Medicare Advantage health insurance plans don’t have many mental wellness services

Health insurance - Person seeing psychiatrist

A new study shows plan holders are struggling to find psychiatrists within their networks.

New research findings are showing that people who are covered by private sector Medicare Advantage health insurance plans are struggling to find psychiatrists and other mental wellness services within their networks.

As a result, people with private Medicare coverage might not be getting the care they require.

Over half the counties studied by the researchers did not have a psychiatrist within a Medicare Advantage health insurance plan. That plan is the counterpart in the private sector to conventional Medicare. There are about 30 million people across the United States who are enrolled in these private plans. This represents just over half the participants in the federal healthcare program.

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The researchers published their findings this month in the Health Affairs journal. They determined that of the plans they reviewed in their study, two out of every three were narrow, as less than one in four psychiatrists available in the plan’s network.

There were some health insurance plans that were found to be less restrictive than Medicare Advantage.

Under an Affordable Care Act (Obamacare) plan or Medicaid managed care, the networks offered weren’t as restricted as Medicare Advantage when it came to metal health services. They included about 40 percent of the available psychiatrists, said the researchers.

More restrictive “networks present a frustrating additional barrier in mental health services even when, on paper, there are a sufficient number of providers in a geographic region,” said the researchers.

Although about one quarter of Medicare enrollees have a mental illness such as anxiety, depression or schizophrenia, estimates from the Commonwealth Fund nonprofit group currently show that about half or fewer of those individuals are receiving treatment.

“We need systems in place so people can easily find and afford the care they need,” explained Commonwealth Fund Vice President of Medicare Gretchen Jacobson. “It’s not clear people are able to do so.”

According to a recent report, many psychiatrists have opted out of seeing not just Medicare Advantage policyholders, but any patients with traditional Medicare health insurance policies. The reason is that since the pandemic, there is an extremely high demand for psychiatrists, making it hard for anyone to find them.

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