Benefit Limits for Behavioral Health Care in Private Health Plans
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- Hodgkin, D., Horgan, C.M., Garnick, D.W. et al. Adm Policy Ment Health (2009) 36: 15. doi:10.1007/s10488-008-0196-5
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Data from a nationally representative sample of private health plans reveal that special lifetime limits on behavioral health care are rare (used by 16% of products). However, most plans have special annual limits on behavioral health utilization; for example, 90% limit outpatient mental health and 93% limit outpatient substance abuse treatment. As a result, enrollees in the average plan face substantial out-of-pocket costs for long-lasting treatment: a median of $2,710 for 50 mental health visits, or $2,400 for 50 substance abuse visits. Plans’ access to new managed care tools has not led them to stop using benefit limits for cost containment purposes.