Medicare Advantage’s psychiatrist networks are notably narrower, covering fewer providers in their service areas, compared to Medicaid and ACA plans. Almost 2/3 of Medicare Advantage psychiatrist networks are limited, with less than 25% of providers included, while Medicaid and ACA plans have around 40% narrow networks. This disparity, not observed in primary care or other specialties, highlights the need to improve network adequacy for mental health services in Medicare Advantage.
The network of psychiatrists available through Medicare Advantage plans is significantly more limited compared to those in Medicaid and ACA markets. Medicare Advantage, which now provides coverage for twenty-eight million elderly individuals, often confines enrollees to a specific network of healthcare providers. This restriction can pose a substantial barrier to receiving mental health care. To examine the scope of this issue, we utilized a unique dataset that linked network service areas, healthcare plans, and providers. Our goal was to assess the breadth of psychiatrist networks, defined as the percentage of providers within a specific area that are considered “in network” for a particular plan. Our analysis encompassed Medicare Advantage, Medicaid managed care, and Affordable Care Act plan markets.
Our findings revealed that nearly two-thirds of psychiatrist networks in Medicare Advantage were considered narrow, meaning they included fewer than 25 percent of the providers in a given service area. In contrast, approximately 40 percent of psychiatrist networks in Medicaid managed care and Affordable Care Act plan markets were categorized as narrow. It’s important to note that this disparity in network breadth was not observed when considering primary care physicians or other physician specialists across these different markets.
In light of ongoing efforts to improve the adequacy of healthcare networks, our research underscores the particular narrowness of psychiatrist networks within Medicare Advantage. This limitation may place enrollees at a disadvantage when seeking mental health services, highlighting the need for further consideration and action to address this issue.
