Kaiser Permanente HMO for Therapy

Kaiser Permanente HMO is a health insurance plan offered by Kaiser Permanente, one of the largest healthcare insurance companies with a massive presence on the west coast but increasingly across the entire country. The Kaiser Permanente provider network has over 750,000 providers, including thousands of therapists.

Does Kaiser Permanente HMO cover therapy?

Yes, the Kaiser Permanente HMO plan offers coverage for mental health services including therapy sessions with a licensed therapist. Kaiser Permanente has an extensive network of therapists to choose from, which means that you have the opportunity to find the therapist that’s right for you.

It’s important to note, however, that most Kaiser Permanente HMO plans do not offer out-of-network therapy benefits. This means, if you see a therapist that’s not on the Kaiser Permanente insurance panel, you may have to pay the full session fee out-of-pocket. Seeing an in-network therapist is generally the most cost-effective way to engage therapy services.

How do I check if my Kaiser Permanente HMO plan covers therapy?

Because there are dozens of different plans that fall under the Kaiser Permanente HMO umbrella, it’s important that you check what your specific plan’s details are before you start therapy so you can avoid surprises. To learn more about your Kaiser Permanente HMO plan, visit your Summary of Benefits document. You can find this document through your online Kaiser Permanente HMO account portal or through your employer, should you receive your plan as an employee benefit. Once you’re looking at your Summary of Benefits document, look for the category “If you need mental health, behavioral health, or substance abuse services,” then under “Outpatient services.” Here, you’ll find how much coverage you receive when you work with an in-network or an out-of-network therapist.

You can also call the customer service number on the back of your insurance card, and speak with a Kaiser Permanente HMO customer service representative who can help you understand your plan’s benefits.

How much does therapy cost with my Kaiser Permanente HMO plan?

How much therapy will cost with your Kaiser Permanente HMO plan depends on your specific plan’s details. On average, you can expect to pay a copay of between $15-35 for each session you have with your in-network therapist. Most plans do not provide members with coverage for out-of-network therapy, which means you’ll be responsible for paying the full session fee if you work with a therapist outside of the Kaiser Permanente network.

Some Kaiser Permanente HMO plans have no charge to the member for therapy sessions, which is a great resource for those individuals, as they can continue working with their therapist without worrying about the impact on their budget.

What types of mental health conditions does Kaiser Permanente HMO cover?

Kaiser Permanente HMO provides coverage for a wide range of mental health conditions to support the everyday well-being of its members. To be eligible for coverage, however, each member needs to receive a mental health diagnosis from their therapist. This diagnosis enables the billing process through Kaiser Permanente.

Some common mental health conditions covered by Kaiser Permanente HMO include:

If you would prefer that your therapist doesn’t disclose your diagnosis with Kaiser Permanente, you can consider your out-of-network options. This way, your mental health care stays between you and your therapist — though you may need to pay more for this to occur.

What types of therapy does Kaiser Permanente HMO cover?

Kaiser Permanente requires all therapy sessions to be led by a credentialed, licensed therapist, such as a psychologist, social worker, counselor, nurse practitioner, or any other mental health profession, in order for them to provide coverage. They also require that the type of therapy used by your therapist is evidence-based. This means that it has clinical evidence pointing towards its efficacy.

Here are some examples of evidence-based therapy approaches that are eligible for coverage under Kaiser Permanente HMO plans:

What types of therapy does Kaiser Permanente HMO NOT cover?

Kaiser Permanente HMO will not cover therapy costs if therapy approaches used in your sessions are not based in clinical rigor, which includes life coaching and career coaching, as these disciplines are less based on the mental health literature and more on goal-setting and achievement. They also do not cover holistic approaches to treatment such as aromatherapy, massage therapy, acupuncture, or nutritional therapy, as well as ketamine and psychedelic treatments, even if the purpose of this treatment is for a mental health condition.

Some therapists will incorporate these types of therapy into their offering, which is still eligible for coverage if they provide them alongside evidence-based, approved approaches.

Does Kaiser Permanente HMO cover online therapy?

Yes, Kaiser Permanente HMO plans offer coverage for online therapy, just as they do for in-person sessions. You’ll pay the same copay for teletherapy that you would if you were meeting with your therapist at their office.

Kaiser Permanente offers members free access to Ginger, a therapy app, for 90 days. On Ginger, you can engage with emotional support coaches either through video call or through text. It’s a helpful resource provided by Kaiser Permanente to continue supporting their members to improve their well-being.

Does Kaiser Permanente HMO cover couples therapy?

Most Kaiser Permanente HMO plans do not cover couples therapy. This is in line with the majority of other health insurance companies, as many do not offer couples therapy benefits for their members because of the lack of mental health diagnoses available for couples. However, you can still work through relationship conflicts with your therapist in individual sessions, or find other options to pay for couples therapy.

Do I need to see my primary doctor before starting therapy?

Yes, you will need to see your primary doctor before starting therapy. This is because your Kaiser Permanente plan is an HMO plan, which requires that you receive a referral for what’s considered “specialist services.” To become eligible for therapy coverage through your Kaiser Permanente HMO plan, you’ll need to get a referral from your primary doctor and renew this referral each year to continue working with your therapist.