Analysis Flags Potential Medicare Advantage Access Issues for Mental Health Care

A new analysis of patterns of mental health care access for people switching from Medicare Advantage (MA) to Original Medicare (OM) shows a small but meaningful increase in mental health care use after the switch. This may reveal that the networks for mental health practitioners in MA plans are inadequate.

People Accessed More Mental Health Care in Original Medicare

The researchers followed a sampling of MA enrollees who had at least one mental health visit, then switched to OM and had at least one mental health visit. The analysis revealed that the switchers accessed more mental health care in OM, with a marked increase in such visits to nurse practitioners and decreased visits with internal medicine and emergency medicine specialties. The researchers flag that the patterns may point to broader access to psychiatrists and non-physician providers in OM.

The patterns may point to broader access to psychiatrists and non-physician providers in Original Medicare.

The researchers also note that many people would not be identified through their methods. For example, they used data that allowed them to track health care utilization, which is an imperfect proxy for demand. And because they only compare people who had a mental health visit in MA and a subsequent visit in OM, they would not be capturing those who wanted but could not access care.

Adequate Networks Are Vital

Compared to OM, MA networks generally limit enrollees’ access to providers. A recent KFF analysis found that MA enrollees had access to around half (48%) of the providers that OM enrollees could see in 2022.

Since most MA plans require enrollees to pay more for care received outside of the network, having access to in-network providers is vital. Access to timely care is especially important for many people seeking help for mental health conditions who may be discouraged by roadblocks.

Plans May Disguise Inadequate Mental Health Networks

Despite this need for adequate networks, a recent Department of Health and Human Services Office of Inspector General (OIG) report showed that many plans have limited networks of mental health practitioners. Even more troubling, the plans list inactive providers in directories; OIG found that more than half of the mental health providers listed as being part of MA networks were inactive.

More than half of the mental health providers listed as being part of Medicare Advantage networks were inactive.

Oversight Must Hold Medicare Advantage Plans to Account

These numbers show the need for rigorous oversight to safeguard MA enrollees’ access to care, given the potential for inadequate networks and inaccurate directories to create barriers and harms for people with Medicare.

At Medicare Rights, we are deeply committed to ensuring that Medicare and taxpayers get what they pay for, and that enrollees get what they need. To realize a more reliable and appropriate system, insufficient networks and incorrect plan materials must be rooted out and prevented from endangering beneficiary access to care.