Kaiser Permanente Insurance Coverage for Rehab Treatment

Specific Kaiser Permanente Plan Details

Kaiser Permanente rehab services may be covered entirely or partially based on the type of Kaiser insurance plan someone has.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

Employer-based or group plans are offered to businesses that provide health insurance to their employees, often with premiums directly deducted from paychecks. Group plans through Kaiser Permanente may include:^{7, 8, 9}

• • Traditional or deductible plans: Fees may be paid by the plan participant until deductibles are met, and generally, there is an out-of-pocket annual maximum amount. Copays may be necessary.
  • Preferred Provider Organization (PPO) plans: These plans may be optimal for individuals who don’t reside in a Kaiser Permanente service region or who wish 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.

• Health Maintenance Organization (HMO) plans: A Kaiser HMO plan will typically require no deductibles, though plan participants will likely have to pay copayments and coinsurance rates for services.⁵ One example of standard coverage is the Kaiser Permanente Platinum HMO plan for California.⁶ This plan covers inpatient detox to manage medical withdrawal from drugs or alcohol in a plan hospital and with plan physician services. Room and board, medical services, medications, education, recovery services, and counseling may all be included.

• Point-of-Service Plans: This type of comprehensive coverage plan allows individuals to use in-network Kaiser Permanente providers and network-contracted providers, or pay more for out-of-network providers. It is a combination of an HMO and PPO plan.
• Out-of-Area Plans: Individuals living outside of a Kaiser Permanente coverage area can receive healthcare services without a referral. Preventative services are typically covered, and other services may be subject to cost-sharing or a deductible amount.
• Consumer-Directed Health Plans: Several options are available, including a health reimbursement account (HRA) plan where employers contribute for qualified medical expenses, a health savings account (HSA) plan that is a tax-free account set up by individuals to pay for medical expenses, and a flexible savings account (FSA) where individuals make contributions that are considered pre-tax, toward many different medical expenses.

Individual

Individual plans range between Gold, Silver, Bronze, and Platinum, depending on the maximum out-of-pocket fees, deductible, and copay amounts as well as monthly premiums. The plans may differ depending on the coverage area. In general, the following types of plans are available:¹⁰

• Deductible plans: With maximum caps, services are provided for a fee until the deductible is met, and 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. This is a comprehensive coverage plan that may incur higher monthly premiums.
• 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. Costs are then covered at a percentage until the maximum out-of-pocket cap is reached. A health savings account can be set up for a tax break on medical costs.
• 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. All additional fees are out-of-pocket expenses until the annual maximum deductible amount is reached. Many preventative services are covered at no charge as well.

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.^11,12 Plans include the Kaiser Permanente Senior Advantage and the Senior Advantage Basic,¹³ which are HMO plans that vary according to the coverage region and plan selected. Most coverage will have low copays 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.

What Is Kaiser Permanente?

Kaiser Permanente is a leading healthcare provider,1 with close ties to local communities, investing large amounts of money and expertise into community outreach. Kaiser also creates new technology, conducts extensive medical research, and focuses on ensuring the overall well-being of members to create a healthier society.

As a company, Kaiser Permanente boasts high-quality ratings by providing comprehensive, competent, and affordable healthcare to as many people as possible. Kaiser offers health insurance plans to employers as group coverage, as well as to families and individuals as private insurance. The company also provides Medicare coverage for seniors age 65 or older or people with a disability that qualifies them for Medicare.

Offering coverage in 8 states (Washington, Oregon, Colorado, California, Hawaii, Georgia, Virginia, and Maryland), as well as the District of Columbia, Kaiser Permanente is one of the primary healthcare providers in the United States.²

Our Insurance Statistics

• Over 21,000 people have used insurance to attend treatment at one of our facilities since 2021.
• Over 130 people have used Kaiser to attend treatment since 2021.
• Our verification of benefits form has been filled out over 30 times for Kaiser insurance since 2021.
• Kaiser has an over 72% acceptance rate for one of our facilities when using our online form.
• See if you are in-network with us.

Sources

1. Kaiser Permanente. (2018). What is Kaiser Permanente?
2. Kaiser Permanente. (n.d.). Getting care away from home.
3. Kaiser Permanente. Experience the Kaiser Permanente difference.
4. Kaiser Permanente. Convenient ways to get care.
5. Kaiser Permanente. (n.d.). Guide to HMO plan bills and costs.
6. Kaiser Permanente. 2019 Individual Plan Combined Membership Agreement, Disclosure Form, and Evidence of Coverage for Kaiser Permanente for Individuals and Families.
7. Kaiser Permanente. Traditional or deductible plans.
8. Kaiser Permanente. Preferred Provider Organization (PPO) plans.
9. Kaiser Permanente. Consumer-Directed Health Plans.
10. Kaiser Permanente. View Plans.
11. Kaiser Permanente. Medicare Health Plans.
12. Medicare. (n.d.). Medicare Home Page.
13. Kaiser Permanente. Medicare Advantage Plans.