The Medicare Advantage "ghost network" trap: Why your mental health provider directory might be haunted

You dial the first psychiatrist on your Medicare Advantage plan's provider list, hoping to finally get help for the anxiety that's been keeping you up at night. The number's disconnected. You try the second one—they retired two years ago. The third office says they never accepted your insurance. By the fourth call, you're starting to wonder if any of these mental health professionals actually exist.

You're not imagining things, and you're definitely not alone. What you've stumbled into is what healthcare watchdogs call a “ghost network”—and it's affecting millions of Medicare Advantage enrollees across the country.

The staggering scope of phantom providers

A recent federal report found that 55% of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care to any of the plans' members. But that official number might actually be conservative. When Senate Finance Committee staff conducted a secret shopper study, calling providers from Medicare Advantage directories, they discovered that over 80% of mental health provider listings were inaccurate or unavailable. Staff could successfully make appointments only 18% of the time.

This isn't a small problem affecting a few unlucky patients. In 2024, Medicare Advantage provided health insurance for upwards of 33 million Americans over 64 years old—over half of all Medicare clients in the country. That means millions of seniors are navigating healthcare decisions based on provider directories that are, quite frankly, more fiction than fact.

What exactly are ghost networks?

A “ghost network” describes the difference between advertised in-network healthcare providers for a given insurance plan and the providers who are in fact available to deliver care to patients enrolled in those plans—meaning a patient has more options on paper than in reality.

These phantom providers come in several varieties:

• Doctors who retired but remain listed in directories
• Professionals who moved practices but old locations still appear
• Providers who never actually signed contracts with the plans
• Clinicians who switched to administrative roles and no longer see patients
• Offices with disconnected phone numbers or incorrect contact information

In one particularly egregious case documented in the federal report, a private Medicaid plan listed a mental health professional as providing care in 19 practice locations. But when investigators checked, a receptionist at one of the clinics said the person had retired a few years ago.

Why mental health networks are especially ghostly

The ghost network problem affects all areas of healthcare, but it hits mental health particularly hard. There are several reasons why psychiatric and counseling provider directories tend to be especially unreliable.

First, there's a massive shortage of mental health providers nationwide. As of 2025, over 122 million Americans live in Mental Health Professional Shortage Areas—formally designated regions with insufficient provider capacity. When demand far outstrips supply, many providers can afford to be picky about which insurance plans they'll accept.

The economics make the situation worse. A psychiatrist could make two to three times more by charging a patient out-of-pocket compared to taking Medicare or Medicaid. Low reimbursement rates by insurers for mental health care and rates that haven't increased in decades are key reasons why many mental health providers don't join insurance networks.

Providers cited administrative burden and low payment rates as factors affecting their willingness to work with managed care plans. For solo practitioners—who make up about 80% of mental health providers—the paperwork and hassle of dealing with insurance companies often isn't worth the reduced payments.

The real cost of phantom care

The consequences go far beyond inconvenience. Take Jeanine Simpkins of Mesa, Arizona, who learned firsthand how devastating ghost networks can be. When a 40-year-old family member was in crisis, Simpkins struggled to find a drug rehabilitation program that would accept the Medicare Advantage insurance the relative is on because of a disability. Simpkins said she contacted about 20 rehab programs, none of which would take the Medicare insurance plan.

”You feel kind of dropped,” she said. “I was pretty surprised, because I thought we had something good in place for her.” Simpkins' relative eventually enrolled in part-time hospital care instead of an inpatient rehabilitation center.

Also read: Are you unknowingly falling for Medicare scams? Here’s how to protect yourself

Recent steps toward solutions

The good news is that federal officials and lawmakers are finally taking action. In 2024, the Centers for Medicare & Medicaid Services finalized rules allowing Marriage and Family Therapists and Mental Health Counselors to enroll in Medicare and bill for select behavioral health services. This step is expected to increase provider participation and improve access for Medicare beneficiaries.

A bipartisan bill known as the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act would, if passed, strengthen requirements for Medicare Advantage plans to maintain accurate provider directories and require the Centers for Medicare & Medicaid Services to publish guidance on how to keep accurate provider directories, beginning in 2026.

What you can do right now

While waiting for systemic fixes, there are steps you can take to protect yourself from ghost network traps:

Before choosing a plan:

• Call providers directly to confirm they accept the specific Medicare Advantage plan you're considering
• Ask about wait times for new patient appointments
• Get confirmation in writing when possible

After encountering a ghost network:

• Document every call and interaction
• File complaints with your state insurance commissioner
• Contact Medicare directly at 1-800-MEDICARE to report inaccurate directories
• Consider switching during the next open enrollment period

When you need care now:

• Ask your primary care doctor for referrals to providers they know personally
• Contact local mental health organizations for recommendations
• Look into telehealth options, which may have broader networks
• Check if your plan covers out-of-network care in cases of network inadequacy

The economics behind the ghosts

Understanding why ghost networks exist can help you navigate them more effectively. Medicare Advantage plans are paid a set amount per person they cover by the government, and they're allowed to keep whatever money they don't spend on patient care. This creates a financial incentive to make their networks appear robust while actually limiting access to expensive services like mental health care.

Around 80% of mental health providers are solo practitioners who don't have the back office staff to file claims or negotiate with insurance companies. It's not that they don't want to accept insurance—it's that they don't have the capacity.

Also read: Compassionate ways to care for an aging parent with mental health struggles

Looking ahead

While the ghost network problem is serious, there are reasons for cautious optimism. Federal oversight is increasing, bipartisan legislation is moving forward, and public awareness is growing. The key is staying informed and advocating for yourself while the system slowly improves.

Remember, you're not powerless in this situation. Every complaint filed, every call documented, and every story shared helps build the case for stronger oversight and better networks.

The mental health care you need shouldn't be a ghost story. While systemic changes take time, your voice and your choices matter. By staying informed and holding insurance companies accountable, you can help ensure that provider directories reflect reality, not wishful thinking.

Read next:

• Why reviewing your Medicare plan every year could save you money and stress
• When to sign up for Medicare: Key dates and tips to avoid penalties
• Medicare’s new plan tool has errors—what seniors need to know before choosing coverage

Key Takeaways

• Many private Medicare Advantage and Medicaid managed care plans are exaggerating their mental health provider networks, with federal investigators finding that over half of listed in-network professionals are not actually available to treat patients.
• Patients are facing significant difficulties accessing mental health care through these insurance plans, as “ghost networks” list professionals who are retired, working elsewhere, or not participating in the plans.
• The federal watchdog report urges the government to use medical billing data to better verify which mental health professionals are genuinely available and to create a national directory of mental health providers that clearly shows which plans they accept.
• Industry groups and government officials agree there is more work to do to improve access and accuracy, and efforts are underway to develop better tools to help patients find available mental health care through Medicare and Medicaid.

What's your experience with finding mental health providers through Medicare Advantage? Have you encountered ghost networks or found strategies that work? Share your story in the comments—your experience could help fellow readers navigate these challenges.