorders receive treatment and that “older adults in America are facing a mental health crisis due to lack of access to Medicare providers and needed services.”

“This provider shortage persists as uncertainty surrounding the COVID-19 pandemic has resulted in significant increases in anxiety and depressive disorders among older adults,” Miller wrote.

Approximately 20 million older adults have reported these mental health disorders since April 2020.

“It takes a lot of effort to find a new psychiatrist, as anyone who has tried for themselves or a family knows. Narrow networks compound this problem,” Barnett said. “This is a major impediment to any national effort to improve mental health for older adults.”

He added that many of these older adults find themselves in particularly vulnerable situations, many of whom find themselves to be the most isolated in society, and often might “have more difficulty navigating complicated networks.”

“Older adults are also less likely to seek care for mental health conditions, to experience stigma, and to have other types of barriers to care—transportation, caregiving, etc.—that may compound this issue,” Zhu said.

Accessing Mental Health Care for Older Adults

When asked if there is an easy solution for an older adult who is on one of these Medicare Advantage plans but can’t seem to find a psychiatrist in their network, Barnett said “the ultimate workaround for anyone is to just pay cash for someone close by.”

That reality of, course brings, with it immense financial barriers for many.

“But that is much too expensive for most Americans,” he added. “There are other providers who may be more easily accessible who can provide excellent mental health care within their scope of practice: primary care physicians, psychiatrist NPs [nurse practitioners], psychologists, and social workers, to name a few.”

Zhu echoed those thoughts. A narrower provider network is going to force people to seek out-of-network care.

“Those with MA plans—or who are considering switching to MA—should make sure that their actual or desired plan covers their current mental health professional or has a set of mental health professionals in-network who accept their insurance,” she said.

Looking ahead, Zhu said that she and her colleagues will be looking at multiple things, “including the effects of provider networks on care outcomes for people with mental health conditions” as well as the factors that could potentially induce more provider acceptance of insurance.

As mental health services are increasingly in demand, shedding a spotlight on solutions for ways to improve access will become ever more important.

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