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Does Kaiser Permanente Insurance Cover Alcohol Addiction Treatment?

If you have insurance through Kaiser Permanente, then you are likely to receive at least partial coverage for alcoholism rehab. Alcohol addiction is considered to be an essential health benefit, which means that insurance companies are required to provide some level of coverage. Your specific coverage largely depends on whether you have the bronze, silver, gold, or platinum plan. If you have platinum, you'll likely have the lowest out-of-pocket costs to pay, while the bronze plan typically requires a much higher out-of-pocket price.

(Please note: Rehabs.com strives to provide you with the most updated information on each carriers' addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. Rehabs.com is an informational site only and is not affiliated or sponsored by Kaiser.)

Your Coverage for an Alcohol-Free Life

man drinking alcohol in grass in need of coverage for addictionAlcoholism is a chronic disease, yet only 6.7% of the people who needed alcohol abuse treatment in 2015 received it2. If you're considering rehab, you are taking a step towards caring for a perfectly treatable disease. If you're considering rehab, you are taking a step towards caring for a perfectly treatable condition. Kaiser Permanente Insurance for alcohol addiction rehab is only a fragment of a larger corporation intensely involved in the peer-reviewed analysis of chemical dependency treatment and its efficacy. This seems to feed the quality of its coverage and the kinds of rehab it supports. You can expect to receive full or partial coverage for treatment in order to obtain and maintain sobriety.

Find out What Treatments Your Insurance Covers

A therapist can help you to assess the kind of treatment that will give you the best odds of achieving long-term sobriety. A doctor may decide that your alcoholism can best be treated in an inpatient center that specializes in treating alcohol abuse while others may be better suited for an outpatient program. It all depends on the individual's needs and situation. In essence, your assessment determines the type of rehab medically necessary for you, which drives your coverage. When you call your insurance company, it is important that you clarify these things, though. You'll want to ask if they cover detox and for how many days, if they cover outpatient and to what extent, and if they cover inpatient and to what extent. It's also important to ask about specific concerns, such as dual diagnosis treatment or medication. Some addictions, such as those to opioids or alcohol, can be treated with a combination of behavioral therapy and medication, so you'll want to know if your medication will be covered.

Your Coverage

Your coverage is affected by the tier of your plan (bronze, silver, gold, or platinum) and its comprehensiveness. Generally, your bronze plan is the least expensive monthly payment with the greatest out-of-pocket fees when you receive care. On the opposite end of the spectrum, platinum is the most expensive per month with the lowest out-of-pocket payments when you get treatment.1 Alcoholism is on the list of 2014 essential health benefits and thus must be covered, but your plan's actuarial value determines the size of your co-payment.

Paying Above Your Insurance for Care

Kaiser Permanente Insurance for alcohol addiction rehab caps your out-of-pocket limit at a minimum of $6,350 for individual plans. This may shrink your co-payments and out-of-network costs if you don't have a Medicaid or CHIP plan. If, in the unlikely event that you are medically advised to take a treatment course that requires you to pay out-of-pocket, it is in your power to do so. If you have a Health Savings Account qualified plan, you may use it to cover superfluous expenses.

Inpatient Addiction Treatment vs. Outpatient Therapy

"Alcoholism is a chronic disease, yet only 6.7% of the people who needed alcohol abuse treatment in 2015 received it. If you're considering rehab, you are taking a step towards caring for a perfectly treatable disease."
Kaiser Permanente's state-by-state integrated care system is supported by doctors specializing in addiction medicine and the dual diagnoses of addiction and psychiatric disorders. Its Chemical Dependence Recovery Programs are founded on the long term success of today's innovative methods, launching a new tier of treatment focused on inpatient detox and intensive outpatient group therapy. Meta-studies show that the quality of your treatment setting is often more important than whether you choose in or outpatient care. Some patients do show better outcomes as inpatients, making your decision one that is best tied around a medical assessment.

Residential Rehab

Alcoholics who feel ambivalent about their need for treatment, those facing complex family dynamics such as childcare and work schedules, and those with co-existing psychiatric diagnoses are more likely to enter a cycle of relapse and recovery after rehab. If these issues apply to you, your choice becomes a fundamental one that needs the backing of a thorough psychological assessment.

Coverage for Out-of-State Treatment

Some Kaiser Permanente plans have a defined out-of-area coverage policy for both urgent and non-urgent medical needs. Regular plans usually cover emergency care, with the same co-payments that apply only to in-state care. The insurer has addiction treatment centers for addiction cases and dual diagnoses, as well as designated providers which limit the rehab centers you can choose at the lowest available co-payment.

Private and Luxury Treatment

Insurance only covers what is deemed medically necessary by your physician. While detox, outpatient treatment, and standard inpatient treatment are all typically covered under this premise, luxury treatment is generally not. Luxury treatment programs feel more like a resort and offer many upscale amenities and services, such as spa treatment, massage therapy, swimming pools, saunas, gourmet meals, and more. It is likely that you'll have to pay far more out-of-pocket for a program like that. On the other hand, private treatment programs, which may have more services to offer than publicly funded programs, are at least partially covered in almost all cases.

Executive Treatment

One of the world's highest treatment center recovery success rates is an executive one. This does not mean that mixing with the rich and famous is going to spark a brighter recovery, but for those in high powered careers, this form of treatment takes care of the crucial sociological aspects that underpin a successful rehabilitation during the first six months of recovery. You will be able to comfortably perform your work duties and enjoy group therapy with peers.

Length of Stay

It is increasingly common for alcoholics to choose intensive outpatient care with long-term support over short-term inpatient care. Long-term relapse prevention is a critical factor in a solid recovery but this doesn't always mean a 9-month inpatient program is indicated for all patients. Kaiser Permanente generally supports and covers intensive outpatient programs, but treatment lengths may be assessed according to the Obsessive Compulsive Drinking Scale and the co-existence of psychiatric diagnoses, such as bipolar disorder. This may extend care and coverage based on medical necessity.

What If I Have No Insurance?

insurance-and-addictionThere's nothing more important than your health and happiness, which is why there are ways to access treatment even without insurance. For alcoholics, asking for help isn't always a learned skill, but at the cusp of a real chance at a healthy life, it may be worthwhile to take that risk now.

Questions and Answers

    • Will Kaiser Permanente Cover Multiple Rehab Stays?

Kaiser Permanente insurance coverage for alcohol addiction rehab/treatment limits acute inpatient care to an annual benefit, which means they renew each year. If you require repeated treatment after having used up your benefits, 2014 plans receive help with out-of-pocket expenses if they comply with the coverage provided for in your policy. This operates on a sliding scale based on your household earnings.

    • Does Insurance Pay for Aftercare?

Some health plans draw a line at 20 days of treatment annually, so you may need to create a priority-based strategy that fits into those limits. Aftercare may be classified as preventative treatment which receives full coverage across all plans. If you have a limited policy, however, you may want to consider paying out of pocket, given that aftercare often carries a light price tag.

    • Could Rehab Make My Insurance Premiums Higher?

While Obamacare's language may seem to suggest that your premiums may not be inflated as a result of rehab, the truth is a little more tangled: Your premiums may rise slightly, but they are not allowed to rise any higher than they would if you were treated for any other medical condition.

  • Does the Affordable Care Act Affect Substance Abuse and Mental Health Insurance Coverage?

2013 was a difficult year for health insurance carriers, with 160, 000 Kaiser Permanente policy holders having their plans terminated because they didn't meet the lofty standards of the Affordable Care Act. With the chaos over, however, Obamacare has left you with a plan that covers you more comprehensively than before, and it is tagged onto a list of essential benefits that includes mental health and chemical dependency coverage. Your annual expenses are capped at a lower level, leaving your bank account far plumper should you need to lay out payment for extra uncovered treatments and co-payments.

Sources

1. Kaiser Permanente for Individuals and Families. (2016). 2016 Enrollment Guide.
2. National Institute on Alcohol Abuse and Alcoholism. (2017). Alcohol Facts and Statistics.

Last updated on October 29 2018
2018-10-29T15:25:30+00:00
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