Does Kaiser Permanente Cover Rehab? What Your Plan Pays For

Kaiser Permanente is a unique integrated healthcare system covering approximately 12.7 million members across 8 states and the District of Columbia. Unlike traditional insurance companies that pay for care delivered by independent providers, Kaiser operates its own hospitals, medical centers, and employs its own physicians. This integrated model extends to mental health and addiction treatment services, which are delivered primarily through Kaiser facilities and addiction medicine departments.

Understanding Kaiser’s Integrated Model

Kaiser Permanente’s structure is fundamentally different from traditional insurance:

How Kaiser Works

Integrated system: Kaiser owns the hospitals, employs the doctors, runs the pharmacies, and manages mental health services — all under one roof.

Regional structure: Kaiser operates in 8 regions:

• Northern California
• Southern California
• Colorado
• Georgia
• Hawaii
• Mid-Atlantic States (Maryland, Virginia, DC)
• Northwest (Oregon, Washington)
• Each region operates somewhat independently

HMO model: Most Kaiser plans are HMOs, requiring you to receive care within the Kaiser system (except emergencies).

Coordinated care: Your primary care physician, mental health providers, and addiction medicine specialists all work within the same system with shared medical records.

What Does Kaiser Permanente Cover for Rehab?

Kaiser covers the full continuum of substance use disorder treatment through Kaiser facilities and contracted partners:

Covered Services

Medical Detoxification — Provided at Kaiser hospitals or contracted detox facilities. Typically $200-$500/day copay depending on plan, or 10-20% coinsurance. Duration 3-14 days based on medical necessity.

Inpatient/Residential Treatment — 24/7 residential care at Kaiser-contracted facilities. Kaiser contracts with residential treatment centers since Kaiser doesn’t operate its own residential programs in most regions. Typical copays $100-$300/day for initial days, then reduced rates. Initial authorization 7-14 days.

Partial Hospitalization Program (PHP) — Day treatment at Kaiser mental health facilities or contracted programs. Typical copays $50-$100/day.

Intensive Outpatient Program (IOP) — Structured outpatient treatment at Kaiser mental health centers. Typical copays $30-$60/day.

Outpatient Therapy — Individual and group counseling at Kaiser mental health departments. Typical copays $15-$50/visit (often same as mental health copay).

Medication-Assisted Treatment (MAT) — Kaiser has robust MAT programs integrated into addiction medicine departments:

• Buprenorphine (Suboxone, generic) — Kaiser physicians prescribe, Kaiser pharmacies dispense
• Methadone — Kaiser operates opioid treatment programs (OTPs) in several regions
• Naltrexone (Vivitrol, ReVia)
• Acamprosate, Disulfiram

Medication copays:

• Generic buprenorphine: $10-$30/month
• Brand Suboxone: $30-$75/month
• Vivitrol injection: $50-$150/month

Kaiser Plan Types and Coverage

Kaiser HMO (Most Common)

Best for: Members living in Kaiser service areas wanting integrated, coordinated care

Network: Must use Kaiser facilities and Kaiser-contracted providers Out-of-network: Not covered except emergencies Referrals: Required from PCP for specialty care, including addiction services Typical coverage: Copay-based (not deductible/coinsurance) Average out-of-pocket for 30-day inpatient: $3,000-$8,000

Kaiser HMO plans typically use copay structures:

• Inpatient days 1-5: $200-$300/day
• Inpatient days 6-30: $100-$150/day
• Total for 30 days: $3,500-$5,250

Kaiser EPO

Best for: Similar to HMO but fewer referral requirements

Network: Must use Kaiser facilities Out-of-network: Not covered except emergencies Referrals: Not always required Typical coverage: Similar to HMO copay structures Average out-of-pocket for 30-day inpatient: $3,000-$8,000

Kaiser Medicare Advantage

Best for: Medicare beneficiaries (65+) in Kaiser service areas

Network: Kaiser facilities and contracted providers Out-of-network: Not covered except emergencies Referrals: May be required Typical coverage: Medicare Advantage copay structures Average out-of-pocket for 30-day inpatient: $2,500-$7,000

Kaiser Medicare Advantage often has lower copays than commercial plans.

Kaiser PPO (Limited Availability)

Best for: Members needing out-of-network flexibility (only available in select regions)

Network: Broader than HMO, includes non-Kaiser providers Out-of-network: Covered at reduced benefit Referrals: Not required Typical coverage: Traditional PPO structure with deductible and coinsurance Average out-of-pocket for 30-day inpatient: $6,000-$18,000

Kaiser PPO is only available in limited regions and is much less common than Kaiser HMO.

How to Access Rehab Through Kaiser

Kaiser’s integrated system has a specific pathway for accessing addiction treatment:

Step 1: Initial Contact

Options:

• Contact your primary care physician
• Call Kaiser’s mental health/substance abuse line directly
• Visit emergency department if in crisis
• Use Kaiser’s online portal to request mental health appointment

Kaiser Mental Health Access Line: Number varies by region (on your member card)

Step 2: Assessment

• You’ll receive an initial assessment with a Kaiser mental health or addiction medicine specialist
• Assessment determines appropriate level of care using ASAM criteria
• Kaiser uses standardized screening tools to assess severity

Step 3: Preauthorization and Placement

• If inpatient or residential treatment is recommended, Kaiser’s utilization management team authorizes appropriate level of care
• Kaiser coordinates placement at Kaiser-contracted facility
• Authorization typically within 24-48 hours

Step 4: Treatment

• You receive treatment at Kaiser facility or Kaiser-contracted treatment center
• Kaiser’s care coordinator maintains contact during treatment
• Concurrent reviews every 3-7 days

Step 5: Step-Down Care

• Kaiser coordinates transition to lower level of care (PHP, IOP, outpatient)
• Follow-up appointments scheduled at Kaiser mental health department
• MAT initiated or continued through Kaiser physicians and pharmacy

Kaiser’s Addiction Medicine Programs

Kaiser has invested significantly in addiction medicine infrastructure:

Regional Addiction Medicine Departments

Most Kaiser regions now have dedicated addiction medicine departments staffed by physicians specializing in addiction treatment.

Services provided:

• Addiction psychiatry
• Medical consultation for complex cases
• Medication-assisted treatment (MAT)
• Coordination with residential and outpatient programs

Opioid Treatment Programs (OTPs)

Kaiser operates methadone clinics in several regions:

• Northern California: Multiple OTP locations
• Southern California: OTP services available
• Colorado: Limited OTP access
• Other regions: Contracted OTP services

Integrated MAT Programs

Kaiser’s integrated model facilitates excellent MAT delivery:

• Same-day buprenorphine induction in some locations
• Coordinated prescribing between addiction medicine and primary care
• Kaiser pharmacies stock MAT medications
• Low-barrier access to buprenorphine in many regions

Typical Out-of-Pocket Costs with Kaiser

Kaiser’s copay-based model creates more predictable costs:

Example: Kaiser HMO (California)

Plan details:

• Medical/surgical deductible: $0 (many Kaiser HMO plans have no deductible)
• Inpatient mental health/substance abuse copay: $250/day for days 1-5, $125/day thereafter

30-day inpatient program:

• Days 1-5: $250 × 5 = $1,250
• Days 6-30: $125 × 25 = $3,125
• Total: $4,375

Medical detox (7 days):

• Days 1-5: $250 × 5 = $1,250
• Days 6-7: $125 × 2 = $250
• Total: $1,500

Outpatient services:

• Individual therapy: $30 copay per visit
• Group therapy: $15 copay per visit
• IOP: $50 copay per day

MAT:

• Generic buprenorphine: $10 copay/month (Tier 1)
• Brand Suboxone: $50 copay/month (Tier 2)
• Vivitrol: $100 copay/month (Tier 3)

Example: Kaiser Medicare Advantage

Plan details:

• Inpatient mental health copay: $375/day for days 1-5, $0 thereafter
• Out-of-pocket maximum: $6,700

30-day inpatient program:

• Days 1-5: $375 × 5 = $1,875
• Days 6-30: $0 × 25 = $0
• Total: $1,875

Kaiser Medicare Advantage plans often have excellent behavioral health benefits.

Geographic Availability and Regional Differences

Kaiser is only available in 8 states, and addiction treatment access varies by region:

Northern California (Strongest Infrastructure)

• Extensive addiction medicine departments
• Multiple OTP locations for methadone
• Strong residential treatment partnerships
• Robust IOP/PHP programs at Kaiser facilities

Southern California

• Growing addiction medicine network
• OTP services available
• Multiple contracted residential facilities
• Good access to MAT

Colorado

• Addiction medicine services at major medical centers
• Contracted residential treatment
• MAT programs available
• Limited OTP access (methadone via contracted providers)

Oregon/Washington (Northwest)

• Addiction medicine integrated into mental health departments
• Residential treatment via contracted facilities
• MAT programs well-developed

Mid-Atlantic (MD, VA, DC)

• Mental health and addiction services integrated
• Contracted residential providers
• MAT available through addiction medicine

Georgia, Hawaii

• Addiction services available but smaller networks
• May require travel to major Kaiser medical centers
• Contracted residential treatment
• MAT programs present but less extensive

Advantages of Kaiser’s Integrated Model for Addiction Treatment

Coordinated Care

• All providers access same medical record
• Primary care, mental health, and addiction medicine coordinate seamlessly
• Easier management of co-occurring medical conditions
• Pharmacy integration for MAT

Lower Costs

• Copay structures more predictable than deductible/coinsurance
• Often lower out-of-pocket costs than traditional insurance
• Medication costs typically lower

Reduced Administrative Burden

• No out-of-network bills or surprise billing
• Preauthorization process streamlined within Kaiser system
• Less paperwork and claim complexity

Disadvantages and Limitations

Limited Network

• Must use Kaiser facilities or Kaiser-contracted providers
• Cannot choose any treatment facility
• Limited options in some regions
• If you move out of Kaiser service area, lose coverage

Geographic Restrictions

• Only available in 8 states + DC
• Members traveling or living temporarily elsewhere have limited access
• No coverage in 42 states

Facility Choice

• Cannot access high-end or specialized facilities unless Kaiser-contracted
• May need to accept Kaiser’s placement recommendation
• Less flexibility than PPO plans from other carriers

Verifying Your Kaiser Coverage

Call Kaiser Mental Health Access Line

Phone: Number on your member card (varies by region)

• Northern California: 1-866-955-5699
• Southern California: 1-800-900-3277
• Colorado: 1-303-471-7700
• Other regions: Check member card

Questions to ask:

• What are my copays for inpatient substance abuse treatment?
• How many days will Kaiser authorize?
• Which facilities does Kaiser contract with in my area?
• What is the process for getting preauthorization?
• What are my MAT medication copays?
• Does Kaiser have an addiction medicine department in my region?

Check Online

Kaiser member portal (kp.org):

• View benefits and coverage
• Check copay amounts
• Find mental health and addiction services
• Schedule appointments
• Refill MAT prescriptions

Contact Your Primary Care Physician

Your Kaiser PCP can:

• Refer you to addiction medicine or mental health
• Explain your benefits
• Initiate the preauthorization process

What If You Need Treatment Outside Kaiser’s Network?

Given Kaiser’s closed network, accessing non-Kaiser treatment is challenging:

Options:

Single-case agreement: Request Kaiser approve out-of-network facility if no suitable Kaiser-contracted option exists. Rarely approved for routine cases.

Emergency stabilization: If in crisis, go to nearest emergency department. Kaiser will cover emergency stabilization even at non-Kaiser hospitals. After stabilization, must transfer to Kaiser or contracted facility.

Switch insurance: If you need treatment at a specific non-Kaiser facility, consider switching to a PPO plan during next open enrollment or if you have a qualifying life event.

Don’t Have Kaiser (and Want Broader Treatment Options)?

If you’re shopping for insurance and want maximum flexibility in choosing treatment facilities, consider PPO plans from carriers like Aetna, Cigna, or Blue Cross Blue Shield, which offer broad national networks and out-of-network coverage.

If you’re currently uninsured, obtaining coverage is essential. A licensed insurance specialist can help you compare Kaiser with other carriers available in your area, weighing Kaiser’s lower costs against the broader networks offered by traditional insurers.

Sources

• Kaiser Permanente. “Mental Health and Substance Use Disorder Services.” Member Resources. 2026.
• Kaiser Permanente. “Addiction Medicine Programs.” Regional Program Descriptions. 2026.
• Centers for Medicare & Medicaid Services. “Kaiser Medicare Advantage Plans.” 2026.
• Healthcare.gov. “Kaiser Permanente Coverage.” 2026.