Medicare Advantage to Traditional Medicare Switch Linked to Increased Mental Health Visits and Provider Shifts

This analysis investigates the changes in mental health care utilization among Medicare beneficiaries who transitioned from Medicare Advantage (MA) to traditional Medicare (TM) in 2018. The study sample includes 1,184 beneficiaries engaged in mental health treatment before and after switching from MA to TM. Findings reveal a statistically significant increase in mental health visits following the switch, highlighting potential care barriers in MA for patients with mental health conditions. While the number of visits with psychiatrists and family medicine specialists remained stable, utilization of nurse practitioners increased significantly after switching to TM. Conversely, visits to internal medicine and emergency medicine specialists for mental health reasons decreased. Notably, 10% of beneficiaries who did not see a psychiatrist while in MA accessed psychiatric care after switching to TM, compared to just 2.1% of those remaining in MA, indicating improved specialty access in TM. MA plans often restrict provider networks, particularly for psychiatrists, limiting beneficiaries' access to mental health specialists. Prior authorization requirements prevalent in MA may also contribute to barriers in care, influencing beneficiaries with complex mental health needs to switch to TM, which offers broader provider access and fewer network restrictions. The increased role of nurse practitioners in TM may reflect enhanced access to nonphysician mental health providers, critical for addressing service gaps. However, reimbursement rates for nurse practitioners under Medicare are lower than for physicians, a dynamic that varies by state. The study underscores the significance of supplemental insurance, such as Medigap, for TM enrollees, as potential premium and coverage limitations may influence beneficiary switching behavior. Methodologically, the study utilized MA encounter data, TM claims, and the OneKey provider database to capture a comprehensive view of mental health service utilization and provider specialty before and after switching Medicare plans. Sensitivity analyses confirmed the robustness of findings, despite the challenges posed by incomplete MA encounter data and provider specialty classification. These findings emphasize the regulatory and network design impacts on mental health care access within Medicare programs. Understanding these dynamics is pivotal for policy and plan design aimed at ensuring equitable access to mental health services for Medicare beneficiaries across different insurance models. Future research directions include exploring cash-pay mental health services, the effects of Medigap policy variations on switching behavior, qualitative assessments of beneficiary experiences, and causal analyses of mental health care utilization patterns in Medicare. Improving the completeness and accuracy of MA encounter data is also critical for advancing research in this domain. The study provides data-driven insight into specialized mental health care access challenges faced by MA enrollees, highlighting the trade-offs between MA supplemental benefits and network limitations for beneficiaries with complex mental health needs. These insights support informed decision-making around Medicare plan selection, regulatory oversight, and strategic health services planning for the aging population.