Kaiser Permanente Insurance Coverage for Drug and Alcohol Rehab

Yes, Kaiser plans typically cover at least a portion of drug and alcohol detox and rehabilitation.

All Kaiser Permanente health plans provide addiction treatment coverage in some way because substance use disorder (SUD) and mental health facilities are one of 10 essential health benefits that any plan sold in the marketplace must cover.¹

Coverage for drug and alcohol rehab treatment may vary between Kaiser Permanente plans. In general, treatment for abuse of drugs and alcohol may be delivered at a variety of levels, such as outpatient, intensive outpatient, and inpatient residential treatment.²  The plan you have will dictate the level of coverage you have, meaning how much you will be responsible for paying in out-of-pocket costs such as co-pays and deductibles.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific treatment received.

Check Your Kaiser Permanente Rehab Coverage

It’s always best to be sure about what your healthcare benefits entail by checking what your Kaiser Permanente rehab coverage includes and insurance costs. You don’t want to be caught by surprise with unexpected financial costs. You may wonder if Kaiser Permanente covers alcohol and drug rehab, and the only way to really have the answer is to check your Kaiser insurance plan coverage.

Always check to make sure the program or provider that you are considering accepts your Kaiser Permanente plan.

Getting the proper addiction treatment is essential for your recovery journey. The type of drug and alcohol treatment plan you need will depend on the severity of your addiction and where you are in the treatment process. Some of the substance abuse treatment programs you can expect to be covered through Kaiser Permanente include:¹⁰

Drug and Alcohol Detox Programs Through Kaiser

During a detox program for addiction, clinicians will assist you as you go through the withdrawal stage of recovery. Medically managed detox ensures that you are comfortable and safe as you go through any uncomfortable, painful, or potentially dangerous withdrawal symptoms. Read more: Medical Detox Centers Near Me.

Inpatient or Residential Addiction Treatment Through Kaiser

Inpatient rehab program is also a residential program because patients will stay overnight and be under medical supervision. People who suffer from co-occurring or dual diagnosis disorders would benefit highly from impatient rehab treatment. Read more: Residential Inpatient Drug and Alcohol Rehab Centers.

Partial Hospitalization Program (PHP) Through Kaiser

This program provides therapy and treatment most days of the week for several hours a day. Patients are usually allowed to go home during the evening, spend the night at home and then return the following day. Read more: Partial Hospitalization Programs.

Outpatient Addiction Treatment Through Kaiser

Outpatient programs may be intensive (intensive outpatient program) or just once a week, depending on your situation. They allow you to obtain treatment while living at home. Read more: Outpatient Substance Abuse Treatment Programs.

In most cases, you will need to seek treatment at a rehab center that is in-network with Kaiser to receive your full benefits. Even if you choose a drug and alcohol addiction treatment facility that is in-network, you may still be responsible for some of the treatment costs.

If you choose a rehab facility that is out-of-network, you may be responsible for all the costs of your addiction treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the facility.

Knowing exactly what type of Kaiser Permanente plans cover substance abuse treatment can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles.

Kaiser Permanente rehab addiction services may be covered entirely or partially based on the type of Kaiser insurance plan you have. There are 3 main types of health plans offered by Kaiser Permanente: group or employer-based plans, family and individual plans, and Medicare plans. Plans may vary from region to region and state to state.

Group: Group plans through Kaiser Permanente may include:^3-5

• Traditional or deductible plans: Fees may be paid by the plan participant until deductibles are met, and there is typically an out-of-pocket annual maximum amount. Copays may be required.
• Preferred Provider Organization (PPO) plans: Recommended for individuals who want to use out-of-network providers. Coverage can be maintained at a higher rate when non-preferred physicians are used, and in-network coverage costs less.
• Point-of-Service Plans: This type of plan allows individuals to use in-network providers and network-contracted providers or pay more for out-of-network providers.
• Out-of-Area Plans: Those who don’t live in an area with Kaiser can receive healthcare treatment without a referral. Preventative services are typically covered, and other facilities may be subject to cost-sharing or a deductible amount.
• Consumer-Directed Health Plans: Several options are available, including a health reimbursement account and a flexible savings account.

Individual: Individual plans range between Gold, Silver, Bronze, and Platinum. In general, the following types of plans are available:⁶

• Deductible plans: Facilities are provided for a fee until the deductible is met. Many services have a copay as well. Preventative services may be completely covered.
• Copay plans: Preventative services are covered, and there is no deductible amount for these services, though they are subject to a copay for office visits and services rendered.
• Health Savings Account (HSA) plans: These plans have a combined pharmacy and medical cost deductible, and all costs are out of pocket until the deductible is reached.
• Deductible catastrophic: Individuals with financial hardship or younger than 30 may qualify for this plan in most coverage regions. It covers up to 3 doctor’s visits a year.

Kaiser Permanente and Medicare

Medicare is federal insurance coverage for adults over the age of 65, and Kaiser Permanente Medicare plans may provide more options than standard Medicare.^7,8 Plans include the Kaiser Permanente Senior Advantage and the Senior Advantage Basic, which are HMO plans that vary according to the coverage region and plan selected.⁹ Most coverage will have low co-payment for services and prescriptions, with no copay for most preventative services.

For seniors seeking substance abuse treatment, a trained insurance professional at a specialized treatment center can help individuals understand their coverage and how it may be used to pay for services.

Where Does Kaiser Permanente Provide Coverage?

Kaiser Permanente offers individual and family insurance plans, both of which offer some sort of coverage for substance abuse treatment.

Depending on the state, Kaiser Permanente may offer health insurance benefits including the following:¹¹

• Preventative care (e.g., mammograms and wellness checkups).
• Prescription drug coverage.
• Doctor office visits, to both primary care and specialty physicians.
• Hospital stays.
• Outpatient treatment for mental health and substance abuse.
• Inpatient treatment for substance abuse and mental health.

In What Locations Do Kaiser Permanente Provide Coverage?

In general, Kaiser Permanente offers care in 8 states and Washington, D.C., as of 2019:¹²

• California.
• Colorado.
• Georgia.
• Hawaii.
• Virginia.
• Maryland.
• Oregon.
• Washington.
• Washington, D.C.

If you’re visiting another Kaiser Permanente service area, substance abuse and mental health services should be covered the same as if you were in your own area, although there are exceptions. You may need a referral. It’s unclear if this coverage would be the same for individuals who intentionally travel to go to a non-local inpatient rehab center. Call Kaiser Permanente’s “Away from Home Travel Line” to check and get all the details.¹²

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

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and specific services received.

Before deciding on a rehab center, check your Kaiser policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Kaiser’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the center you are considering is in-network with Kaiser. Or, call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.

If your Kaiser insurance policy does not cover all your rehab expenses, it’s important not to let that stop you from getting treatment. You don’t have to use the insurance when you decide to check into drug and alcohol facility. The total of these out-of-pocket costs can vary based on many factors, but some treatment programs may have one or more options to help you afford recovery help, such as:

• Payment plans: Rehab programs may offer payment plans where you arrange to spread out the total cost over regular payment installments, to make the financial burden more manageable. Be sure to look at interest rates and other details of the plan.
• Sliding fee scale: Programs may offer a sliding fee scale, where the treatment costs will vary based on the individual’s income—if you make less money, you will have lower costs. This may only be an option if you pay entirely out-of-pocket.
• Scholarships: Programs may offer rehab scholarships where you can potentially receive treatment at a discounted cost or no cost at all.

Find out more:How to Pay for Rehab Without Insurance?

Make sure to do thorough research when looking for drug and alcohol rehabilitation so that you can find one that meets your financial needs.

Here are additional resources that provide more information about other ways to pay for rehab treatment with or beyond what Kaiser covers:

• How to Pay for Rehab Without Insurance
• FAQs about Paying for Rehab
• What is the Cost of Drug Rehab?

We know that finding a rehab facility is a confusing task, but we’re ready to help you navigate through the world of treatment centers. Call one of our admissions navigators if you’re worried about a loved one or you’re ready to take action to begin the process toward recovery.

1. U.S. Centers for Medicare & Medicaid Services. (n.d.). What Marketplace health insurance plans cover.
2. Medicare.gov. (2017). Medicaid Innovation Accelerator Program: Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.
3. Kaiser Permanente. (n.d.). Traditional or deductible plans.
4. Kaiser Permanente. (n.d.). Preferred Provider Organization (PPO) plans.
5. Kaiser Permanente. (n.d.). Consumer-Directed Health Plans.
6. Kaiser Permanente. (n.d.). View Plans.
7. Kaiser Permanente. (n.d.). Medicare Health Plans.
8. Medicare. (n.d.). Medicare Home Page.
9. Kaiser Permanente. (2020). Medicare Health Plans & Rates for 2020.