Benefit Limits for Behavioral Health Care in Private Health Plans
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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.
KeywordsInsurance coverage Parity Out-of-pocket costs
- Agency for Healthcare Research and Quality. (2008). Medical expenditure panel survey. Retrieved July 17, 2008, from http://www.meps.ahrq.gov/mepsweb/.
- Barry, C. L., & Sindelar, J. L. (2007). Equity in private insurance coverage for substance abuse: A perspective on parity. Health Affairs. doi:10.1377/hlthaff.26.6w706.
- Buchmueller, T. C., Cooper, P. F., Jacobson, M., & Zuvekas, S. (2007). Parity for whom? Exemptions and the extent of state mental health parity legislation. Health Affairs, 483–487. doi:10.1377/hlthaff.26.4.w483.
- Frank, R. G., & McGuire, T. G.(2003). Economics and mental health. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics.Google Scholar
- Horgan, C. M., Garnick, D. W., Merrick, E. L., & Hodgkin, D. (in press, forthcoming). Changes in how health plans provide behavioral health services. The Journal of Behavioral Health Services & Research.Google Scholar
- Kaiser Family Foundation. (2004). Employer health benefits: 2004 annual survey. California: Menlo Park.Google Scholar
- Kemper, P., Blumenthal, D., Corrigan, J. M., et al. (1996). The design of the community tracking study: A longitudinal study of health system change and its effects on people, Inquiry. Summer, 33(2), 195–206.Google Scholar
- Kronenfeld, J. J. (2003). Organizational variation in the managed care industry in the 1990s: Implications for institutional change. In D. Anthony & J. Banaszak-Holl (Eds.), Reorganizing health care delivery systems: Problems of managed care and other models of health care delivery. Emerald Group Publishing.Google Scholar
- Martin, J. K., Pescosolido, B. A., & Tuch, S. A. (2000). Of fear and loathing: The role of ‘disturbing behavior’, labels, and causal attributions in shaping public attitudes toward persons with mental illness. Journal of Health and Social Behavior, 41(2), 208–223. doi:10.2307/2676306.CrossRefGoogle Scholar
- Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Pub. L. No. 110-343, 122 Stat. 3765 (2008).Google Scholar
- Research Triangle Institute. (2002). SUDAAN user’s manual: Release 8.0. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
- Substance Abuse and Mental Health Services Administration. (2007). Results from the 2006 national survey on drug use and health: National findings. NSDUH Series H-32, DHHS Publication No. SMA 07-4293. Rockville, MD.Google Scholar
- US Bureau of Labor Statistics. (2007). National compensation survey: Employee benefits in private industry in the United States, 2005. Bulletin, 2589.Google Scholar
- Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640. doi:10.1001/archpsyc.62.6.629.PubMedCrossRefGoogle Scholar