JustCare

Tag: Psychiatrist

  • Few psychiatrists accept Medicare

    Few psychiatrists accept Medicare

    If you and your spouse are not working, you likely need to enroll in Medicare at 65. But, as with many health insurance policies, it is extremely difficult to find psychiatrists who will accept Medicare coverage, reports Eugene Rubin, M.D. for Psychiatry Today.

    A study by John Havlik et al., reported in JAMA Network, finds that just over 18,000 psychiatrists were willing to bill Medicare for their services, out of a total of more than 56,000 psychiatrists nationwide.  The number willing to bill Medicare decreased by nearly 4,000 over eight years between 2014 to 2022.  That’s a 16.8 percent decrease in the number of shrinks willing to bill Medicare. Overall, only about one in three psychiatrists take Medicare.

    The researchers could not study the number of psychiatrists who contract with Medicare Advantage plans. But, overall, fewer physicians agree to work with Medicare Advantage plans than traditional Medicare. And, Medicare Advantage plans do not tout their great mental health coverage. So, it’s more than likely that it’s even harder to see a shrink in Medicare Advantage than in traditional Medicare.

    Other research has shown that people with Medicare can wait up to six months to see a therapist. But, Medicare now covers mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, as well as psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers, increasing the pool of mental health providers available for people with Medicare.

    People with employer coverage and in state health insurance plans also struggle to get insurance coverage for visits to the shrink. Fewer than three in five shrinks accept any health insurance.

    To be clear, access to Medicare coverage for visits to the shrink differs depending on where you live. In Wyoming, for example, there are just 13.8 shrinks who take Medicare for every 100,000 people with Medicare, in Mississippi, 22.1 shrinks, and Montana, 27.4 shrinks. In Rhode Island, there are 174.7 shrinks for every 100,000 people with Medicare. In nine states, there are fewer than 40 shrinks for every 100,000 people with Medicare.

    While Medicare Part B covers mental health services for people enrolled in Medicare Advantage and traditional Medicare, the federal mental health parity laws do not apply to Medicare. They should!

    Here’s more from Just Care:

  • Need a shrink? Your Medicare Advantage plan might not think so

    Need a shrink? Your Medicare Advantage plan might not think so

    Reed Abelson reports for the New York Times on the difficulty people in Medicare Advantage plans can have getting mental health care. Too often there are no psychiatrists in their Medicare Advantage plan network, according to a new study published in Health Affairs. If you would like to see a shrink and have your care covered–if you’d like to get any specialty care and ensure it is covered– traditional Medicare is likely to be a better option than a Medicare Advantage plan.

    Researchers were not able to find even one psychiatrist in more than half of the Medicare Advantage plan networks they analyzed. Even in the networks with psychiatrists, psychiatrists were few and far between; fewer than one in four psychiatrists in the area were in network. And, it’s not clear that these psychiatrists were taking new patients.

    Loneliness is a huge challenge for many older adults, only aggravated by the Covid-19 pandemic. Many older adults need to see a psychiatrist for their mental well-being. About 25 percent of people with Medicare suffer from depression, anxiety or another mental illness. But, the Commonwealth Fund has found that not even half of them get mental health care.

    There are too few psychiatrists in the US. So, it can be hard to find a psychiatrist no matter what health insurance coverage you have. But, the researchers note, people with Medicaid and people in state health insurance exchange plans created by the Affordable Care Act have considerably better access to psychiatrists than people in Medicare Advantage.

    Lack of access to mental health care in Medicare Advantage plans is a problem getting mounting attention. Senator Ron Wyden’s team on the Senate Finance Committee conducted a study of Medicare Advantage plans in Oregon and could not find a single psychiatrist taking new patients in any of their networks. Senate Wyden described their networks as “ghost networks” at a recent Senate Finance Committee hearing. In Medicare Advantage plans outside Oregon, Senate Finance staff could not get an appointment with a mental health provider more than 80 percent of the time.

    A psychiatrist from the American Psychiatric Association testified at the Senate Finance Committee hearing that as hard as it is for psychiatrists to deal with insurance company paperwork, it is all the harder for them to deal with administrative requirements imposed by Medicare Advantage plans. “Many of the challenges and frustrations are emphasized in the Medicare Advantage plans.”

    The researchers who published the Health Affairs study found that some insurers offering Medicare Advantage plans pay mental health providers less than the Original Medicare rate. That impedes access to care for people in Medicare Advantage plans and should be prohibited.

    Here’s more from Just Care: