Kaiser Permanente Insurance covers 12.5 million members in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C. residents.1,2 The insurance company offers a variety of plans, including individual policies for single and family coverage, employer-sponsored plans, Medicare plans, and Medicaid plans.3
Covered members can seek rehab treatment at Kaiser Permanente facilities and may be able to receive care at little to no out-of-pocket cost, depending on the insurance plan. Rehab centers can verify your benefits and coverage to help you determine whether your care would be covered at their facility. You can also call the number on the back of your insurance card to check your benefits and coverage.
What Will Kaiser Permanente Insurance Cover?
As mandated by the Affordable Care Act (ACA), Kaiser Permanente plans provide coverage for at least 10 essential health benefits, including mental health and substance use disorder treatment.4 Under this ACA mandate, your Kaiser Permanente plan must cover the following mental health services in some capacity:4
- Substance use disorder treatment
- Inpatient mental and behavioral health services
- Outpatient mental and behavioral health treatment
In most cases, your specific Kaiser Permanente health plan will cover some of the most common treatments for heroin addiction and rehabilitation in some capacity:
- Inpatient or residential rehab: With inpatient or residential care, you or your loved one would stay at the facility for a set period of time and be monitored 24/7. 5, “How are behavioral therapies used to treat drug addiction?”
- Outpatient rehab or therapy: People in outpatient treatment travel to a facility during the day to receive health care services (e.g., medications, therapy, or counseling), and then return home after their session is complete. 5, “How are behavioral therapies used to treat drug addiction?”
- Partial hospitalization programs: You or your loved one may be hospitalized in a limited capacity, such as a structured day program, to receive treatment, and then leave at the end of each day.6
This list of common treatments for mental health and substance use disorders is not exhaustive. It’s important to remember that the extent to which a plan may cover treatment will vary depending on your plan and location. As such, you should always contact a Kaiser rehab center or your Kaiser insurance representative to verify coverage before seeking treatment.
Does Kaiser Permanente Insurance Cover Mental Health Care?
Because mental and behavioral health services are considered essential health benefits under the ACA, all Kaiser Permanente plans are required to provide coverage for such services in some capacity.4 The ACA mandate means that plans must provide coverage for both stand-alone drug rehabilitation and co-occurring disorder treatment.
Data from the National Institute on Drug Abuse shows that 7.7 million Americans have a co-occurring disorder,7 which is when a person has both a substance use disorder and a mental health disorder. The recommended treatment for co-occurring disorders is an integrated approach that addresses both issues at the same time.8
American Addiction Centers-accredited facilities provide an integrated approach when addressing heroin and drug addiction. In many cases, your Kaiser Permanente plan will provide coverage for treatment at an AAC facility. Be sure to verify your benefits with an AAC customer service representative or with your insurance company before entering a program.
How Long Does Kaiser Permanente Cover Rehab?
You or your loved one should work with a health professional to determine how long your road to recovery may be. People who are working to overcome a substance use disorder or a co-occurring disorder typically benefit from longer periods of treatment. However, everyone’s rehab path and insurance will vary. The length of time that Kaiser Permanente will cover rehab depends on your plan. You can contact your Kaiser Permanente insurance representative to verify your levels of coverage. You can also request a summary of benefits and coverage (SBC) so that you can view all of your plan’s benefits.
What if My Kaiser Permanente Insurance Policy Does Not Cover Rehab?
Your Kaiser Permanente Insurance policy may not cover the full cost of rehab at the facility of your choice. Or your policy may provide only partial coverage for your treatment. If this is the case, you may be responsible for out-of-pocket costs. Check if your plan will provide any level of reimbursement for out-of-network rehab care.
Additional financing options may be available to you. Some facilities have payment plans or special financing programs. Others offer scholarship opportunities to help cover some of the associated rehab costs.
It is important not to let finances or insurance complications delay getting the care you or a loved one needs. Seeking help today rather than putting it off is critical to your long-term health. Call the customer service line at AAC to discuss your options.
Kaiser Permanente In-Network vs. Out-of-Network Rehab Centers
Depending on your Kaiser Permanente health plan, you may need to be treated by an in-network provider to avoid high medical costs. The Permanente Medical Groups and Kaiser Foundation Hospitals are in-network, so all or part of your rehab stay will typically be covered if you receive care at one of these facilities.9 Some plans may offer partial coverage for treatment at an out-of-network facility (one that is not within the Permanente Medical Groups).
To check whether a treatment provider is in or out-of-network, be sure to call the number on the back of your insurance card. You can also ask the treatment facility to contact your insurance company on your behalf to verify coverage.
Check Kaiser Permanente Coverage for Addiction Treatment
Getting treatment is of utmost importance for anyone struggling with addiction or mental health disorders. American Addiction Centers provides high-quality treatment for addiction and mental health disorders, and we can help you check whether treatment will be covered at one of our facilities. Please enter your information in the form below or contact us today to verify your benefits and coverage, and to learn more about our treatment services.
Sources
- Kaiser Permanente. (2021). Fast facts.
- Kaiser Permanente. (2015). Kaiser Permanente service areas.
- Kaiser Permanente. (2021). Shop plans.
- Gov. Mental health & substance abuse coverage/
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2019). Treatment Approaches for Drug Addiction DrugFacts.
- Mental health care (partial hospitalization).
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2018). Comorbidity: Substance Use and Other Mental Disorders.
- Brouselle et al. (2010, Jul-Sep). Integrating services for patients with mental and substance use disorders: What matters?
- Permanente Medicine. About us.
