Kaiser Permanente offers coverage for routine vision exams in standard plans and additional coverage with an Advantage Plus option.
The Kaiser Permanente organization have more than 12.5 million members. This non-profit healthcare plan provider has a hospital and insurance system, plus a network of salaried healthcare providers.
This article explores Kaiser Medicare Advantage plans, vision care coverage, and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Kaiser Permanente (Kaiser) is a not-for-profit healthcare plan provider that started in 1945 in Oakland, California. The company offers Medicare Advantage plans in the following nine states:
- California
- Colorado
- Georgia
- Hawaii
- Maryland
- Oregon
- Virginia
- Washington
- Washington D.C.
Kaiser has 39 hospitals, more than 700 medical offices, and a staff of more than 80,000 medical professionals. The company provide a wide range of health insurance plans, including Medicaid and Medicare Advantage plans.
Medicare Advantage is one of two options for eligible people to receive Medicare benefits. Medicare is a federal government health program that helps individuals age 65 and over with healthcare costs.
Younger people with defined disabilities or health conditions can also join Medicare.
Medicare has four parts:
- Part A of original Medicare covers inpatient care in the hospital or other facility.
- Part B of original Medicare covers outpatient medical care, which may extend to preventive care.
- Part D is an add-on prescription drug plan for those with original Medicare
- Part C is a Medicare Advantage plan that combines Part A, Part B, and commonly Part D into a single, bundled plan.
Learn more about original Medicare here.
People can choose between enrolling in original Medicare or a Medicare Advantage plan offered by private insurance companies such as Kaiser.
Both options offer equal basic coverage, but Medicare Advantage plans typically extend their coverage to include additional benefits, such as dental, hearing, and vision care.
Medicare Advantage plan types include:
- Health Maintenance Organization (HMO) plans: These plans have a network of providers, and members select a primary care doctor to organize their care and write specialists’ referrals.
- Health Maintenance Organization Point of Service (HMO-POS) plans: Members can use out-of-network care at a higher cost.
- Preferred Provider Organization (PPO) plans: These plans utilize provider networks but do not require named primary care doctors or specialist referrals.
- Private Fee-For-Service (PFFS) plans: Members pay a specified amount for care.
- Special Needs Plans (SNP): These plans cater to people with chronic health conditions, disabilities, or financial restraints.
The government’s plan finder tool can help a person find available Medicare Advantage plans in their location.
The Kaiser Medicare Advantage plans include the same coverage as original Medicare (Part A and Part B), and additional optional benefits, such as vision, dental, and hearing. The plans also include prescription drug coverage.
The types of plans offered include:
- Senior Advantage Health Maintenance Organization (HMO) plans
- Senior Advantage HMO Point of Service (HMO-POS) plans
- Senior Advantage Preferred Provider Organization (PPO) plans
- Senior Advantage Medicare Medicaid Dual Eligible Special Needs Plan (HMO D-SNP)
Plans have different coverage levels and availability, depending on location.
Basic coverage
Kaiser Medicare Advantage plans provide equal cover to original Medicare, including:
- inpatient stays in hospitals, clinics, or skilled nursing facilities
- outpatient visits, including preventive care and vaccinations
- diagnostic tests and procedures
- mental health services
- physical therapy
- durable medical equipment, such as crutches and diabetic supplies
- emergency and urgent care
- some transportation services
Additional coverage
Kaiser plans provide additional coverage that may include:
- Part D prescription drug coverage and mail order pharmacy
- Silver Sneakers fitness program
- telehealth services
- routine hearing, vision, and dental care
- podiatry services
- discounted meal delivery service
Advantage plus
Kaiser offers an optional supplemental plan called Advantage Plus. When someone adds this option to their Medicare Advantage plan, they receive additional dental, vision, and hearing benefits.
Star ratings
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that administers Medicare. Every year, they rate Medicare Advantage plans using a star rating system of 1 to 5 stars based on its members’ experiences.
Medicare awarded Kaiser Medicare Advantage plans a 5.0 out of 5.0-star rating for their 2021 plans in Virginia, Colorado, California, Maryland, Oregon, Georgia, Hawaii, Southwest Washington, and Washington D.C., and 4.5 stars in Washington.
Kaiser provide vision coverage with their Medicare Advantage plans, although coverage level varies.
The Kaiser standard Medicare Advantage plan covers routine eye exams and Medicare-covered eyewear following surgery for cataracts. A person can choose from a designated basic range of frames and lenses or contact lenses.
If a person prefers premium eyeglasses, lenses, and other options, such as coatings or tints, they must pay any additional amount above the Medicare-allowed amount.
People with the Advantage Plus supplemental plan get a $175 allowance every 2 years, in addition to the standard coverage.
The Kaiser Evidence of Coverage (EOC) document offers detailed plan information. A person will receive this document when they enroll in one of the company’s plans.
The total costs of a Kaiser Medicare Advantage plan depend on:
- Monthly premium. People pay a premium to Kaiser plus the Medicare Part B premium and Part A if applicable. For 2021, the Part B premium is $148.50.
- Copays and coinsurance. Copays are a set amount, whereas coinsurance is a percentage.
- Deductible. This is what someone has to pay before Kaiser covers costs.
For example, for a person living in Los Angeles, CA, the Kaiser Permanente Senior Advantage (HMO) Individual plan costs for 2021 are:
- $0 monthly premium
- $0 deductible
- $5 physician and $10 specialist copay
Individuals who prefer a greater level of coverage can also purchase the Advantage Plus supplemental plan. This costs an additional $44 per month.
People can find costs and plan details for their area on the Kaiser Medicare Advantage website.
People must qualify for original Medicare (Parts A and B) to enroll in a Kaiser Medicare Advantage plan. Coverage depends on the person’s location.
Typically, people qualify for original Medicare at age 65. Younger people qualify if they have received:
- Social Security disability benefits or a disability pension from the Railroad Retirement Board for 24 months
- a diagnosis of end stage renal disease or Lou Gehrig’s disease, or amyotrophic lateral sclerosis (ALS)
Kaiser Medicare Advantage plans provide an all-in-one alternative to original Medicare for people aged 65 and above or with a qualifying health condition.
Kaiser plans cover routine vision exams in their standard plans and offer additional coverage with their Advantage Plus supplemental option.