Kaiser Permanente Insurance Coverage for Rehab

Insuring about 12.6 million Americans, Kaiser Permanente is a not-for-profit health insurance company. Among other health services, many people who are insured by Kaiser Permanente may seek alcohol and drug addiction treatment.

If you or your loved one is a Kaiser Permanente policyholder, scroll on to learn all about addiction treatment coverage with Kaiser Permanente.

Answer: Yes, Kaiser Permanente does cover drug and alcohol addiction rehab as required by the Affordable Care Act (ACA).

Under the ACA, all health insurance plans must provide some level of coverage for substance use disorder (SUD) treatment.

Like coverage of any other healthcare service, coverage for substance abuse treatment may differ among Kaiser Permanente policyholders. This is because coverage is often contingent on multiple factors, one of which being the type of plan you have.

Answer: Kaiser Permanente offers coverage for diverse addiction treatments to provide for the various addictions people may experience.

Based on your needs, the addiction you have, and other factors, your healthcare providers might suggest a particular treatment method or a combination of several.

Read below to learn more about addiction treatment options you may encounter on your recovery journey.

Medical Detox

Many Kaiser Permanente plans cover medical detoxification or detox services at least partially, though some plans may require a copay.

Detox services are often the first service offered in a treatment program as they help individuals get rid of any addictive substances still in their bodies.

Medical detox, which helps you safely detox with medical supervision, is a very important service as detoxing on your own can be dangerous.

You can expect your care providers to monitor your vitals, help manage withdrawal symptoms, and administer any necessary medications.

Medication-Assisted Treatment

Often referred to as MAT, medication-assisted treatment is another service your Kaiser Permanente health insurance plan may cover. You may need prior authorization if this is provided through residential treatment.

MAT uses U.S. Food and Drug Administration (FDA)-approved medications to treat addiction. This works by helping people through withdrawal and cravings while reducing the risk of relapse as they work through other facets of their recovery journey.

Inpatient Rehab

Inpatient rehab is covered partially by many Kaiser Permanente plans, many of which require a copay for a set amount of days followed by no charge for the remaining days. You will also likely need prior authorization.

Considered the highest level of care, inpatient treatment is around-the-clock care provided in a designated facility where individuals live throughout the course of their treatment.

Inpatient programs are very structured and regimented, making them well-suited for people who are just starting their journey.

Dual Diagnosis Treatment

You may be able to receive coverage for dual diagnosis treatment through Kaiser Permanente with prior authorization and possible copays.

Dual diagnosis treatment is a comprehensive approach for people who have co-occurring disorders. Co-occurring disorders are mental health disorders that occur alongside addiction, often exacerbating it or being the root of it.

Dual diagnosis treatment addresses addiction and mental health simultaneously. This treatment service may be offered in inpatient or outpatient programs and will likely fall under the coverage of that type of program.

Outpatient Treatment Programs

Similar to inpatient rehab programs, Kaiser Permanente does partially cover outpatient rehab often with copays for each visit. Prior authorization will most likely need to be obtained first.

Outpatient treatment is less intensive than inpatient rehab as patients do not have to live in a treatment facility. However, they will be expected to travel to a care center for treatment up to multiple days a week for several hours at a time.

You may find partial hospitalization programs (PHP) or intensive outpatient programs (IOP) to be a good bridge between inpatient and outpatient care.

Counseling & Behavioral Therapy

Counseling and behavioral therapy are services that often require copays under Kaiser Permanente coverage. Typically, these services are offered in inpatient or outpatient programs, so your copay will likely align with the cost of the program.

Counseling is a popular treatment service that occurs on an individual or group basis and provides a space for discussing emotions, thoughts, concerns, and goals related to addiction treatment.

Behavioral therapy, on the other hand, is a more targeted treatment service. Also known as talk therapy, it narrows in on behavioral patterns and thought processes that may be making your addiction worse.

It is often used in people with co-occurring disorders and may be offered in different formats such as motivational interviewing, cognitive behavioral therapy (CBT), or dialectical behavioral therapy (DBT).

Continuing Care

Kaiser Permanente at least partially covers continuing care or aftercare. What makes this service tricky is it differs quite a bit from person to person.

For example, for some, aftercare will be counseling, support groups, group therapy, or behavioral therapy, while it will be sober living or MAT for others. Your treatment team will help you determine what aftercare looks like for you.

When it comes to determining the level of coverage you receive for addiction treatment services, Kaiser Permanente will take several things into account.

Factors that may affect your coverage include:

• Your plan: The type of plan you have will determine whether a service is covered, how much of it is covered, and any requirements for coverage such as a referral, prior authorization, or copays.
• Your location: The state you live in can affect access to certain plans, treatments, and the cost of treatment. Additionally, your state may have laws that affect coverage for substance abuse treatment.
• Type of treatment: Treatments are not created equally. Some may cost more than others and some may be covered at a higher level than others. If you need a particular type of treatment, your coverage may be contingent primarily on this.

That being said, don’t count on the experience of another policyholder to estimate your coverage level. Instead, check your summary of benefits and talk with a representative at Kaiser Permanente.

Answer: Yes, Kaiser Permanente will cover out-of-network addiction treatment programs in some cases for certain plans. However, if you choose an out-of-network provider, you will likely accrue higher out-of-pocket costs.

According to Kaiser Permanente, “You can receive care from any licensed behavioral health or chemical dependency professional for mental illness, emotional disorders, and drug or alcohol abuse.”

A disclaimer is also attached to this statement, emphasizing inpatient and outpatient care are subject to prior authorization.

If you are looking for the highest level of coverage and lowest out-of-pocket costs, sticking with in-network providers is your best shot.

Kaiser Permanente offers a variety of plans including Marketplace plans, Medicaid plans, and Medicare plans.

These may include:

• Marketplace plans:
  • Kaiser Permanente – Bronze 60 HMO
  • Kaiser Permanente – Silver 70 HMO
  • Kaiser Permanente – Gold 80 HMO
  • Kaiser Permanente – Platinum 90 HMO
  • Kaiser Permanente – Minimum Coverage HMO
• Medicare plans:
  • Kaiser Permanente Senior Advantage
  • Kaiser Permanente Senior Advantage Core DM (HMO)
  • Kaiser Permanente Senior Advantage Choice DM (PPO)
  • Kaiser Permanente Senior Advantage Bronze DM (HMO-POS)
  • Kaiser Permanente Senior Advantage Silver DM (HMO-POS)
  • Kaiser Permanente Senior Advantage Gold (HMO-POS)
• Medicaid plans:
  • Senior Advantage Medicare Medicaid (HMO D-SNP)

Available plans will depend on your location and other eligibility factors. You’ll be able to compare plan details and choose the one that is right for you and your family based on deductibles, premiums, and more.

Substance abuse treatment coverage through Kaiser Permanente is not determined based on the type of addiction you have. That being said, almost any substance addiction will be covered under your plan as long as you meet the specified requirements.

Common covered addictions include:

• Cocaine
• Alcohol
• Heroin
• Prescription drugs
• Opioids
• Meth
• Benzodiazepines

After doing some research, the next step in your recovery journey will be to find a treatment center that accepts your Kaiser Permanente insurance plan.

There are several ways to find in-network rehab facilities. The first is to discuss your need with your primary care provider. They will likely be able to refer you to several treatment facilities that accept your insurance plan.

You can also use your patient portal with Kaiser Permanente to find a rehab center that accepts your plan. Just click “Find doctors and locations” type in your ZIP code and keywords like “addiction treatment” or “substance abuse” and the system will provide you with a list of eligible care centers.

If you find a rehab program that interests you via another search engine or word of mouth, you can also search that provider in your patient portal or call the Kaiser Permanente helpline to check if it is in-network. You may be able to find important numbers on the back of your insurance card.

Look for high-quality rehab centers in your state by viewing our list of treatment centers in each state.

Kaiser Permanente is a popular health insurance provider that can help you cover the costs associated with addiction treatment. However, it’s important to understand the limits of your coverage and what kind of care you need.

Are you ready to take the first step in your journey toward a new life? Give our helpline a call today for more guidance.