The majority of Medicare Advantage plans significantly limit access to psychiatrists, as their psychiatrist networks encompass less than 25 percent of all available psychiatrists in a given area, according to a study published July 5 in Health Affairs.
Twenty-eight million Americans with Medicare Advantage plans are facing scarcer access to psychiatrists than individuals covered by Medicaid managed care or by insurance plans in the Affordable Care Act, according to the study.
Researchers from Portland-based Oregon Health & Science University and Baltimore-based Johns Hopkins University created a data set that connected network service areas, plans and providers to reveal the extent of psychiatrist network coverage for different plans in a given area. The research compared the psychiatrist network scope across three different markets: Medicare Advantage, Medicaid managed care and Affordable Care Act plans.
The study revealed the percentage of psychiatrists that are in network for two-thirds of networks covered by Medicare Advantage was significantly narrow, comprising only 25 percent of the total providers in that given area. In comparison, 40 percent of Medicaid managed care and Affordable Care Act plan networks were similarly narrow in a given area, according to the study.
"More than half of the counties for which we had data did not have a single [Medicare Advantage]-participating psychiatrist," authors of the research told News Medical.
Even with the small percentage of psychiatrists considered in network, the researchers know the realistic number is significantly lower, according to Jane Zhu, MD, lead author of the study and assistant professor of medicine at the School of Medicine at Oregon Health & Science University. Dr. Zhu and other researchers express concerns surrounding the potentially dangerous effects that a significant lack of mental health services resources may have on Medical Advantage enrollees, as mental health conditions among older adults are becoming more prominent.
With mental health disorders on the rise and a growing pressure to fix the national shortage of psychiatrists, many psychiatrists who are technically in network may not have the capacity to take new patients. The potential effects of a narrow scope of Medicare Advantage psychiatrist networks becoming even narrower from the shortage is likely to result in higher out-of-pocket costs, delays in care or abandoning care altogether, Dr. Zhu told News Medical.