Mental health care use after leaving Medicare Advantage for traditional Medicare

To evaluate changes in mental health visits and specialties among beneficiaries with at least 1 mental health visit before and after switching from Medicare Advantage (MA) to traditional Medicare (TM).

This study examines Medicare beneficiaries with mental health diagnoses who switched from MA to TM in 2018, analyzing their mental health utilization 12 months before and after the switch using MA encounter and TM claims data.

A longitudinal design was used, comparing mental health visits before and after the switch. We applied Wilcoxon signed rank tests to compare the total number of visits and McNemar tests for specific provider specialties used. Statistical significance was defined as a P value less than .05.

Of the 32,710 beneficiaries who switched from MA to TM in 2018, 1184 beneficiaries (11,015 claims) were included in our sample because they had at least 1 health care visit attributed to a mental health condition both before and after switching. We found a statistically significant increase in the number of mental health visits after switching (P = .014). For the top 5 most prevalent specialties used for mental health care, we found no change in the use of psychiatrists (P = .607) or family medicine specialists (P = .696). However, we found increased use of nurse practitioners (P < .001) alongside decreased use of internal medicine (P = .003) and emergency medicine specialists (P = .001) for mental health care after switching.

Among beneficiaries with continued mental health care utilization, switching from MA to TM was associated with increased mental health visits and a shift in provider composition, which suggests potential care gaps or unmet needs in MA.