Kaiser Permanente Drug Rehab Insurance: Coverage Options
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Kaiser Permanente insurance coverage is relied upon by millions of Americans. Currently operating in eight states, Kaiser Permanente insurance plans are part of the largest managed care organization in the U.S. As a result, about 12 million people rely on Kaiser Permanente drug rehab coverage.
Learn About Kaiser Permanente Insurance Coverage For Drug Rehab:
Does Kaiser Permanente Insurance Cover Drug Rehab?
Kaiser Permanente insurance coverage extends to drug rehab in the vast majority of cases. To have Kaiser coverage of drug rehab, the insured needs to first meet with their primary care physician. At this appointment, a doctor will evaluate the need for rehab and then write a referral, usually specifying a specific type of rehab they feel will best suit the patient. In general, to have Kaiser Permanente drug rehab coverage, it must be at a center or delivered by a doctor that is in-network—in other words, pre-approved by Kaiser and within the network, the insured belongs to.
Kaiser Permanente Rehab Coverage: Available Options
To get Kaiser Permanente insurance coverage for rehab, it must be shown that the insured meets the criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders. Users who are approved may be given access to inpatient rehab, outpatient rehab, and detoxification services.
Inpatient Rehab Treatment
Assuming that the patient has been approved for the treatment and the facility selected in in-network, is licensed and provides 24-hour individualized treatment, Kaiser Permanente insurance plans for substance abuse treatment should cover the following treatments:
- Individual counseling
- Group counseling
- Medical services
- Medication monitoring
- Room and board
- Social services
- Drugs prescribed by a provider as part of treatment, with restrictions
- Discharge planning
Outpatient Rehab Treatment
When patients enroll in a program at an approved facility, the following services are covered:
- Day treatment programs
- Individual counseling
- Group counseling
- Intensive outpatient care
- Medical treatment for withdrawal
Types Of Health Plans
Kaiser Permanente insurance plans for drug rehab come in three primary types: group (or employer-based), individual and family, and Medicare plans. The specifics of Kaiser Permanente coverage vary between these options, from state to state, and even based on what coverage for drug rehab an employer seeks.
Many people access their health insurance through their employers. When this is done, a Kaiser Permanente drug rehab coverage is through a group plan. The insurance is provided by the employer to the employees with premiums generally being deducted directly from their paychecks.
Some types of Kaiser group plans include:
- Traditional or deductible plans: The participant is responsible for paying fees associated with their healthcare until they meet their deductible. In most cases, there is a maximum out-of-pocket amount set annually, and copays must be paid.
- Preferred Provider Organization (PPO) plans: Usually selected when Kaiser coverage is wanted, but the business or workers are not in a Kaiser Permanente service region. It comes at a higher rate but allows the use of out-of-network providers.
- Point-of-Service plans: This is a comprehensive option that allows the insured to use in-network providers or pay more to use out-of-network providers. It is a combination of an HMO and a PPO plan.
- Out-of-Area plans: If someone lives outside the Kaiser coverage area, they can access healthcare without a referral, with preventative services being covered and other services subject to cost-sharing or deductibles.
- Consumer-Directed Health plans: There are multiple options under this umbrella, including health reimbursement account, health savings account, and flexible savings account plans.
If someone has Kaiser Permanente insurance coverage through a group plan, they should have access to at least some forms of drug rehab.
Individual And Family
Individual plans are divided into four tiers: Bronze, Silver, Gold, and Platinum. Each tier will have different maximum out-of-pocket fees, deductibles, copays, and premiums.
Some types of individual and family policies offered by Kaiser include:
- Deductible plans: The insured pays for their healthcare until the deductible is met. There is usually a copay to be paid as well until they meet their maximum out-of-pocket spending.
- Copay plans: There is no deductible for some or all services, though there will be a copay. Usually, this type of plan has higher monthly premiums.
- Health Savings Account plans: These have a deductible that combines pharmacy and medical costs, with all costs being out-of-pocket until the deductible is reached. Once the deductible is met, the insured pays a percentage until they meet their maximum out-of-pocket spending. This can help the insured get a tax break on medical costs.
- Deductible Catastrophic: People with financial hardship or who are under the age of 30 may qualify for this plan. It covers just three doctor’s visits a year with additional fees being covered by the insured until they reach their deductible.
It should be noted that not all of these Kaiser insurance plans cover drug rehabilitation.
Adults over the age of 65 can opt for Medicare coverage. Kaiser Permanente Medicare plans essentially enhance Medicare coverage. These are HMO plans that can give seniors additional coverage and more options when it comes to healthcare providers. These Kaiser plans have low copays and do provide access to drug rehabilitation centers.
Kaiser Permanente Rehab Coverage By Plan
An insured individual cannot fully understand Kaiser Permanente health insurance coverage for drug rehab until they speak with their provider, as there are numerous variables at play. However, they can get a general idea of the costs for mental and behavioral health services that relate to substance use disorders. Below is a chart outlining costs for different services for substance abuse treatment through different Kaiser plans.
|Limitations, Exceptions, & Other Important Information|
|Flex Bronze||20% coinsurance||No coverage||20% coinsurance||No coverage||Preauthorization needed for inpatient care|
|Core Bronze HSA||20% coinsurance||No coverage||20% coinsurance||No coverage||Preauthorization needed for inpatient care|
|Core Silver HSA||10% coinsurance||No coverage||10% coinsurance||No coverage||Preauthorization needed for inpatient care|
|Flex Silver HD||$20 primary or $45 specialty|
|No coverage||30% coinsurance||No coverage||Preauthorization needed for inpatient care|
|Flex Gold||$15 primary or $40 specialty|
|No coverage||20% coinsurance||No coverage||Preauthorization needed for inpatient care|
How To Enroll Into Drug Rehab Insurance
The process of enrolling in Kaiser Permanente insurance coverage for rehab or other conditions depends on the type of policy being sought:
- If the policy is through an employer, the employee will need to seek Kaiser Permanente coverage at work during periods of open enrollment.
- If it is through the government, they will need to work with their local DHS office during enrollment periods.
Should someone want to take out an individual plan, they should contact Kaiser directly. An application will need to be completed for the primary insured and all their dependents. This can be submitted at any time. Once submitted, the company will review the application and either approve or deny coverage or possibly ask for additional documents. Usually, the initial approval is contingent upon having a physical examination performed, after which Kaiser Permanente coverage will be extended. There may or may not be a waiting period before coverage takes effect.
Verify Coverage With Kaiser And Start Treatment
If someone is insured through Kaiser Permanente and needs to get clean from their substance use disorder, they have access to affordable treatment. However, the specifics will depend on their policy. Verify Kaiser Permanente coverage directly with the company to get on the road to a healthier life.
- Health & Wellness. Kaiser Permanente. https://healthy.kaiserpermanente.org/health-wellness.
- 2019 Individual Plan Combined Membership Agreement, Disclosure Form, and Evidenceof Coverage for Kaiser Permanente for Individuals and Families. Kaiser Permanente. 2018. 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.
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