Original Paper

Administration and Policy in Mental Health and Mental Health Services Research

, Volume 36, Issue 1, pp 15-23

Benefit Limits for Behavioral Health Care in Private Health Plans

  • Dominic HodgkinAffiliated withSchneider Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University Email author 
  • , Constance M. HorganAffiliated withSchneider Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University
  • , Deborah W. GarnickAffiliated withSchneider Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University
  • , Elizabeth L. MerrickAffiliated withSchneider Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University

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Abstract

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.

Keywords

Insurance coverage Parity Out-of-pocket costs