Kaiser Permanente Hospital Insurance Coverage

Hospital Surgery

Have you ever taken a cruise? They are lots of fun and can be very relaxing. Granted, they tend to be very expensive, but usually, the entry price includes meals and events while you are on the cruise. Now, I would much rather be on a five-star cruise than in the hospital for a week. However, Kaiser Permanente hospital insurance coverage acts similar to an all-inclusive cruise package. Below are details regarding what’s usually covered under hospitalization benefits on Kaiser Permanente health insurance plans.

Services Included under Hospitalization Insurance

Generally, hospitalization insurance from Kaiser Permanente would cover the following services while the member is in the hospital:

  • Room and board
  • Surgery
  • Anesthesia
  • X-rays
  • Lab tests
  • Prescription drugs

Note: Restrictions apply, subject to the terms of the member’s medical policy that includes hospital insurance.

Typically, covered hospital costs are the same whether the member is enrolled on a private policy or a small business plan. Slight modifications may apply, so review your plan benefit details.

Not Hospital-Only Plans

Kaiser Permanente does not offer hospital insurance plans, per se, that cover hospitalization only. What they do offer are health plans that include hospitalization services as one of the covered benefits. Where this article refers to “hospital insurance” and any variation of the term, which would refer to the hospitalization services benefit of a health plan.

How Hospitalization Insurance Works

Kaiser Permanente hospitalization insurance coverage works a bit differently between the plan designs.

  • Copayment Plans
    On Copayment Plans, you would pay a flat, discounted amount for hospitalization. On Kaiser Permanente plans, the copayment fee would be for each day you are at the hospital, until you reach the maximum out-of-pocket amount.
  • Deductible Plans
    On Deductible Plans, Kaiser Permanente members would first pay up to the deductible amount on their policy. If the hospital costs were more than the deductible, then, either a flat copayment amount for each day at the hospital, or a percentage of the remaining balance would also be due, depending on the policy chosen.
  • HSA Deductible Plans
    When it comes to hospitalization insurance coverage, HSA Deductible Plans act very much like a standard deductible plan. The main difference is that HSA Deductible Plans give you the option of opening up an HSA (Health Savings Account) at a bank of your choice. The bank account is designated for medical or dental expenses. In this scenario you have the option to save money that can apply towards your medical/hospitalization expenses.


Your Maximum Out-of-Pocket for Hospital Costs

Each Kaiser Permanente plan has a maximum out-of-pocket amount, which is the most you would pay for all covered medical services, including hospitalization, in a calendar year. Usually, this would be your copayments or deductible plus copayments or coinsurance, if applicable, until your out-of-pocket maximum is reached.

What if a health plan excludes prescription benefits?

Some of the Kaiser Permanente plans do not include prescription drug benefits. Members on these plans would have to pay out-of-pocket for prescriptions. However, this is not the case while a member is in the hospital. During a covered hospital stay, drugs administered while a member is admitted would be covered. Any prescriptions given as a follow up to take at home would then be out of pocket for the member.

Cruise Control

Out-of- pocket maximums and cruise tickets are similar in that both give unlimited access to free covered services once reached. We welcome you to hop aboard and check out the Kaiser Permanente hospital insurance coverage that protects you for the expected and the unexpected.