At a glance
- Kaiser Permanente offers Medicare Advantage plans and a supplement Advantage Plus plan that includes dental, vision, and hearing benefits.
- More than 12.2 million Americans had health coverage through Kaiser in 2019.
- Plans are offered in many areas around the United States.
- Many of Kaiser’s plans are 5-star rated, which is the highest rating for a Medicare Advantage plan.
Kaiser Permanente has been operating in the United States since 1945. The organization has a unique model that is often noted for its quality and efficiency, according to an article in the journal
Many of their Medicare Advantage plans are HMOs, with an emphasis on preventive care services.
Keep reading to find out more about what types of Medicare Advantage plans Kaiser offers as well as where you can find them.
The following are examples of Kaiser’s Medicare Advantage plan offerings. Levels of coverage often depend on the plan selected and region where you live.
Kaiser HMO plans
Kaiser’s Health Maintenance Organization (HMO) plans require you to have an in-network primary care physician. You’ll see this provider for preventive care and when you are ill or need further medical attention. If you need specialty care, your primary care provider can refer you to an in-network specialist.
In addition to these services, Kaiser’s Medicare Advantage HMO plans often include additional services, such as a SilverSneakers membership. This gives you membership to exercise programs at participating gym facilities, as well as several home fitness programs. They also offer prescription drug coverage that includes a mail-order pharmacy.
Kaiser PPO plans
Kaiser’s Preferred Provider Organization (PPO) plans separate providers (and the costs for seeing them) into two tiers. The first is “participating provider,” which has lower out-of-pocket costs. The second is “nonparticipating provider,” in which you can see any licensed provider, but may have to pay coinsurance or even full upfront costs before submitting claims for reimbursement.
A PPO plan is different from an HMO in that you do not need a referral to see a specialist. However, Kaiser’s plan will likely require pre-certification before you have a scheduled outpatient surgery, radiology procedure, or complex lab work.
Kaiser Part D plans
While many Kaiser Medicare Advantage plans include prescription drug coverage, you can also purchase prescription drug (Medicare Part D) plans separately from Kaiser. These include a prescription “formulary” list of covered prescriptions that’s divided into tiers. Low or generic tier medications are the least expensive, while premium tiers are usually name-brand and more expensive drugs.
Choosing Kaiser-affiliated pharmacies or Kaiser’s mail-order pharmacy is often a way to get better cost savings.
Kaiser Special Needs Plans
Kaiser also offers plans for those with extra healthcare needs. These are called Special Needs Plans (SNPs), and there are a few different types available, including:
- Chronic Condition Special Needs plans (C-SNPs): for people with chronic health conditions
- Institutional Special Needs plans (I-SNPs): for people who live in nursing homes or long-term care facilities
- Dual Eligible SNPs (D-SNPs): for patients who are eligible for both Medicare and Medicaid coverage
These plans each offer comprehensive hospitalization, medical service, and prescription coverage, but have been separated based on the kinds of patients they serve.
Kaiser currently offers Medicare Advantage plans in the following states:
Kaiser Medicare Advantage plans provide different aspects of coverage depending on what plan you choose and where you live. However, some general examples of what a plan may cover include:
- Original Medicare (Part A and Part B): Medicare requires a Medicare Advantage plan cover the same aspects of care as original Medicare. You’ll still receive hospital and medical benefits from a Kaiser Medicare Advantage plan.
- Preventive care services. These benefits are often offered at no to low cost, including blood pressure, cholesterol, and colorectal cancer screenings (for adults older than age 50).
- Basic hearing and vision services. Kaiser will provide one routine hearing exam a year, as well as one routine eye exam per year. However, eyewear, hearing aids, and other related exams are offered under their Advantage Plus plans.
Many plans also offer SilverSneakers programs, which are preventive fitness and wellness programs.
You can find Kaiser Medicare Advantage plans in your area by searching Medicare.gov’s plan finder. The following are some examples of cities across the country where these plans are offered and their costs for 2021.
|City/plan||Star rating||Monthly premium (with drug coverage)||Health deductible, drug deductible||Out-of-pocket max (in-network)||Primary care physician copay||Specialist copay|
Kaiser Permanente Senior Advantage Enhanced (HMO)
|5 stars||$71||$0, $0||$4,500||$0||$25|
|Denver, CO: Kaiser Permanente Senior Advantage Core (HMO)||5 stars||$0||$0, $95||$4,400||$5||$35|
|Honolulu, HI: Kaiser Permanente Senior Advantage Basic (HMO)||5 stars||$78||$0, $0||$7,550||$20||$45|
|Portland, OR: Kaiser Permanente Senior Advantage Value (HMO)||5 stars||$0||$0, $0||$5,600||$5||$45|
|Washington, D.C.: Kaiser Permanente Medicare Advantage Standard DC (HMO)||5 stars||$30||$0, $0||$6,900||$10||$40|
These plan costs do not include the Part B premium for Medicare, which you’ll have to pay in addition to any premium for your Part C plan.
Medicare Advantage, or Medicare Part C, is an alternative to original Medicare where Medicare contracts with a private insurance company to provide services to Medicare members.
Medicare Advantage plans will provide Medicare Part A and Part B coverage as well as some additional services. These may include prescription drug coverage and vision, hearing, dental, or health and wellness programs.
HMOs and PPOs are two examples of common Medicare Advantage plans. Insurance companies like Kaiser contract with doctors and medical facilities to receive discounts in return for their members choosing their services.
Kaiser Permanente offers Medicare Advantage plans in several states and Washington, D.C. You can evaluate the plans based on cost, coverage, and availability in your area. Pay careful attention to enrollment dates as you can only choose Kaiser’s Medicare Advantage plans at key times throughout the year.