Benefit Limits for Behavioral Health Care in Private Health Plans

  • Dominic Hodgkin
  • Constance M. Horgan
  • Deborah W. Garnick
  • Elizabeth L. Merrick
Original Paper


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.


Insurance coverage Parity Out-of-pocket costs 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Dominic Hodgkin
    • 1
  • Constance M. Horgan
    • 1
  • Deborah W. Garnick
    • 1
  • Elizabeth L. Merrick
    • 1
  1. 1.Schneider Institute for Behavioral Health, Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA

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