New study highlights lack of coverage and access to mental health care

Amid growing demand for mental health care, a new study finds that nearly two-thirds of Medicare Advantage psychiatrist networks contain less than 25% of all psychiatrists in a given service area.

This means that many people who have coverage through Medicare Advantage plans may not actually have access to psychiatrists, given how few people are considered in-network.”

Jane Chu, MD, lead author, assistant professor of medicine (general internal medicine and geriatrics), Oregon Health & Science University College of Medicine

The research was published today in the July issue of the journal Health Affairs.

Medicare is the federal health insurance program for people 65 years of age or older. Medicare Advantage, which covers 28 million Americans through private insurance plans supported by Medicare, has a narrower network of psychiatrists available to patients than those covered by Medicaid managed care or through insurance plans in The Affordable Care Act. Insurance plans often contract with groups of providers -; considered “inside the network” – ; To provide services to registrants.

The researchers built a national dataset of health plan networks, their service areas and participating providers in 2019.

The new study is the latest in a series of findings that highlight a lack of coverage and access to mental health care nationwide. Provider networks are one of the most important means of access, and Zhu noted that the new study likely underestimates the scale of the problem.

“It is likely that the picture is rosier than the reality,” Zhou said. “We know that the actual number of psychiatrists available to see patients is much lower.”

That’s because even if a psychiatrist is technically within the network, Chu said the general national shortage of psychiatrists means many are already fully booked and not accepting new patients. This could translate into higher out-of-pocket costs, delays in care, or missed treatment, she said.

For Zhu, these findings suggest that it is necessary for insurance companies to incentivize more psychiatrists and mental health professionals to accept health insurance, or to expand coverage of services provided by other healthcare professionals such as psychologists, counselors, or primary care physicians who provide mental health care.

In some of the areas examined in this latest study, the picture is even more horrifying, with not a single psychiatrist accepting Medicare Advantage insurance for patients.

“More than half of the counties for which we have data did not have any [Medicare Advantage]—an associate psychiatrist,” the authors write. Our results provide upper limit estimates of network breadth, raising concerns about MS enrollees’ access to mental health services amid the increasing prevalence of mental health conditions among older adults. “

In addition to Chu, co-authors included Mark Katz Messelbach, Ph.D., Daniel Polsky, Ph.D., of Johns Hopkins University, and Coleman-Drake, Ph.D., of the University of Pittsburgh.

The research was supported by NIH National Institute of Mental Health Award K08MH123624; Agency for Healthcare Research and Quality Award T32HS00029; and National Institute on Drug Abuse of NIH Award K01DA051761. The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the AHRQ.