Founded in 1945, Kaiser Permanente is a not-for-profit healthcare provider and health service plan. Kaiser offers both employer group coverage and private insurance for individuals and families. Kaiser provides Medicare coverage for seniors who are 65 or older and for people qualified for Medicare with a disability. Kaiser Permanente health insurance offers healthcare services in 8 states and by zip codes. Coverage areas include the following:
- Washington
- Oregon
- Colorado
- California
- Hawaii
- Georgia
- Virginia
- Maryland
- District of Columbia
Kaiser Permanente is a primary healthcare provider. Kaiser offers insurance plans for partial or full coverage of addiction treatment costs. Kaiser may reduce your health insurance costs and make it easier to find affordable treatment for recovery.
Before considering a rehab program, you must determine which drug and alcohol treatment services Kaiser will cover. Not all rehabilitation centers accept Kaiser insurance. For both inpatient and outpatient services, paying for treatment may be expensive. Knowing which drug and alcohol rehab programs Kaiser will cover is essential for recovery.
- Annual and lifetime dollar limits
- Financial requirements
- Treatment limitations
Large group health insurance plans and health plan insurers that CHOOSE to include mental health and substance use disorder benefits in their benefits packages must cover MH/SUD in the same manner, or without imposing less favorable benefit limitations, as coverage permits for medical and surgical procedures. The amount of coverage for substance abuse treatment, however, varies by state and depends upon the insurance plan you choose. The MHPAEA does not apply directly to small group health plans; indirectly, individuals who purchase through the marketplace under the Affordable Care Act (ACA) may have access to coverage through the essential health benefit (EHB) requirements.
Non-federal government insurance plans are regulated by the Department of Health and Human Services (HHS). The Department of Labor (DOL) regulates private employment-based group plans.
Preliminary Questions
- Substance abuse treatment and recovery services?
- Inpatient and residential stay?
- Medication-assisted treatment?
- Outpatient services?
- Aftercare and transitional planning?
Once you understand Kaiser Permanente insurance coverage, the next goal will be to locate an affordable specialized substance abuse treatment facility. Information about deductibles, copays, and other out-of-pocket costs will help you to develop a payment plan to pay for healthcare costs.
Primary Care Physician
Appointments
Scope of Coverage
- Screenings for drugs and alcohol
- Emergency care services
- Detox
- Residential inpatient treatment
- Outpatient treatment services
- Transitional recovery services
You will be required to meet copay and deductible costs. Standard coverage for an individual, family of one member, for substance abuse rehabilitation and treatment services might include the following fees and may overlap depending on inpatient/outpatient status:
- $3,350: plan, out-of-pocket maximum
- $0: plan deductible
- $0: drug deductible
- $15: per visit, primary care visit
- $30: per visit, physician specialist visit
- $0: covered individual health education counseling (outpatient)
- $0: covered health education programs (outpatient)
- $250: per day up to $1,250 per admission, room and board, surgery, anesthesia lab tests, drugs (inpatient detoxification)
- $150: emergency department visits
- $15: per visit, individual outpatient substance use disorder evaluation and treatment
- $5: per visit, group outpatient substance use disorder treatment
Coverage may not eliminate costs. When treatment is not fully covered, substance abuse rehabilitation facilities often house financial advisors who understand the complexities of health insurance. They are professionals who are knowledgeable in drug and alcohol treatment center costs and how to help individuals pay for services with alternate funding.
Coverage may extend to counseling and therapy services. Advise nurses and wellness coaches are available by phone to discuss counseling options, mental health goals, and support group meetings. Kaiser Permanente insurance programs also offer classes and support groups for chemical dependency.
Sample Plan & Type of Coverage
Inpatient Treatment
- Room and board
- Medical services
- Medications
- Education
- Recovery services
- Counseling
The copay for these services is $250 per day up to a maximum of $1,250 per stay under the plan.
Outpatient Treatment
- Intensive outpatient programming
- Day treatment programming
- Medical withdrawal treatment
- Individual or group chemical dependency counseling
The copay for outpatient treatment is $15 per visit for individual treatment but $5 per group session.
Residential Treatment
- 24-hour care in a licensed facility
- Individual and group counseling
- Medical services and monitoring
- Room and board
- Social services
- Medications and drugs prescribed by the plan provider
- Discharge planning
The copay for residential treatment is $100 per admission. Residential services are covered when treatment is provided in a licensed treatment facility that operates 24 hours and offers individualized substance use disorder treatment.
Medication-Assisted Treatment (MAT)
Contact Us
Types of Health Plans
- Group, which include employer-based
- Individual, labeled Gold, Silver, Bronze, and Platinum
- Medicare
Each category outlines deductibles, copays, and plan options.
Group
- Traditional/deductible plans:Â The participant pays fees until the deductible is met. Copays are typically necessary. There is a standard out-of-pocket annual maximum amount.
- PPO plans:Â Preferred Provider Organization (PPO) plans are approved for individuals who live outside the Kaiser Permanente plan provider service regions. In-network coverage costs less. Out-of-network coverage is maintained at a higher rate for non-preferred physicians.
- POS:Â Point of Service (POS) plans offer comprehensive coverage for plan participants using in-network Kaiser Permanente providers and network-contracted providers. Out-of-network plan participants pay higher costs for out-of-network providers. POS combines both HMO and PPO plans.
- Out-of-Area Plans:Â Out-of-area plans are for individuals who live outside the Kaiser Permanente coverage areas. Individuals can receive healthcare services without a referral.
- Consumer-Directed Health Plan: Consumer-Directed Health Plan is available as one of three healthcare savings account. The HRA is a health reimbursement account where employers contribute to the plan participant’s qualified medical expenses. The HSA is the health savings account that is tax-free account individuals create to pay for medical expenses. The FSA is a flexible savings account where individuals make pre-tax contributions for different medical expenses.
This is an overview of group plans. See Kaiser Permanente for more information.
Individual
- Deductible plans:Â Deductible plans require payment of fees until the deductible is met. A copay is required. Preventative services may be covered.
- Copay plans:Â Preventative services may be included. A copay is required for office visits and medical services.
- HSA:Â Health Savings Account plans combine pharmacy and medical cost deductibles. Plan participants pay out-of-pocket costs until the deductible is met. Health savings accounts are established to provide a tax break on medical expenses.
- Deductible catastrophic: Plan participants younger than 30 years old and can prove financial hardship may qualify for deductible catastrophic. The insurance plan covers three doctor’s visits. The individual must pay out-of-pocket expenses until the annual maximum deductible is met. Preventative services may be included at no charge.
This is an overview of individual plans. See Kaiser Permanente for more information.
Medicare
Centers for Medicare & Medicaid Services. (n.d.). The mental health parity and addiction equity act (MHPAEA). The Center for Consumer Information & Insurance Oversight. Retrieved from https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html.
Kaiser Permanente Fast Facts:
https://about.kaiserpermanente.org/who-we-are/fast-facts
Kaiser Permanente Individual & Family Plans:
https://wa.kaiserpermanente.org/individual-family/plans
Kaiser Permanente Member Agreement (2019):
http://info.kaiserpermanente.org/healthplans/plandocuments/california/pdfs/2019/KPIF-Off-Exchange/800222_01_14_11_2019_KP_CA_Platinum_90_HMO_ON-OFF_FINAL_ADA_LCK.pdf