Medicare Advantage Psychiatric Networks Limited Compared to Medicaid, Exchange Plans

Psychiatry networks in Medicare Advantage plans are more limited than in Medicaid or individual health exchange plans.

A study by researchers at Oregon Health & Science University (OHSU), Johns Hopkins University and the University of Pittsburgh found that 65% of Medicare Advantage plans had psychiatrist networks that were considered narrow or included fewer than 25% of a service area’s psychiatrists.

By comparison, 43% of Medicaid managed care plans and about 40% of exchange plans had narrow psychiatrist networks.

Regardless of plan type, psychiatrist networks were narrower than those of other provider types. Primary care physicians and specialists see the share of narrow networks limited to about 20% to 30%.

The study examined 682 Medicare Advantage networks, 167 Medicaid managed care networks, and 220 exchange plan networks in 37 states in 2019. 

“Psychiatrist networks not only were limited but also were much more limited in MA than in Medicaid managed care and ACA plan markets,” the study noted. “This finding is surprising, given the attention in both research and policy that is given to mental health care access in Medicaid in particular.”

About half of all Medicare Advantage plans had psychiatrist networks that included less than 12.5% of providers in a service area. The weighted average of network breadth was 20% in Medicare Advantage.

Further, more than half of the counties the study’s researchers examined did not have a single Medicare Advantage-enrolled psychiatrist, “raising concerns about MA enrollees’ access to mental health services amid the growing prevalence of mental health conditions among older adults.” 

Federal survey data show that people aged 50 and older reported experiencing any mental illness at a rate of 15% and a serious mental illness at 2.5% in 2021. The same age group reported getting treatment for a major depressive episode at the highest rate of any age group, at 68%.

“Finally, given our findings of narrow psychiatrist networks across insurance markets, broader efforts to increase mental health providers’ acceptance of insurance are urgently needed,” the study continued. “Ongoing state and federal efforts, including increasing behavioral health care reimbursement, reducing administrative burdens and payment delays, and extending the behavioral health workforce across a range of provider types, will be important to monitor, evaluate, and replicate where effective.”

Key Senate leaders have blasted the insurance industry for having inadequate networks and poorly maintaining provider directories, creating “ghost networks.”

Operators and investors see senior-specific behavioral health care as an opportunity. At the end of June, a Boston-based startup called Author Health announced it had secured $115 million to establish a chain of hybrid behavioral health clinics that partner exclusively with Medicare Advantage plans.

Humana is Author Health’s first partner.