Benefit limits for behavioral health care in private health plans.
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.
Hodgkin
Dominic
D
Schneider Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110, USA. hodgkin@brandeis.edu
Horgan
Constance M
CM
Garnick
Deborah W
DW
Merrick
Elizabeth L
EL
D005382:Financing, Personal; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration*; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D017149:Private Sector / Q000191:economics / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*