Page Reviewed / Updated - August 31, 2020
Kaiser Permanente offers all-in-one Medicare Advantage plans that encompass and surpass the provisions of Original Medicare. While Original Medicare covers about 80% of hospital expenses under Part A and medical costs under Part B, Medicare Advantage (Medicare Part C) plans can provide those benefits plus vision, hearing and dental services. Additionally, some plans help pay for Medicare Part D prescription drugs.
Some Kaiser Medicare Advantage plans feature a $0 yearly deductible and $0 copays for preventive care. Kaiser Part C plans may also provide local and online wellness programs, including prediabetes coaching, mental health help and a host of other holistic support resources. Many of these benefits come at no cost to enrollees.
Kaiser Permanente offers two main types of Part C plans: HMO plans and Special Needs plans.
Kaiser Permanente Medicare Advantage is Kaiser's Medicare Advantage Health Maintenance Organization plan program. The HMOs use a network of providers to facilitate coordinated care. This helps keep copays and out-of-pocket expenses more predictable.
New plan members must choose a primary care doctor in their plan's service area and transfer their prescriptions. Any service received from a non-network provider is typically not covered unless it's emergency care or referred by a primary care physician.
Seniors with certain health care needs or a limited income may qualify for the Kaiser Permanente Senior Advantage Medicare Medicaid Plan, an HMO Special Needs Plan. These individuals include those who live with a chronic or disabling condition, reside in a nursing home or require an institutional level of care, or qualify for both Medicare and state Medicaid. A Kaiser SNP plan is a Medicare contract and a contract with the enrollee's state Medicaid program.
SNP enrollees get Medicaid assistance with Medicare Parts A and B cost-sharing, so they pay nothing for Medicare medical services. Medicaid and Medicare may also provide benefits such as long-term care, home and community-based services and prescription drugs.
Standard and High Kaiser Medicare Advantage Plans provide Medicare Part D prescription medication coverage. Coverage depends on the plan, the medication's cost-sharing tier on the Kaiser formulary and whether the enrollee uses a network pharmacy or nonaffiliated entity. Enrollees can sign on to their account and use Kaiser's drug pricing tool to determine how much their prescription drugs will cost.
Kaiser's Advantage Plus adds supplemental coverage to Medicare Advantage plans for an additional monthly premium. This optional package covers an additional eyewear allowance, hearing aids and preventive and comprehensive dental services. In most states, Advantage Plus is available for Medicare Advantage HMO and Senior Advantage SNP individual plan members.
Eligible seniors should sign up as soon as possible for Medicare Parts A and B to get their Medicare cards. This could take up to eight weeks. Information on the card is needed to enroll in a Medicare Advantage plan. Seniors must reside in the Kaiser Permanente Medicare Advantage plan service area in which they enroll.
Kaiser Permanente recommends completing its Turning 65 Checklist four to six months before turning 65. This resource includes a guide to understanding Medicare, star quality ratings and specific Kaiser Medicare Advantage health plans.