The Rise of Medicare Advantage: Implications for Psychiatric Care

23/10/2026

AI Summary

Medicare Advantage expansion has strained psychiatric care by restricting access through managed care practices such as narrow networks and prior authorisation.
MA plans increase out-of-pocket costs and perpetuate inequities, and may reduce psychiatrist participation in the Medicare programme.
Research and policy must correct for diagnosis upcoding and selective enrolment and address networks, costs, and prior authorisation to protect vulnerable patients.

TL;DR (AI Generated)

This analysis revealed that increased penetration of MA into the Medicare-eligible population worsened existing strains on psychiatric care through managed care practices that limited access, increased out-of-pocket costs, perpetuated inequity, and may have contributed to lower psychiatrist participation in the Medicare program.

To better understand the consequences of MA's emerging predominance on psychiatric care, studies of care quality and outcomes must correct for diagnosis upcoding and selective enrollment in MA, which limit comparisons between MA and traditional Medicare.

Basic summary

Psychiatr Serv. 2026 Oct 22:appips20260050. doi: 10.1176/appi.ps.20260050. Online ahead of print.

ABSTRACT

In light of the dramatic rise in Medicare Advantage (MA) enrollment over the past 20 years and the negative impacts of certain MA plans on accessibility, affordability, and equity in mental health care, the authors analyzed literature and publicly available data to explore the impacts of the expansion of MA on psychiatric care. A comprehensive search was conducted in PubMed between December 2025 and January 2026, and data from KFF published between 2021 and 2025 were analyzed to examine trends in MA with a particular focus on mental health. This analysis revealed that increased penetration of MA into the Medicare-eligible population worsened existing strains on psychiatric care through managed care practices that limited access, increased out-of-pocket costs, perpetuated inequity, and may have contributed to lower psychiatrist participation in the Medicare program. To better understand the consequences of MA’s emerging predominance on psychiatric care, studies of care quality and outcomes must correct for diagnosis upcoding and selective enrollment in MA, which limit comparisons between MA and traditional Medicare. Efforts to address accessibility, affordability, and equity in MA must address narrow networks, high out-of-pocket costs, and prior authorization requirements in MA plans, which create barriers to accessing mental health care, especially for vulnerable populations.

PMID:42908072 | DOI:10.1176/appi.ps.20260050

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