Medicare Advantage plans are popular, but critics frequently blast this form of retirement health insurance for its shortcomings.
A new analysis has found another potential hidden downside of these plans.
Researchers who looked closely at patterns of mental health care access discovered that retirees who switched from Medicare Advantage to Original Medicare (aka traditional Medicare) used mental health services more often.
The increase was characterized as small but still significant. Researchers say it may suggest a lack of robust networks for mental health professionals in Medicare Advantage plans.
The results of the analysis appeared in the American Journal of Managed Care.
Medicare Advantage plans have become popular with seniors, likely in part due to the fact that the privately run plans typically bundle benefits such as dental and vision coverage, plus an out-of-pocket maximum spending cap and perks such as gym memberships, according to the analysis.
It is no secret that Medicare Advantage plans tend to restrict coverage options. A recent KFF analysis found that as of 2022, enrollees in Medicare Advantage plans had access to less than half (48%) as many physicians as patients in Original Medicare.
With Original Medicare, you can see any doctor that accepts Medicare.
A recent Department of Health and Human Services Office of Inspector General (OIG) report also found that Medicare Advantage plans have limited networks of mental health practitioners. The report noted that, on average, more than half of the mental health providers listed as being part of Medicare Advantage networks were inactive.
As a story published on the Medicare Rights Center website notes, the fact that Medicare Advantage plans typically restrict access to providers compared to Original Medicare can lead to more costly outcomes for patients. According to the Medicare Rights Center report:
“Since most MA plans require enrollees to pay more for care received outside of the network, having access to in-network providers is vital. Access to timely care is especially important for many people seeking help for mental health conditions who may be discouraged by roadblocks.”
The analysis published in the American Journal of Managed Care notes that “high-need and high-cost beneficiaries” and those who have developed functional disability or Alzheimer’s disease and related dementias tend to switch from Medicare Advantage to traditional Medicare. It goes on to say:
“In particular, MA’s managed care strategies, including prior authorization requirements and provider networks, can create barriers to timely access to care. These barriers may disproportionally affect beneficiaries with certain health issues, including mental health conditions, prompting those beneficiaries to switch back to [traditional Medicare].”
For more on Medicare Advantage coverage, check out “Many People on Medicare Advantage Are Losing Out Because of This Mistake.”
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