- Kaiser Permanente offers Medicare Advantage plans, and a supplement Advantage Plus plan that includes dental, vision, and hearing benefits.
- Plans are divided into eight regions, largely on the west coast.
- Many of Kaiser’s plans are five star-rated, which is the highest rating for a Medicare Advantage plan.
Kaiser Permanente has been operating in the United States since 1945, and had more than 12.2 million Americans participating in their health plans in 2019. The organization has a unique model that is often noted for its quality and efficiency, according to an article in the journal
Keep reading to find out more about what types of Medicare Advantage plans the Kaiser organization offers as well as where you can find them.
The following are examples of Kaiser Permanente Medicare Advantage plan offerings. Levels of coverage often depend upon the plan selected and region where a person lives. You can shop these plans using Medicare.gov’s plan finder.
Kaiser Medicare Advantage HMO Plans
Kaiser’s health maintenance organization (HMO) plans are those that require you to have an in-network primary care physician that you see for preventive care as well as 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 enables you to participate in exercise programs at participating facilities as well as several home fitness programs. They also offer prescription drug coverage that includes a mail-order pharmacy.
Kaiser Medicare Advantage PPO Plans
Kaiser’s preferred provider organization (PPO) plans separate providers (and the subsequent costs for seeing them) into two tiers. The first is “participating provider,” which results in lower out-of-pocket costs to you. The second is “non-participating provider,” in which you can see any licensed provider, but may have to pay coinsurance or even full up-front 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 Medicare Prescription Plans (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” that separates prescriptions 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 experience cost savings.
Other Kaiser Medicare plans
Kaiser offers an “Advantage Plus” supplemental plan that you can add to a Medicare Advantage plan. The Advantage Plus option include dental, extra vision, and hearing benefits on top of the Medicare Advantage benefits you receive with your current plan.
Kaiser currently offers Medicare Advantage plans in the following states:
- Washington D.C.
Some of the plans vary by region and county. Kaiser divides their plan offerings into eight “local markets,” which include the following:
- Northern California
- Northwest: including Washington, Central Washington, Eastern Washington, Coastal and Olympic region, and Puget Sound
- Northwest: including Portland, Eugene, and Salem, Oregon; Vancouver, Washington, and Longview/Kelso, Washington
- Southern California
Kaiser Medicare Advantage plans provide different aspects of coverage depending upon what plan you choose and where you live. However, some general examples of what a plan may cover include:
- Traditional 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: 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 Medicare Advantage plans (as well we Medicare Part D and Medigap) in your area through searching Medicare.gov’s plan finder. The following are some examples of cities across the country and costs for their Kaiser Medicare Advantage plans.
Kaiser Medicare Advantage costs in select cities
|City||Star rating||Monthly premium (with drug coverage)||Health plan deductible||Drug deductible||Out-of-pocket max (in-network)||Copay/coinsurance primary doctor||Specialist||City|
Kaiser Senior Advantage Enhanced (HMO)
|5 stars||$71.00||$0||$0||$4,000||$3 copay per visit||$35 copay per visit||Atlanta, GA|
|Denver, CO: Kaiser Senior Advantage Core (HMO)||5 stars||$0||$0||$225||$4,400||$5 copay per visit||$50 copay per visit||Denver, CO|
|Honolulu, HA: Kaiser Senior Advantage Basic (HMO)||5 stars||$78||$0||$0||$4,900||$20 copay per visit||$45 copay per visit||Honolulu, HA|
|Portland, OR: Kaiser Senior Advantage (HMO)||4.5 stars||$127||$0||$0||$2,500||$10 copay per visit||$25 copay per visit||Portland, OR|
|Washington, D.C.: Kaiser Medicare Advantage Standard DC (HMO)||5 stars||$30||$0||$0||$6,700||$10 copay per visit||$40 copay per visit||Washington, D.C.|
Remember these plan costs do not include the Part B premium for Medicare, which is $144.60 in 2020.
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.
To purchase a Medicare Advantage plan, a person must qualify for Medicare. This usually means a person is age 65. However, those with a disability, end stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS) may also qualify for Medicare Advantage plans when they are eligible to receive Medicare benefits.
important medicare enrollment dates
Medicare has specific times when you can enroll, dis-enroll, or make changes to your Medicare Advantage account. These key dates include the following:
- Initial enrollment period: You can enroll in Medicare Advantage when you first qualify for Medicare. This is the time period 3 months before, the month of, and 3 months after your birthday.
- Open enrollment period: From October 15 to December 7, you can change from original Medicare to Medicare Advantage (and vice-versa), switch your Medicare Advantage plan, and join or switch your Medicare Part D coverage.
- Medicare Advantage open enrollment period: From January 31 to March 31, you can switch from one Medicare Advantage plan to another. However, you can’t switch from original Medicare to Medicare Advantage during this period.
- Special enrollment period (SEP): Throughout the year, you can switch plans if you move out of your Medicare Advantage coverage area or have other circumstances that may qualify you for a SEP
Kaiser Permanente offers Medicare Advantage plans in several states and the District of Columbia. 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.