Medicare Advantage Plans Have Narrow Psychiatrist Networks, Study Finds

Psychiatrist networks in Medicare Advantage plans are narrower than those in Medicaid managed care and Affordable Care Act (ACA) plans, according to a study published in Health Affairs.

As demand for mental healthcare increases among older adults, it is important to note that access to mental health coverage does not always equal access to mental health services. Too often, limited mental health provider networks can create additional barriers to care.

While state and federal policies require Medicare Advantage, Medicaid managed care, and ACA plans to monitor network adequacy, certain markets receive more attention than others around mental health network adequacy.

Researchers used a linked data set of mental health provider networks in the three markets to assess psychiatrist network breadth—the percentage of providers in a given area that are in-network for a plan. The sample included 682 Medicare Advantage networks, 167 Medicaid managed care networks, and 220 ACA plan networks across 37 states in 2019.

Psychiatrist network breadth was narrower in Medicare Advantage than in Medicaid managed care and ACA plan markets, the researchers found.

Almost two-thirds (64.6 percent) of psychiatrist networks in Medicare Advantage were narrow, meaning they had an average network breadth of less than 25 percent. Meanwhile, 43.1 percent and 39.5 percent of psychiatrist networks in Medicaid managed care and the ACA marketplace were narrow.

Psychiatrist networks were more likely to be narrow across all markets compared to other physician specialties. For example, only 20 percent of primary care and specialist networks in Medicare Advantage were narrow. Around 25 percent of primary care and specialist networks were narrow in the ACA marketplace, and about 20 percent were narrow in Medicaid managed care plans.

Among the 1,905 counties in the study, 51.4 percent had no psychiatrists participating in Medicare Advantage plans.

More than half (55.3 percent) of psychiatrists included in the study participated in all three health plan markets, which could be exacerbating access barriers.

Even though the findings illustrate a lack of mental healthcare providers in Medicare Advantage networks, they likely show an upper-bound estimate of network breadth as the data was pulled from provider directories which may not always be accurate.

For example, a secret shopper survey conducted by the Senate Finance Committee found that, of 120 provider listings across 12 Medicare Advantage health plans, 33 percent were inaccurate, non-working numbers, or resulted in unreturned calls.

Psychiatrists may be less likely to participate in insurance networks than other specialties due to the combined impacts of workforce shortages, low reimbursement, administrative barriers, and high demand for care.

Additionally, federal mental health parity rules that require health plans to offer equal coverage for mental health, medical, and surgical services do not apply to Medicare or Medicare Advantage.

The study results generate concerns about mental healthcare access, especially as Medicare Advantage enrollment grows. State and federal policymakers should work to strengthen network adequacy standards in Medicare Advantage to help facilitate access to this care, researchers said.

Additionally, policymakers should focus on increasing behavioral healthcare reimbursement, minimizing administrative burdens and payment delays, and extending the behavioral health workforce across various provider types.