“I was referring them out, but they could just not get access to any mental health providers,” Dr. Zhu said. One of her patients called more than a dozen providers before getting an appointment, she said.
Insurers say their goal is to provide a wide array of mental health services. “Everyone deserves access to effective, affordable and equitable mental health support,” Kristine Grow, a spokeswoman for AHIP, a trade group representing the insurers, said in an email.
But Ms. Grow criticized the Health Affairs study for not comparing the plans with traditional Medicare and for not examining other types of mental health services available to patients that would be provided by other clinicians or via telehealth. “In essence, this study uses a very narrow definition of mental health clinician to prove a pre-existing thesis about Medicare Advantage,” she said.
More broadly, regulators and lawmakers have voiced concerns that people in the private Medicare plans may not be getting the services they are entitled to under the federal program. Critics have long complained about inadequate access to mental health services.
Senator Ron Wyden, the Oregon Democrat who leads the Senate Finance Committee, held a hearing in May about so-called “ghost networks” of mental health providers, in which many of the clinicians listed in the Medicare Advantage plans’ directories are not, in fact, accepting patients. His staff conducted a secret shopper survey and could only obtain an appointment 18 percent of the time.
The Health Affairs study may have overstated the availability of psychiatrists because it only looked at which providers were listed in the plan’s directory, Dr. Zhu said. “It likely paints a rosier picture,” she said.
Doctors may be unwilling to participate in Medicare Advantage plans because of the low payments paid by the insurers, coupled with all of the required paperwork, said Dr. Robert Trestman, who is the chairman of the council on health care systems and financing for the American Psychiatric Association and testified at the Senate hearing. “Many of the challenges and frustrations are emphasized in the Medicare Advantage plans,” he said.
Some insurers pay psychiatrists less under their Medicare Advantage plans than traditional Medicare pays for the same services, the researchers said. The plans may also have an incentive to contract with a smaller group of doctors to have more control over the cost and care being delivered, the researchers said.