Kaiser Permanente Insurance Coverage for Alcohol Abuse And Addiction Treatment

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Kaiser Permanente insurance can significantly lower the cost of alcohol abuse and addiction treatment, and deductibles and copays will vary by plan.

Kaiser Permanente Insurance For Alcohol Rehab Treatment

In response to the nearly 21 million Americans suffering from a substance use disorder, addiction treatment is becoming more available across the country. There are multiple treatment approaches to help those struggling with addiction, including inpatient, outpatient, and partial hospitalization care.

These types of treatment vary in price, but having Kaiser Permanente insurance helps to offset the overall cost. Many individuals struggling with alcohol abuse and addiction are already experiencing financial difficulties, and seeking treatment should not be an additional financial stressor. By utilizing Kaiser Permanente insurance, individuals can find affordable ways to access the care they need.

Using Kaiser Permanente Insurance For Alcohol Use Disorder Treatment

Although Kaiser Permanente has been serving regions of the U.S. for the past 60 years, it’s been difficult in years past for people to access addiction treatment, even if they have insurance. However, this has started to shift, as Kaiser Permanente and other insurance companies expanded policies and coverage for drug and alcohol addiction treatment after the 2008 Mental Health Parity and Addiction Equity Act.

Effective in 2010, this legislation requires insurance companies and healthcare providers to cover mental health and substance abuse services in the same way that other medical services are covered and provided.

That means that if someone is hospitalized due to substance abuse, they will be covered by their insurance in the same way that someone is covered for diabetes. If an individual’s plan covers a percentage of a hospital stay, that same percentage would be covered for an inpatient drug rehab stay.

Sometimes individuals struggling with alcohol abuse are also experiencing additional health issues, including malnutrition, gastrointestinal complications, or mental health diagnoses. For these reasons, Kaiser Permanente offers holistic coverage to ensure that each health concern is addressed individually. Those with pre-existing conditions are protected under the Affordable Care Act and will not be denied coverage.

What Will Kaiser Permanente Insurance Cover For Alcohol Addiction Treatment?

Finding a quality treatment center that takes your insurance can feel overwhelming. It’s helpful to start by understanding the details of your specific plan in order to gauge the estimated costs. Some of the variables to keep in mind include the exact coverage associated with your plan and the cost of the addiction treatment center you’ve selected.

For example, if someone chooses an inpatient treatment program and their plan specifies a 25 percent copay, this means that Kaiser Permanente will cover 75 percent of the overall cost, and the policyholder is responsible to pay the remaining 25 percent (usually at the time of service).

Kaiser Permanente provides multiple levels of insurance plans (Bronze, Silver, and Gold), to enable members to choose an affordable monthly premium that is personalized to their medical needs. If someone needs to use Kaiser Permanente insurance for alcohol addiction treatment, most plans provide at least partial coverage, and the copays differ by plan.

The three levels of Kaiser Permanente HSA insurance include:

  1. Kaiser Permanente HSA Bronze

    • Yearly deductible: $4,800
    • Out-of-pocket maximum: $6,550
    • In-network copay: 40 percent after deductible
    • Out-of-network copays: emergency services are covered at 60 percent

Addiction Treatment Services under Kaiser Permanente HSA Bronze:   

  • Detox: Provides up to 60 percent coverage for drug and alcohol detox
  • Inpatient and outpatient treatment: policyholders to pay 40 percent in coinsurance, HSA Bronze plan covers 60 percent
  • Medication-assisted treatment: individuals pay 40 percent in coinsurance
  • Sober living house/aftercare options: May be covered, based on facility
  1. Kaiser Permanente HSA Silver

  • Yearly deductible: $2,000
  • Out-of-pocket maximum: $7,000
  • In-network copay: Costs range from $25 to 30 percent of service.
  • Out-of-network copays: Emergency services covered; individual pays $45 for urgent care, $250 for ambulance, and $350 for ER visit

Addiction Treatment Services under Kaiser Permanente HSA Silver:  

  • Detox: Covered—individuals can expect to pay between $45 to 35 percent of service cost, depending on whether detox services are inpatient or outpatient
  • Inpatient treatment: policyholders to pay 35 percent of inpatient costs
  • Outpatient treatment: policyholders to pay $45 for individual visit and $22 per group session
  • Medication-assisted treatment: Covered—drug copays would apply
  • Sober living house/aftercare options: May be covered, based on facility
  1. Kaiser Permanente HSA Gold

  • Yearly deductible: $0
  • Out-of-pocket maximum: $6,000
  • In-network copay: Costs range from $15 to 20 percent of service
  • Out-of-network copays: Emergency services covered; individual pays $25 for urgent care, $250 for ambulance, and $350 for an ER visit

Addiction Treatment Services under Kaiser Permanente HSA Gold:   

  • Detox: If detox is inpatient, individuals pay 20 percent coinsurance; for outpatient detox, individuals are charged $25 per visit
  • Inpatient treatment: policyholders to pay 25 percent of the total cost
  • Outpatient treatment: policyholders to pay $25 for an individual visit, $5 per group session, and $12 for mental health group services
  • Medication-assisted treatment: Covered—drug copays would apply
  • Sober living house/aftercare options: May be covered, based on facility

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Prior Authorization Requirements For Kaiser Permanente Insurance Plans

There are some medical services that require prior authorization by the insurance companies, often including services related to addiction treatment. Sometimes called precertification, this policy ensures that the insurance company, policyholder, and the medical provider are all on the same page regarding cost responsibility.

Seeking treatment without prior authorization could result in a fee for the policyholder. Contact a Kaiser Permanente representative to ensure you proceed through the proper precertification channels for your plan.

Some of the medical services requiring prior authorization may include:

  • inpatient or residential treatment
  • outpatient care
  • intensive outpatient programs
  • partial hospitalization programs

Do Rehab Centers Need To Be In-Network For Kaiser Permanente Insurance Coverage?

Although there may be coverage offered outside the Kaiser Permanente network, the best coverage will be within the areas in which Kaiser Permanente operates.

Kaiser Permanente offers insurance coverage in the following states and regions:

When selecting a treatment center, make sure you verify what your cost responsibility will be with both the rehab center and your Kaiser Permanente plan. Some of the services associated with addiction treatment (such as medical detox) could have higher out-of-pocket costs if received out of network. However, most Kaiser Permanente plans pay for medical detox services when provided in network.

Understanding the coverage details of your plan will ensure that you incur the lowest amount of cost possible, and the best way to clarify your plan details is to contact Kaiser Permanente directly.

The type of plan you have will determine important cost responsibilities, such as copays, deductibles, and out-of-pocket maximums. It will be helpful to have a general idea of the types of plans available when you speak with a Kaiser Permanente representative.

There are three general types of plans that most major insurance carriers offer:

  • Group Insurance Plans: Often provided through an employer or member association, this plan may be offered as part of a benefits package. Depending on the employer, this type of plan may be covered in part or in full by the employer.

Companies with fewer than 51 employees will typically offer plans that cover addiction treatment, whereas companies with more than 51 employees are able to be more flexible in the types of coverage they offer.

  • Private Insurance Plans: This type of coverage is usually purchased by an individual, independent of an organizational affiliation. Many of these private plans have higher premiums (monthly cost), but they allow for more personalized options and flexibility within the plan. Addiction treatment will also be more flexible within a private plan, as the individual will be able to choose a treatment facility either in or outside their plan’s network.

            Typically, there are three categories within private insurance plans:

  • HMO (Health Maintenance Organization) Plans: This is the most restrictive, specified type of plan, meaning that members with an HMO plan can only seek care within the insurance company’s network. Otherwise, they will be responsible for most of the cost.
  • PPO (Preferred Provider Organization) Plans: Similar to HMO, this type of plan differs in that it may pay for an even higher percentage of in-network cost. If care is sought out-of-network, PPO plans will provide reduced coverage.
  • Point-of-Service Plans: Considered the most flexible plan, this allows members to choose between PPO or HMO coverage for each separate health need.

Alcohol Addiction Treatment Services Covered With Kaiser Permanente Insurance

Because of the addiction and overdose epidemic currently facing the U.S., more treatment options are becoming available, which can empower those suffering to find the help they need. Although coverage will differ by plan, each of these approaches to addiction treatment will be at least partially covered by Kaiser Permanente.

The treatment approaches likely covered by Kaiser Permanente include:

Alcohol Detox Programs

When someone has used heavy amounts of alcohol for an extended period of time, their body becomes physically dependent on having that substance in order to function normally. If the individual stops alcohol use suddenly, it can result in dangerous withdrawal symptoms.

Most drug withdrawals are uncomfortable but not necessarily dangerous, but this is not the case with alcohol. Alcohol detoxification should always take place under medical supervision, as the withdrawal symptoms can be life-threatening, including delusions, seizures, and coma.

Supervised medical detox programs are offered at most treatment facilities, and will be covered by Kaiser Permanente if provided in-network. Alcohol detox programs will also include counseling, education, and medication-assisted treatment to ensure the patient is kept stable and comfortable. Once the patient has successfully detoxed, they are able to begin the next steps in the recovery process.

Inpatient Addiction Treatment Programs

Inpatient or residential care is the most secure and stable environment for someone after they’ve successfully detoxed. Treating addiction requires more than just a physical approach, and a residential treatment facility provides the opportunity to take a break from the daily demands of life and fully focus on recovery.

Inpatient rehab facilities are highly structured environments, where patients participate in therapies such as counseling, equine therapy, and group sessions. Many inpatient treatment centers have detox services onsite, and the average inpatient stay is between 30 and 90 days. The National Institute on Drug Abuse states that stays of at least 90 days in treatment are associated with positive recovery outcomes.

Outpatient Alcohol Addiction Treatment Programs

Outpatient drug and alcohol treatment services include any type of nonresidential care, which can refer to full-day sessions or half-day sessions. All levels of outpatient care place an emphasis on group therapy.

Common outpatient treatment services include:

Partial hospitalization programs (PHPs): Sometimes referred to as “day treatment,” PHP sessions are held five days per week, up to six hours per day. PHPs have rigorous schedules, intending to reintroduce individuals to a daily routine. Program activities include recovery-based recreation, 12-Step meetings, addiction education courses, and group therapy sessions.

Intensive outpatient programs (IOPs): Intensive outpatient programs are considered a “step down” treatment level from inpatient or PHP, as the sessions occur in half-day increments, three times per week. IOP sessions may be offered in the morning, afternoon, or evening in order to accommodate all schedules. Sober living skills are taught, and guest speakers are often brought in to inspire patients, but the core schedule is centered around group therapy.

Opioid addiction treatment programs: Although someone addicted to opioids could benefit from any of these treatment programs, there are now specialized approaches that focus solely on treating opioid use disorder. If an individual has an issue with several substances, such as alcohol and opioids, they can still participate in an opioid treatment program.

Opioid treatment programs can occur in either inpatient or outpatient facilities. A unique focus of this approach is the use of medication-assisted treatment (MAT), which has patients engaging in therapies while also taking buprenorphine-based medication. These medications not only alleviate painful withdrawal symptoms, but they also work to prevent relapse by reducing drug cravings.

Identifying Your Kaiser Permanente Insurance Coverage

Kaiser Permanente ensures that treatment is affordable and available for those that need it. While there are many options for addiction treatment, knowing the details of your insurance policy will help you select the right treatment center for you or your loved one.

The best way to maximize the use of your Kaiser Permanente insurance policy is to stay in-network for detox and treatment. If you have questions regarding your policy, Kaiser Permanente has knowledgeable team members available to address these concerns.

For more information on using Kaiser Permanente insurance for alcohol addiction treatment, contact us today.

Disclaimer: This site is not affiliated with, nor endorsed by, Kaiser Permanente. The information about Kaiser Permanente’s benefits are meant for informational purposes only, and the details of your plan’s coverage may be different.

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