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Kaiser Permanente Drug Rehab Insurance: Coverage Options

Last Updated: February 15, 2022

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

The expensive nature of addiction rehabilitation services is one reason why many individuals struggling with addiction find it hard to obtain the medical care they need. Fortunately, according to the Affordable Care Act, also called Obamacare Insurance, that passed in 2010, all marketplace insurance providers, like Kaiser rehab insurance, must cover drug and alcohol rehabilitation programs as part of the “ten essential health benefits.”

Also, the Mental Health Parity and Addiction Equity Act (MHPAEA) demands that all health insurance providers cover substance use disorder treatment and rehabilitation to the same degree as they would cover any other medical issue. Kaiser alcohol treatment and Kaiser drug rehab are two addiction rehabilitation services offered by any Kaiser Permanente rehab center as part of their drug rehab program.

What Is Kaiser Permanente?

Kaiser Permanente is an integrated managed care health insurance provider based in the United States that functions primarily as a Health Maintenance Organization (HMO) and allows specific clients to choose a Preferred Provider Organization (PPO) plan.

Integrated managed care is a healthcare delivery system that provides comprehensive and cost-effective medical services to its customers through a network of contracted healthcare providers and medical facilities for a prepaid cost.

An HMO is a form of the integrated managed care plan which allows participants to receive medical services only from an assigned healthcare provider within the network. On the other hand, a PPO allows the client to choose healthcare providers outside the network but at a higher cost.

Kaiser insurance agent giving a consultation on insurance plans.

The organization is the largest managed care organization in the country. It provides coverage for eight states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) and the District of Columbia. It offers group or employer-based, family and individual plans and Medicare plans. The group employs over 304,000 physicians and caters to over 12.5 million clients.

Kaiser Permanente Substance Abuse Program

The Kaiser Substance Abuse Program includes Kaiser Permanente alcohol treatment and Kaiser drug rehab coverage. These offer complete or partial coverage for various forms of substance abuse treatment and mental health treatment programs such as outpatient treatment, inpatient treatment, detoxification, transitional recovery services, and so on.

Kaiser Permanente Rehab Coverage: Available Options

To get insurance coverage for rehab under the organization, 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.

Kaiser Inpatient Rehab Treatment

Assuming that the patient has been approved for the treatment and the facility selected in-network is licensed and provides 24-hour individualized treatment, the 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

There is usually some form of copay for Kaiser inpatient rehab treatment. The specific amount may vary based on the particular Kaiser rehab inpatient plan, the program’s duration and size, and the treatment and amenities provided. Also, there may be other out-of-pocket expenses you may be required to cover during your stay in the Kaiser inpatient rehab, but the cost of these may vary widely as well.

Kaiser Outpatient Rehab Treatment

Kaiser rehab also covers outpatient rehab treatment. Participants are also allowed to seek the services of healthcare providers or medical facilities outside of the Kaiser Permanente rehab network. Still, they should bear in mind that seeking an out-of-network provider may cost you significantly higher.

When Patients Enroll in a Kaiser Rehab Program at an Approved Facility, the Following Services Are Covered:

  • Day treatment programs
  • Individual counseling
  • Group counseling
  • Intensive outpatient care
  • Medical treatment for withdrawal

There is typically a copay for Kaiser rehab outpatient treatment as well. The specific amount of copay varies based on the specific outpatient services offered, the number of visits, and your insurance plan. Also, there may be other out-of-pocket expenses you may be required to cover, but the cost of these expenses may vary widely as well. The best way to determine the overall cost of an outpatient plan under Kaiser alcohol rehab and substance abuse rehab programs is to contact the customer service center for further information.

Types Of Health Plans Covered Under the Kaiser Substance Abuse Program

The insurance plans for drug rehab come in three primary types: group (or employer-based), individual and family, and Medicare plans. The specifics of each coverage plan vary between these options, from state to state, and even based on what coverage for drug rehab an employer seeks.

Group

Many people access their health insurance through their employers. When this is done, Kaiser drug rehab coverage is through a group plan. The employer provides the insurance to the employees, with premiums generally being deducted directly from their paychecks.

Some Types of 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 members must pay copays.
  • Preferred Provider Organization (PPO) plans: Usually selected when coverage is wanted, but the business or workers are not within the service region covered by the organization. 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 coverage area, they can access healthcare without a referral, with preventative services 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 insurance coverage through the organization’s 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 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. It can help the insured get a tax break on medical costs.
  • Deductible Catastrophic. People with financial hardship or under the age of 30 may qualify for this plan. It covers just three doctor’s visits a year, with additional fees covered by the insured until they reach their deductible.

Medicare

Adults over the age of 65 can opt for Medicare coverage. The Medicare plans essentially enhance Medicare rehab coverage. These are HMO plans that can give seniors additional coverage and more options when it comes to healthcare providers. In addition, these plans have low copays and do provide access to drug rehabilitation centers.

Does Kaiser Cover Therapy?

According to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), health insurance providers and group help plans must provide the same coverage and benefits to mental health and substance use disorder treatment as they do to other medical or surgical illnesses.

Mental health support, people holding hands.

Therefore, any Kaiser drug rehab center is mandated under federal law to cover full or partial costs of mental health therapy and other forms of addiction therapy such as Kaiser alcohol treatment. The particular form of substance use disorder therapy offered depends on the insurance plan one registered.

Usually, Most Participants Have Access to the Following Forms of Addiction Therapy:

  • Group counseling
  • Individual counseling
  • Inpatient and outpatient treatment programs
  • Self-care and wellness support

Addiction Medicine Coverage

The program covers various prescription addiction medications, including opioid medications used as part of the opioid addiction and Kaiser alcohol treatment medications like methadone, suboxone, and naltrexone. These medications are part of medication-assisted treatment (MAT) and are the only three medications approved by the Food and Drug Administration (FDA) to treat opioid addiction. However, the coverage level depends on the particular plan you are under.

Medication-assisted treatment involves using particular medications, behavioral therapy, and counseling to provide comprehensive help and treatment to those struggling with substance use disorders. Kaiser alcohol treatment and Kaiser drug rehab programs are carefully tailored to meet every participant’s needs. Studies have shown the effectiveness of MAT in reducing opioid use and opioid-related overdose deaths. Also, integrating MAT therapy into programs like the Kaiser alcohol rehab program for treating alcoholism has shown clear benefits, especially for those struggling with mental health issues.

How To Enroll In Kaiser Drug Rehab Insurance

The process of enrolling in under the 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 coverage at work during open enrollment periods.
  • 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 the organization directly for further information. An application will need to be completed for the primary insured and dependents. Applicants can submit this information at any time. Once submitted, the company will review the application and approve or deny coverage or possibly ask for additional documents.

Verify Your Coverage And Start Treatment

On the road to recovery from substance use disorders, one needs all the help one can get. Health maintenance organizations like Kaiser Permanente offer a wide range of insurance coverage for various forms of drug addiction and mental health therapy. With the backing from federal policies like the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, these organizations are mandated to give drug addiction therapy the same level of coverage as other medical procedures.

Therefore, if you or anyone you know is struggling with substance abuse, reach out to the nearest rehabilitation center near you for further information. They will inform you about the available treatment plans and coverage options, including Kaiser inpatient rehab and outpatient rehab services. The journey may be long, but that does not mean you have to walk the path alone.

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Page Sources

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  3. Pope, G. C., Greenwald, L., Kautter, J., Olmsted, E., & Mobley, L. (2006). Medicare preferred provider organization demonstration: plan offerings and beneficiary enrollment. Health care financing review, 27(3), 95–109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194956/
  4. NIDA. 2016, November 1. Effective Treatments for Opioid Addiction. https://nida.nih.gov/publications/effective-treatments-opioid-addiction
  5. Robertson, A. G., Easter, M. M., Lin, H., Frisman, L. K., Swanson, J. W., & Swartz, M. S. (2018). Medication-Assisted Treatment for Alcohol-Dependent Adults With Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes. The American journal of psychiatry, 175(7), 665–673. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032529/
  6. Drug and alcohol treatment and recovery. Kaiser Permanente. https://healthy.kaiserpermanente.org/health-wellness/addiction-and-recovery/drug-and-alcohol-treatment
  7. Individual & family plans. Kaiser Permanente. https://individual-family.kaiserpermanente.org/healthinsurance#1-getaquote
  8. Business. Kaiser Permanente. https://business.kaiserpermanente.org/
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Published on: October 2nd, 2019

Updated on: February 15th, 2022

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.