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Kaiser Permanente

Kaiser Permanente offers a variety of health insurance coverage for individuals and groups, as well as small and larger businesses for health needs.

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What Is Kaiser Permanente?

Kaiser Permanente is a health maintenance organization (HMO) insurance plan with a Medicare contract. Kaiser Permanente offers coverage for individuals and families as well as small groups in California, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington DC, and Washington state. Kaiser Permanente offers care for those battling mental health disorders, health issues, and offers some financial support for addiction treatment.

Coverage is offered for small and large businesses, multi-state and Federal businesses, group Medicare, and consumer-directed healthcare. They offer services covering elements of treatment with a network of medical staff. Kaiser Permanente offers individual and group plans, and qualifying patients can combine Medicaid, Medicare, and Medi-Cal with their Kaiser Permanente insurance for more savings. Kaiser is also available in Preferred Provider Organization (PPO) plus plans for select patients. To view which treatment centers are covered by Kaiser Permanente, click here and explore a directory of available rehabs.

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Kaiser Permanente And Addiction Treatment Coverage

Kaiser offers a variety of coverage for addiction treatment depending on the type of insurance plan one has. Typically, patients can access:

  • Detox
  • Group counseling
  • Individual counseling
  • Withdrawal symptom management
  • Inpatient and outpatient treatment programs
  • Medication
  • Self-care and wellness support

Kaiser offers treatment and prescription drug coverage for substance use disorders. Treatment programs offer peer support group access, and educational resources for sobriety. Some plans cover family counseling services. Patients can utilize Kaiser’s network of physicians, psychologists, doctors, social workers, nurses, physician assistants, and therapists. Contact a treatment provider here for more information on treatment programs and additional financial assistance options.

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Kaiser Permanente PPO And PPO Plus Plans

Patients can choose a physician in-network. There are 2 types of tiers available with different benefits, such as:

  • PPO providers
  • Non-participating providers

Such tiers offer benefits unique to them, offering patients the choice from 750,000 providers. Patients can receive coverage for doctors visits and preventive services.

With the first tier, Kaiser offers PPO providers in network from First Choice Health Network, (available to people in certain states), First Health Network, and Kaiser Permanente provider network. To discover which states offer Tier 1 PPO coverage, explore Kaiser Permanente’s website to see if you qualify. Both tiers offer a separate deductible for prescription drugs according to Kaiser’s website. Tier 2 offers help for those who want a provider that is not in the PPO provider network. Patients can get coverage for generic meds and some brand-name drugs. To explore providers, contact Membership Services available on their website.

Kaiser Permanente Senior HMO Medicare Plan Costs

It is best to log onto Kaiser Permanente’s website and put in your location to determine your state’s costs for Kaiser Permanente’s Medicare. For the state of Washington, Kaiser Permanente noted the following 2021 Medicare health plans for seniors:

  • Senior Advantage Value (HMO). Individuals pay $0 monthly premium or annual deductible. Doctor visits are $5 for primary or $45 for specialist. Emergency Room care is $90 and $45 for urgent care. Inpatient hospitalization is $335 each day for the first 6 days, and no charge after. Ambulance services are $250 one way. Yearly out-of-pocket costs are $5,600. There is no charge for preventive services.
  • Senior Advantage Standard (HMO). Individuals pay $44 per month, with no payment with no annual deductible. Doctor visits are $5 for primary or $35 for specialist. Emergency Room care is $90 and $35 for urgent care. Inpatient hospitalization is $265 each day for the first 6 days, and no charge after. Ambulance services are $200 one way. Yearly out-of-pocket costs are $4,900. There is no charge for preventive services.
  • Senior Advantage Enhanced (HMO). Individuals pay $127 per month, with no payment with no annual deductible. Doctor visits are $5 for primary or $25 for specialist. Emergency Room care is $120 and $25 for urgent care. Inpatient hospitalization is $200 each day for the first 6 days, and no charge after. Ambulance services are $150 one way. Yearly out-of-pocket costs are $3,000. There is no charge for preventive services.

The website also notes the above costs include coverage for Medicare Part D prescription drugs.

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Enrollment For Kaiser Permanente And Medicare Plans

The enrollment process is relatively simple. According to Kaiser Permanente’s website, individuals who qualify for Medicare must meet the following requirements:

  • Be 65 and older or having a disability qualifying for Medicare (e.g. end-stage renal disease)
  • Be enrolled into Medicare Parts A or B
  • Be located in a Kaiser Permanente area

Depending on whether someone meets the requirement, and if they are approved, individuals should check their enrollment status to see their progress after completing a form. It is helpful to learn about the different types of plans available; someone can add options benefits. According to Kaiser Permanente’s site, after 10 days of form receipt, the individual is sent an identification card. At this point, the individual can sign in and read documents for their new coverage. After getting their card, the patient can choose their doctor, register online, and transfer prescriptions. If they are denied, Kaiser Permanente’s website site says they provide reasons.

Take Control Of Your Life

Fighting addiction can seem overwhelming and intimidating. Fortunately, someone can feel supported and empowered to take action for sobriety. If you or a loved is struggling with an addiction, contact a treatment provider for more information about treatment options.

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