The Effect of Medicare Advantage on Access to Mental Health Care Services

I assessed the consequences of access to treatment services for seniors with mental health illnesses enrolled in Medicare Advantage (MA) plans. There is a robust economics literature on self-selection of healthier Medicare beneficiaries into MA plans in acute and post-acute care settings. However, little research has been done on the impact of insurance plan choice for individuals with mental health illnesses. I begin to fill this gap by analyzing to see if seniors with a mental illness self-select into Fee-For-Service (FFS) plans, and whether there is differential access to mental health care and outcomes by insurance plan type as a result.

I used the National Health Interview Survey to conduct multivariate regressions of the effect of being enrolled in a MA plan compared to a Fee-For-Service plan on access to mental health care services and self-reported health status. Mental health illness is defined as responding yes to alcohol/drug/substance abuse problem, depression, anxiety, or other mental/behavioral/emotional problem causes limitations. I use a sample of 12,758 older adults of which 6,937 are enrolled in a MA plan. Of these 12,758 beneficiaries, 192 individuals have a mental health illness severe enough to cause a limitation in their life, split evenly between the FFS and MA groups.

For the general Medicare population, MA enrollees have slightly better self-reported overall health status. MA enrollees were significantly less likely than FFS beneficiaries to say they had delayed medical care for cost and that they needed but did not get medical care because of the cost in the past 12 months. However, when focusing on individuals with mental health illnesses, the disparity disappears. There is no difference between the severity of illness in MA versus FFS plans or the duration suffered from mental health illness. Seniors enrolled in MA plans do not report a difference in access to mental health services compared to those in FFS plans. Individuals in MA and FFS plans are equally likely to say that they had seen/talked to a mental health professional in the past 12 months or that they couldn’t afford mental health care counseling.

This is one of the first studies to investigate how individuals in MA access treatment for mental health conditions. As enrollment in Medicare Advantage plans continues to increase and the importance of access to mental health services and treatment becomes increasingly salient, our results suggest that Medicare Advantage plans are an appropriate alternative to Medicare Fee-For-Service for treating mental health illness.