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Will Kaiser Cover Drug Rehab and Treatment

Kaiser Permanente health insurance plans will differ based on where you live and your eligibility. Coverage can often be used to offset costs related to drug rehab and treatment services.

Rehab Coverage Through Kaiser

With over 20 million Americans battling addiction involving drugs and/or alcohol in 2016, per the National Survey on Drug Use and Health (NSDUH), there is a high demand for drug rehab and treatment services.

Kaiser Permanente is one of the bigger healthcare companies, offering health insurance coverage to millions of Americans in several states throughout the country.

The Affordable Care Act (ACA) indicates that treatment for drug abuse and addiction must be covered as an “essential health benefit” under most health insurance plans. Therefore, drug rehab and treatment services are usually included through Kaiser plans. The level of coverage, types of services covered, and amount of coverage provided is determined by your specific Kaiser Permanente plan.

There are many plans in which to choose. Kaiser Permanente offers coverage for the following groups:

  • Individuals
  • Families
  • Employees under employer group plans
  • Medicaid and Medi-Cal beneficiaries
  • Medicare beneficiaries

Kaiser Plans Explained

There is a wide variety of health insurance plans offered by Kaiser Permanente, and most are specific to the state and county where you live.

kaiser plans

Medicare, Medi-Cal, and Medicaid plans are designed for low-income and eligible individuals. These include children, the elderly, families with children, and individuals struggling with disabilities.

If you qualify for Medicare or Medicaid (or Medi-Cal in California), you can indicate Kaiser Permanente as your health insurance provider. Drug rehab and treatment services are usually covered through these plans if they are deemed to be “medically necessary.”

Individual and family plans are varied based on location. There are many levels and types of plans in which to choose. Examples of Kaiser Permanente plans include:

  • High-deductible health plans (HDHPs). These plans offer coverage after the deductible is reached. Then, a high co-insurance rate kicks in up until the out-of-pocket maximum amount. The co-insurance rate for these plans is often 40 percent, which can mean you are responsible for paying that percentage of the costs of services rendered.
  • Health savings accounts (HSAs) paired with health maintenance organization plans (HMOs). These are tax-exempt accounts that allow you to set money aside in a specialized account to pay for medical expenses. Most treatment services are subject to a deductible that can range based on the coverage level and plan type. After the deductible is met, coverage is provided at the coinsurance percentage, and you will be responsible for the rest until your out-of-pocket maximum is met.
  • Copay, co-insurance plans. With these plans, there is generally a copay for treatment at the time services are provided. This is a set amount. There is often no deductible for these plans.
  • Deductible plans. With a deductible plan, you will pay for all services out of pocket until the deductible is reached. Then, the co-insurance rate will apply up until the out-of-pocket maximum is reached, and at that point, all covered services are covered. Many outpatient services will have a copay and not be subject to the deductible, while inpatient services will.
  • Deductible catastrophic plans. These are minimum coverage plans with high deductibles and specific eligibility requirements. Once the deductible is reached, services are covered completely.

Within these plans, there are also differing “metal” levels of coverage, from platinum at the highest to gold, silver, and then bronze. Platinum plans provide the highest level of coverage with the lowest deductibles and out-of-pocket fees but the highest monthly premiums. The plans descend in order down to bronze plans, which have the highest out-of-pocket fees, lowest monthly premiums, and highest deductibles.

Using Kaiser Insurance for Drug Rehab 

Detox, case management, outpatient services, medication management, evaluation, crisis services, mental health care, group and individual counseling, therapies, and inpatient drug rehab and treatment services can be covered by Kaiser Permanente plans. Coverage amounts and services covered will vary based on the plan itself.

An HSA Bronze plan may cover 60 percent of services and require you to cover the remaining 40 percent of outpatient mental health and specialty care visits, for example. A CoPayment Gold plan has a copay of $30 for a mental health office visit and $55 for a specialty office visit.

Many people

Drug rehab often needs prior authorization or a referral from a primary care provider (PCP). Services will have to be listed as “medically necessary” to be covered. 

There may be a limit on the number of days in a treatment program that will be covered, and there may also be an annual or even a lifetime allowable number of days in a drug rehab program.

A Kaiser Permanente representative can provide detailed information on your specific plan, coverage options, and how it works to pay for drug rehab and addiction treatment services.

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Sources

(September 2017) Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

(December 2018) Fast Facts About Kaiser Permanente. Kaiser Permanente. from http://xnet.kp.org/newscenter/aboutkp/fastfacts.html

What Marketplace Insurance Plans Cover. HealthCare.gov. from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

(2018) Shop Plans. Kaiser Foundation Health Plan. from https://healthy.kaiserpermanente.org/shop-plans

(2019) Learn About Your Medi-Cal/Medicaid Options. Kaiser Permanente. from https://thrive.kaiserpermanente.org/medicaid

(January 2019) View our 2019 Plans. Kaiser Permanente. from https://individual-family.kaiserpermanente.org/healthinsurance/plan/view

Plan Details. Kaiser Permanente. from https://individual-family.kaiserpermanente.org/healthinsurance/plan/detail

Plan Details. Kaiser Permanente. from https://individual-family.kaiserpermanente.org/healthinsurance/plan/detail

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