“I had been referring them to other providers, but my patients were still unable to access any mental health services,” explained Dr. Zhu. She recounted that one patient had to call over a dozen providers before finally securing an appointment.
Insurers assert that their aim is to offer a wide range of mental health services. Kristine Grow, a spokeswoman for AHIP, a trade group representing the insurers, affirmed, “Everyone deserves access to effective, affordable, and equitable mental health support.”
However, Ms. Grow criticized the Health Affairs study for its failure to compare the plans with traditional Medicare and its exclusion of other mental health services provided by different clinicians or through telehealth. She argued, “Essentially, this study uses a narrow definition of mental health clinician to support a pre-existing thesis about Medicare Advantage.”
More broadly, regulators and lawmakers have expressed concerns about potential inadequacies in the services provided to individuals under private Medicare plans. Insufficient access to mental health services has been a longstanding issue.
In May, Senator Ron Wyden, the Oregon Democrat who chairs the Senate Finance Committee, conducted a hearing on “ghost networks” of mental health providers, where many listed clinicians in Medicare Advantage plans’ directories were found to be unavailable for appointments. A secret shopper survey conducted by his staff revealed that appointments were only obtainable 18% of the time.
According to Dr. Zhu, the Health Affairs study may have exaggerated the availability of psychiatrists, as it solely relied on the information listed in the plan’s directory. She remarked, “It likely presents a more favorable view.”
Dr. Robert Trestman, Chairman of the Council on Health Care Systems and Financing for the American Psychiatric Association, who testified at the Senate hearing, suggested that doctors may be hesitant to participate in Medicare Advantage plans due to the insurers’ low payments and excessive administrative burden. He noted, “Many of the challenges and frustrations are amplified within the Medicare Advantage plans.”
The researchers highlighted that some insurers pay psychiatrists less under their Medicare Advantage plans compared to traditional Medicare for the same services. Additionally, these plans may prefer to contract with a smaller group of doctors to exert greater control over costs and care delivery.
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