Kaiser Permanente is a nonprofit organization that offer healthcare plans, including Medicare Advantage. They also have a network of hospitals and healthcare providers.
A person eligible for Medicare can receive their Part A and Part B benefits through original Medicare or through a Medicare Advantage plan.
Private insurance companies offer Medicare Advantage bundled plans, which must provide the same benefits as original Medicare but also typically offer additional coverage.
Extra benefits may include preventive, vision, and dental care.
The Kaiser Permanente organization are a nonprofit healthcare plan provider with a hospital network, an insurance system, and a network of salaried healthcare providers.
This article looks at the different Kaiser Medicare Advantage plans available, coverage, benefits, costs, and other plan options.
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 offer a range of Medicare Advantage (MA) plans. Typically, the plans include prescription drug coverage and additional benefits.
Senior Advantage Health Maintenance Organization (HMO) plans
People who select a Kaiser HMO plan must choose an in-network primary care physician (PCP).
The PCP is the first point of contact for a person who needs medical attention.
If an individual then needs specialist care, their PCP can refer them to an in-network consultant.
Individuals must use the network of doctors and other healthcare providers unless it is an emergency.
Kaiser provide limited out-of-network benefits. However, Kaiser’s Medicare Advantage HMO plans do include additional benefits, such as vision, hearing, and dental care.
Also included is a tailor-made gym membership. A person can take part in fitness programs at participating facilities.
The HMO plans provide prescription drug coverage. A person can order their prescription drugs through a mail-order pharmacy that delivers straight to their home.
HMO Point of Service (HMO-POS) plans
Kaiser offer an HMO-POS plan that they call the Senior Advantage Plus Choice plan.
It has the benefits of using a PCP for coordinated care, but with greater flexibility.
A person can use out-of-network providers for some services, although this usually costs more.
Preferred Provider Organization (PPO) plans
Kaiser Medicare Preferred Provider Organization (PPO) plans offer more freedom.
Individuals are not required to use in-network healthcare providers and can visit any provider without a referral. Specific procedures, such as surgery or radiology, may require preapproval.
If a person uses an in-network provider, the cost is generally lower.
Some PPO plans offer the member the choice of selecting a PCP, which will also save on costs.
As with the HMO plans, benefits include dental, vision, and hearing coverage and a mail-order prescription drug service.
People who are living in the following nine states can enroll in a Kaiser Medicare Advantage plan:
- Washington D.C.
A person can find plans available in their area by using the Medicare plan finder.
No matter the provider, Medicare advantage plans must offer the same level of coverage as original Medicare parts A and B.
Kaiser Medicare Advantage benefits differ depending on the specific plan chosen and a person’s location.
Typically, the plans provide coverage for:
- preventive care, such as breast cancer screening or colorectal cancer screening
- routine flu shots
- prescribed drugs
- routine eye exams
- hearing tests
A fitness and wellness program is also offered, in which a person can attend a local gym for fitness classes.
A person may also be able to use the gym facilities and enjoy complimentary health benefits, such as massages.
Kaiser offer individuals a supplemental plan called Advantage Plus that can be added to a Medicare Advantage plan. Advantage Plus is not available on its own.
The Advantage Plus plan provides dental coverage and vision and hearing benefits beyond those included with the Medicare Advantage plan.
Coverage may also be available for hearing aids, spectacles, or other necessary medical items.
Besides Medicare Advantage plans, Kaiser also offer Medicare prescription drug plans (PDPs).
Most Kaiser Medicare Advantage plans include prescription drug coverage, but Kaiser also provide a separate, stand-alone PDP.
The PDP uses a formulary that advises on the cost of medication.
Low tier medication is the least expensive and usually includes generic drugs.
Higher tiers may be more expensive and include name brand and specialty drugs.
When a person uses a pharmacy within the Kaiser network, they can usually save on costs.
The exact cost of Kaiser Medicare Advantage plans varies according to an individual’s circumstance, location, and the plan they enroll in.
As an example, the table below outlines the approximate costs for plans in Washington.
|Out-of-pocket expense limit||$4,900||$3,000|
|Doctor visits||$5 (PCP)|
|$5 (PCP) |
|Ambulance service (one way)||$200||$150|
People can enroll in a Medicare Advantage plan at several points during the year. These periods include:
Initial Enrollment Period
This is a 7-month period starting 3 months before an individual’s 65th birth month. At this time, a person can enroll in original Medicare or a Medicare Advantage plan.
Open Enrollment Period
This period runs from October 15 through December 7. People can switch between original Medicare and a Medicare Advantage plan, change their current Medicare Advantage plan to another, or join or change a PDP.
Medicare Advantage Open Enrollment Period
This period runs from January 31 through March 31. A person can switch between Medicare Advantage plans, but they cannot switch to a Medicare Advantage plan from original Medicare.
Special Enrollment Period (SEP)
Special circumstances trigger this enrollment period. For example, a person could have delayed enrollment while applying for Extra Help. If the application is successful and Extra Help awarded, the SEP would take effect.
A range of exclusions apply to the Medicare Advantage plans, and a person should consult policy documentation to see the full details.
Some general exclusions that apply to Kaiser plans are:
- Acupuncture: Plans do not cover acupuncture unless a participating physician refers the member. The service is subject to benefit limitations.
- Chiropractic services: Plans only cover these services under certain circumstances.
- Cosmetic services: Plans do not cover services that are primarily to change a person’s appearance without treating a health condition.
- Custodial services: Plans do not cover services such as help with bathing, dressing, and general personal care.
Further details of exclusions appear in Kaiser’s evidence of coverage documentation.
Kaiser Permanente provide Medicare Advantage plans that have been rated highly by Medicare.
Coverage is available in just nine states, so it is beneficial for a person to find out if the plan they wish to enroll in is available in their area.
Individuals must enroll in a Medicare Advantage plan at specific enrollment periods throughout the year.
Medicare Advantage plans generally offer additional benefits that original Medicare does not provide.
A person can compare all Medicare Advantage plans in their area by using the online Medicare plan finder or by contacting Medicare directly.