Kaiser Permanente Health Insurance Coverage for Drug and Alcohol Rehab Treatment

Does Kaiser Insurance Cover Drug or Alcohol Rehab?

If you have Kaiser Permanente health insurance, your drug or alcohol addiction rehab treatment may be fully or partially covered. American Addiction Centers (AAC) is in-network with many insurance companies, including Kaiser Permanente. Depending on your coverage plan your addiction treatment and rehab could be covered. To learn more about your coverage contact Kaiser Permanente, directly contact an insurance representative by calling the phone number on the back of your insurance card.

How to Check Whether Kaiser Permanente Covers Drug or Alcohol Rehab

American Addiction Centers (AAC) has a relationship with Kaiser Permantente and may be able to help you get into one of our inpatient or outpatient rehabilitation centers for substance abuse in a location near you. Give us a call , or use our online insurance checker to see if there is coverage for you.

American Addiction Centers strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.

What Is Kaiser Permanente?

With 11.8 million members in 2017, approximately 22,000 doctors, 57,000 nurses, 39 hospitals, and 682 medical offices and other facilities, Kaiser Permanente is a top-tier, not-for-profit health plan service and healthcare provider.1

Kaiser Permanente has close ties to local communities, investing large amounts of money and expertise into community outreach. Kaiser also creates new technology, conducts extensive medical research, and focuses on ensuring the overall well-being of members to create a healthier society.

As a company, Kaiser Permanente boasts high-quality ratings by providing comprehensive, competent, and affordable healthcare to as many people as possible. Kaiser offers health insurance plans to employers as group coverage, as well as to families and individuals as private insurance. The company also provides Medicare coverage for seniors age 65 or older or people with a disability that qualifies them for Medicare.

Offering coverage in 8 states (Washington, Oregon, Colorado, California, Hawaii, Georgia, Virginia, and Maryland), as well as the District of Columbia, Kaiser Permanente is one of the primary healthcare providers in the United States.2

How to Use Kaiser Permanente Coverage for Rehab

Kaiser inpatient rehab coverage is common among members. Individuals who live within a Kaiser Permanente coverage area, and have a Kaiser Permanente healthcare plan, may choose a Kaiser Permanente healthcare provider at kp.org and may change doctors at any time.3 Appointments can be made online or over the phone. Nonurgent health concerns may be addressed via email communication with a doctor’s office; lab results may be viewed online; prescriptions can also be refilled online; and nurses are available for medical advice 24 hours a day, 7 days a week.3,4

The first step to seeking treatment for a substance abuse or dependency concern is often an initial meeting and conversation with your primary Kaiser Permanente doctor. Individuals can set up this meeting or appointment over the phone, online, or email the doctor’s office. Depending on medical necessity, a primary care physician may refer or authorize individuals for further treatment.

Depending on medical necessity, a primary care physician (PCP) may refer or authorize individuals for further treatment, after an initial assessment, in a specialized substance abuse treatment facility. Drug and alcohol treatment centers often have professionals who understand the complexities of insurance and how to help individuals use their coverage to pay for services. When treatment is not entirely covered, these same professionals are likely to have suggestions on alternate funding.

Scope of Coverage

What is specifically covered depends on the individual plan. Some of the typical treatment services for substance abuse may include:

One example of standard coverage is the Kaiser Permanente Platinum HMO plan for California.5 This plan covers inpatient detox to manage medical withdrawal from drugs or alcohol in a plan hospital and with plan physician services. Room and board, medical services, medications, education, recovery services, and counseling may all be included.

Specific Kaiser Permanente Plan Details

Kaiser Permanente rehab services may be covered entirely or partially based on the type of Kaiser insurance plan someone has.There are 3 main types of health plans offered by Kaiser Permanente: group or employer-based plans, family and individual plans, and Medicare plans. Plans may vary from region to region and state to state.

Group

Employer-based or group plans are offered to businesses that provide health insurance to their employees, often with premiums directly deducted from paychecks. Group plans through Kaiser Permanente may include:7, 8, 9

  • Traditional or deductible plans: Fees may be paid by the plan participant until deductibles are met, and generally, there is an out-of-pocket annual maximum amount. Copays may be necessary.
  • Preferred Provider Organization (PPO) plans: These plans may be optimal for individuals who don’t reside in a Kaiser Permanente service region or who wish to use out-of-network providers. Coverage can be maintained at a higher rate when non-preferred physicians are used, and in-network coverage costs less.
  • Point-of-Service Plans: This type of comprehensive coverage plan allows individuals to use in-network Kaiser Permanente providers and network-contracted providers, or pay more for out-of-network providers. It is a combination of an HMO and PPO plan.
  • Out-of-Area Plans: Individuals living outside of a Kaiser Permanente coverage area can receive healthcare services without a referral. Preventative services are typically covered, and other services may be subject to cost-sharing or a deductible amount.
  • Consumer-Directed Health Plans: Several options are available, including a health reimbursement account (HRA) plan where employers contribute for qualified medical expenses, a health savings account (HSA) plan that is a tax-free account set up by individuals to pay for medical expenses, and a flexible savings account (FSA) where individuals make contributions that are considered pre-tax, toward many different medical expenses.

Individual

Individual plans range between Gold, Silver, Bronze, and Platinum, depending on the maximum out-of-pocket fees, deductible, and copay amounts as well as monthly premiums. The plans may differ depending on the coverage area. In general, the following types of plans are available:10

  • Deductible plans: With maximum caps, services are provided for a fee until the deductible is met, and many services have a copay as well. Preventative services may be completely covered.
  • Copay plans: Preventative services are covered, and there is no deductible amount for these services, though they are subject to a copay for office visits and services rendered. This is a comprehensive coverage plan that may incur higher monthly premiums.
  • Health Savings Account (HSA) plans: These plans have a combined pharmacy and medical cost deductible, and all costs are out of pocket until the deductible is reached. Costs are then covered at a percentage until the maximum out-of-pocket cap is reached. A health savings account can be set up for a tax break on medical costs.
  • Deductible catastrophic: Individuals with financial hardship or younger than 30 may qualify for this plan in most coverage regions. It covers up to 3 doctor’s visits a year. All additional fees are out-of-pocket expenses until the annual maximum deductible amount is reached. Many preventative services are covered at no charge as well.

Medicare

Medicare is federal insurance coverage for adults over the age of 65, and Kaiser Permanente Medicare plans11 may provide more options than standard Medicare.12 Plans include the Kaiser Permanente Senior Advantage13 and the Senior Advantage Basic, which are HMO plans that vary according to the coverage region and plan selected. Most coverage will have low copays for services and prescriptions, with no copay for most preventative services.

For seniors seeking substance abuse treatment, a trained insurance professional at a specialized treatment center can help individuals understand their coverage and how it may be used to pay for services.

Drug Rehab Programs That Accept Kaiser Insurance

Kaiser Permanente drug rehab services are covered at most American Addiction Centers locations. Kaiser Permanente rehab programs may include inpatient treatment, outpatient treatment, individual therapy, and more. Be sure to call Kaiser health insurance by dialing the phone number on the back of your insurance card. Here, a health care representative at your insurance company can verify your insurance benefits and tell you more information on your addiction treatment coverage and where to find Kaiser drug rehab facilities.

Verify Your Insurance

Sources

  1. Kaiser Permanente. (2018). 2017 Annual Report.
  2. Kaiser Permanente. Fast Facts About Kaiser Permanente.
  3. Kaiser Permanente. Experience the Kaiser Permanente difference.
  4. Kaiser Permanente. Convenient ways to get care.
  5. Kaiser Permanente. 2019 Individual Plan Combined Membership Agreement, Disclosure Form, and Evidence of Coverage for Kaiser Permanente for Individuals and Families.
  6. National Institute on Drug Abuse. (2017). Trends & Statistics.
  7. Kaiser Permanente. Traditional or deductible plans.
  8. Kaiser Permanente. Preferred Provider Organization (PPO) plans.
  9. Kaiser Permanente. Consumer-Directed Health Plans.
  10. Kaiser Permanente. View Plans.
  11. Kaiser Permanente. Medicare Health Plans.
  12. Medicare. Medicare Home Page.
  13. Kaiser Permanente. Medicare Health Plans & Rates for 2020.

 

Last Updated on November 5, 2020
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Dan Wagener
Dan Wagener is a Senior Web Content Editor at American Addiction Centers.

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