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Using Kaiser Permanente to Pay for Rehab

If you have Kaiser Permanente insurance coverage and need substance abuse treatment, you’re in luck. Kaiser Permanente plans typically cover a portion of drug and alcohol rehab. When you’re searching for an addiction treatment program, make sure you ask if they accept your insurance plan. If you’d like more information about the details of your plan, make sure to call Kaiser Permanente.

(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.)

Kaiser Permanente

Side Note PictureKaiser Permanente is a managed care consortium that was founded in 1945. It does not operate in all of the states, but it is the largest not-for-profit managed care organization in the U.S. It consists of three organizations:

  • Kaiser Foundation Health Plan.
  • Kaiser Foundation Hospitals.
  • Permanente Medical Groups.

Kaiser Permanente offers individual and family insurance plans that generally offer some sort of coverage for substance abuse treatment.

Does Kaiser Permanente Cover Rehab?

Kaiser Permanente health insurance plans should cover some portion of rehab. The Affordable Care Act (ACA) lists drug or alcohol addiction as one of ten "essential health benefits," which means that any insurance sold on the Health Insurance Marketplace must cover addiction treatment.1 Further, the Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that all private insurance plans cover substance abuse treatment to the same degree that they cover other medical issues, so you can expect equal levels of coverage for both.2

This means that if your insurance plan covers 80% of your medical costs, it will pay 80% of your rehab costs. You will be expected to pay the remaining 20% out-of-pocket.

Kaiser Permanente insurance coverage will vary by each policy’s particular offerings. In general, they will cover all substance abuse screening and assessment costs and part of the formal treatment program costs—outpatient, intensive outpatient, and inpatient services.

Always check to make sure the program that you are considering accepts your Kaiser Permanente insurance plan to reap the full insurance benefit.

Specialty Alcohol and Drug Treatment Through Kaiser Permanente

Treatment facilities with a focus on comfort and amenities tend to cost more than basic rehab services, since upscale locations and services, such as spa treatment, massage therapy, and gourmet meals are not considered "essential." These facilities, known as luxury or executive rehab programs, come with a higher price due to the facility maintenance costs and amenities offered.

Kaiser Insurance Coverage for Luxury Rehab

Because your Kaiser Permanente insurance plan will cover a certain percentage of rehab costs regardless of program, selecting a higher-cost facility will mainly impact your out-of-pocket costs.

For example, if your policy requires that you cover 20% of treatment costs, 20% of a $5,000 program will end up costing you far less than 20% of a $40,000 program.

This cost differential is an important factor to consider when looking at treatment programs. Finances can be a significant stressor and trigger that can lead to drug relapse—you want to ensure that your portion of treatment costs works with your financial needs.

Does it Cover Non-Local Rehab?

Kaiser Permanente operates in 9 states as of 2015:3

  • California.
  • Colorado.
  • Georgia.
  • Hawaii.
  • Virginia.
  • Maryland.
  • Oregon.
  • Washington.
  • The District of Columbia.

These are the Kaiser Permanente areas. Your insurance plan may cover treatment within these area networks, but as always, make sure to call your insurance plan to get all the details.

If You're Out of Network

Outside of the areas listed above, substance abuse treatment may not be covered.

With a Kaiser Permanente insurance plan, you must stick within the Kaiser Permanente service network. Out-of-region treatment will incur full out-of-pocket costs for you.

Make sure to verify that the program that you are considering accepts your insurance plan.

Questions to Ask Your Insurance Company

When you call Kaiser Permanente, you'll want to have your insurance card in front of you. If you're calling for someone else, make sure that you have their insurance card accessible. This is important, because your card has your policy number and name on it. Asking relevant questions can help you clarify the details of your plan and guide your treatment search. Some questions include:

  • Do you cover detox services?
  • Do you cover outpatient rehab? To what extent?
  • Do you cover inpatient treatment? To what extent?
  • Do you cover the cost of prescription medications?
  • What will my out-of-pocket fees be?
  • How many days of treatment do you cover?

This information will be useful to you moving forward.

How to Pay Your Portion of Costs

It’s up to you to cover the leftover costs after your Kaiser Permanente insurance policy covers their portion of treatment. The total of these out-of-pocket costs will vary by program, but there is always a way to afford recovery help!

  • Payment plans: Many rehab programs offer payment plans, where you arrange to spread out the total cost over monthly payment installments, to lessen the financial burden.
  • Sliding scale payments: Many programs also offer what is known as sliding scale payments, where the treatment costs will vary based on the individual’s income- if you make less money, you will have lower costs.

Other Financing Options

Other financing options to help you cover your portion of treatment costs include:

  • Using credit cards (depending on your credit limit).
  • Taking out private loans (including personal and home equity loans).
  • Applying for financial help with treatment costs.
  • Some facilities have money set aside for rehab scholarships, where they will help you cover part or sometimes all of the costs.

Recovery is your number one concern, and if you need help figuring out how to afford rehab, call your insurance company to learn more about the details of your individual plan.

Sources:

1. Office of National Drug Control Policy. (n.d.). Substance Abuse and the Affordable Care Act.
2. Centers for Medicare & Medicaid Services. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA).
3. Kaiser Permanente. (2018). Find doctors and locations.

Last updated on November 1 2018
2018-11-01T15:10:44+00:00
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