Benefit Limits for Behavioral Health Care in Private Health Plans

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

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 

References

  1. Agency for Healthcare Research and Quality. (2008). Medical expenditure panel survey. Retrieved July 17, 2008, from http://www.meps.ahrq.gov/mepsweb/.
  2. Barry, C. L., Frank, R. G., & McGuire, T. G. (2006). The costs of mental health parity: Still an impediment? Health Affairs, 25(3), 623–634. doi:10.1377/hlthaff.25.3.623.PubMedCrossRefGoogle Scholar
  3. Barry, C. L., Gabel, J. R., Frank, R. G., et al. (2003). Design of mental health benefits: Still unequal after all these years. Health Affairs Sep-Oct, 22(5), 127–137. doi:10.1377/hlthaff.22.5.127.CrossRefGoogle Scholar
  4. 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.
  5. 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.
  6. Daly, R. (2006). Law opens MCO panels to `any willing provider’. Psychiatric News, 41(13), 10.CrossRefGoogle Scholar
  7. 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
  8. Gabel, J., Claxton, G., Gil, I., et al. (2005). Health benefits in 2005: Premium increases slow down, coverage continues to Erode. Health Affairs, 24(5), 1273–1280. doi:10.1377/hlthaff.24.5.1273.PubMedCrossRefGoogle Scholar
  9. Gabel, J. R., Whitmore, H., Pickreign, J. D., et al. (2007). Substance abuse benefits: Still limited after all these years. Health Affairs, 26(4), w474–w482. doi:10.1377/hlthaff.26.4.w474.PubMedCrossRefGoogle Scholar
  10. Gitterman, D. P., Sturm, R., Pacula, R. L., & Scheffler, R. M. (2001). Does the sunset of mental health parity really matter? Administration and Policy in Mental Health, 28(5), 353–369. doi:10.1023/A:1011113932599.PubMedCrossRefGoogle Scholar
  11. Goldman, H. H., Frank, R. G., Burnam, M. A., et al. (2006). Behavioral health insurance parity for federal employees. The New England Journal of Medicine, 354(13), 1378–1386. doi:10.1056/NEJMsa053737.PubMedCrossRefGoogle Scholar
  12. Hodgkin, D., Horgan, C. M., Garnick, D. W., Merrick, E. L., & Volpe-Vartanian, J. (2007). Management of access to branded psychotropic medications in private health plans. Clinical Therapeutics, 29, 371–380. doi:10.1016/j.clinthera.2007.02.011.PubMedCrossRefGoogle Scholar
  13. 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
  14. Huskamp, H. A. (2005). Pharmaceutical cost management and access to psychotropic drugs: The US context. International Journal of Law and Psychiatry, 28(5), 484–495. doi:10.1016/j.ijlp.2005.08.004.PubMedCrossRefGoogle Scholar
  15. Kaiser Family Foundation. (2004). Employer health benefits: 2004 annual survey. California: Menlo Park.Google Scholar
  16. 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
  17. 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
  18. LoSasso, A. T., & Lyons, J. S. (2004). The sensitivity of substance abuse treatment intensity to co-payment levels. The Journal of Behavioral Health Services & Research, 31(1), 50–65. doi:10.1007/BF02287338.CrossRefGoogle Scholar
  19. Mark, T. L., Levit, K. R., Buck, J. A., et al. (2007a). Mental health treatment expenditure trends, 1986–2003. Psychiatric Services (Washington, D.C.), 58(8), 1041–1048. doi:10.1176/appi.ps.58.8.1041.Google Scholar
  20. Mark, T. L., Levit, K. R., Vandivort-Warren, R., et al. (2007b). Trends in spending for substance abuse treatment, 1986–2003. Health Affairs, 26(4), 1118–1128. doi:10.1377/hlthaff.26.4.1118.PubMedCrossRefGoogle Scholar
  21. 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
  22. McKusick, D. R., Mark, T. L., King, E. C., Coffey, R. M., & Genuardi, J. (2002). Trends in mental health insurance benefits and out-of-pocket spending. The Journal of Mental Health Policy and Economics, 5(2), 71–78.PubMedGoogle Scholar
  23. Merrick, E. L., Horgan, C. M., Garnick, D. W., & Hodgkin, D. (2006). Managed care organizations’ use of treatment management strategies for outpatient mental health care. Administration and Policy in Mental Health, 33(1), 104–114. doi:10.1007/s10488-005-0024-0.PubMedCrossRefGoogle Scholar
  24. Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Pub. L. No. 110-343, 122 Stat. 3765 (2008).Google Scholar
  25. Peele, P. B., Lave, J. R., & Xu, Y. (1999). Benefit limits in managed behavioral health care: Do they matter? The Journal of Behavioral Health Services & Research, 26(4), 430–441. doi:10.1007/BF02287303.CrossRefGoogle Scholar
  26. Research Triangle Institute. (2002). SUDAAN user’s manual: Release 8.0. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
  27. Ringel, J. S., & Sturm, R. (2001). Financial burden and out-of-pocket expenditures for mental health across different socioeconomic groups: Results from healthcare for communities. The Journal of Mental Health Policy and Economics, 4(3), 141–150.PubMedGoogle Scholar
  28. Sturm, R. (1997). How expensive is unlimited mental health care coverage under managed care? Journal of the American Medical Association, 278(18), 1533–1537. doi:10.1001/jama.278.18.1533.PubMedCrossRefGoogle Scholar
  29. Sturm, R., & McCulloch, J. (1998). Mental health and substance abuse benefits in carve-out plans and the Mental health parity act of 1996. Journal of Health Care Finance, 24(3), 82–92.PubMedGoogle Scholar
  30. Sturm, R., Zhang, W., & Schoenbaum, M. J. (1999). How expensive are unlimited substance abuse benefits under managed care? The Journal of Behavioral Health Services & Research, 26(2), 203–210. doi:10.1007/BF02287491.CrossRefGoogle Scholar
  31. 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
  32. US Bureau of Labor Statistics. (2007). National compensation survey: Employee benefits in private industry in the United States, 2005. Bulletin, 2589.Google Scholar
  33. 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
  34. Zuvekas, S. H. (2005). Prescription drugs and the changing patterns of treatment for mental disorders, 1996–2001. Health Affairs, 24(1), 195–205. doi:10.1377/hlthaff.24.1.195.PubMedCrossRefGoogle Scholar
  35. Zuvekas, S. H., Banthin, J. S., & Selden, T. M. (1998). Mental health parity: What are the gaps in coverage? The Journal of Mental Health Policy and Economics, 1(3), 135–146. doi:10.1002/(SICI)1099-176X(1998100)1:3<135::AID-MHP17>3.0.CO;2-S.PubMedCrossRefGoogle Scholar
  36. Zuvekas, S. H., & Meyerhoefer, C. D. (2006). Coverage for mental health treatment: Do the gaps still persist? The Journal of Mental Health Policy and Economics, 9(3), 155–163.PubMedGoogle Scholar

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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