Kaiser Permanente and Senior Care Coverage

Overview of Kaiser Permanente Insurance Plans for Seniors

As of 2024, Kaiser Permanente offers Medicare insurance in the following locations:

• California
• Colorado
• Georgia
• Hawaii
• Maryland
• Virginia
• Washington D.C.
• Oregon
• Washington State

If you don’t live in one of the aforementioned states, you may need to look elsewhere for a private Medicare provider. Alternatively, if you do live in one of these states or areas, you may find an affordable Kaiser Permanente Medicare plan to fit your needs.

Currently, Kaiser Permanente offers standard, HMO Medicare Advantage plans (Part C) and Dual-Eligible Special Needs Plans (D-SNP). It does not offer standalone Medicare prescription drug plans (Part D) or Medicare Supplement plans (Medigap).

Does Kaiser Permanente Cover Nursing Homes and Skilled Nursing Care?

Unless you need short-term nursing home care after staying at a hospital, Medicare — including plans provided by Kaiser Permanente — will not cover it. Original Medicare and Medicare Advantage do not typically cover custodial care. However, if you meet the right qualifications, a Kaiser Permanente Medicare Advantage plan may cover the first 100 days of care in a skilled nursing facility.

Does Kaiser Permanente Cover Home Care?

Kaiser Permanente Medicare Advantage plans may cover some forms of at-home care for seniors, including home visits from nurses. Most plans help pay for medical professionals to come to your home for occupational, speech, or physical therapy. Some plans even offer home care services to help seniors with chores and companionship.

In an effort to keep seniors safe in the wake of COVID-19, Kaiser Permanente has also introduced free and low-cost telehealth services to many of its plans. Availability varies by location and need, but telehealth allows you to talk directly to a nurse or doctor without leaving the comfort and security of your home. You can use this service to refill subscriptions, ask questions, get medical advice, and schedule future appointments.

Does Kaiser Permanente Cover Hospice Care?

In most cases, if you meet the minimum requirements for hospice care outlined by Medicare, your Kaiser Permanente plan will cover it. Here are the two most essential requirements:

• You have a terminal illness with no known cure
• Your doctor believes that you will not live more than six months (you will need a signed document stating this diagnosis from your doctor)

Hospice care is specifically designed for patients in need of end-of-life services. Medicare, Medicaid, and Medicare Advantage usually cover the costs as long as your doctor confirms the aforementioned requirements. If you have a Kaiser Permanente Medicare Advantage plan, you can expect the standard Medicare coverage for hospice care.

Does Kaiser Permanente Cover Assisted Living?

Unfortunately, Kaiser Permanente does not cover the cost of assisted living care. This is because Medicare does not cover long-term residential care.1 Most seniors who need help paying for an assisted living facility get a long-term care insurance policy. Alternatively, if you qualify for Medicaid, you may be able to get some help paying for assisted living care.

It is important to note that Kaiser Permanente does not currently offer long-term care insurance plans. If you want to keep your Kaiser Permanente Medicare Advantage plan, you may also want a long-term care plan from another carrier. This way, you will have ample coverage for the vast majority of your long-term health costs.

How Do I Enroll in a Kaiser Permanente Medicare Plan for Senior Care?

Kaiser Permanente makes it easy to see which (if any) plans are available in your area. Simply put your ZIP code into the search on the Kaiser Permanente Medicare page and view the available plans. For example, if you live in Georgia, you may have access to two Medicare Advantage plans: Kaiser Permanente Senior Advantage Basic 1 (HMO) and Kaiser Permanente Senior Advantage Enhanced 1 (HMO). Additionally, seniors in Georgia who qualify for Medicaid may also qualify for the Senior Advantage Medicare Medicaid Plan 1 (HMO D-SNP).

Once you compare plans and find one that works for your needs, you can either call a Kaiser Permanente representative or look for a local agent via this link. While the process is relatively straightforward, there is no way to apply online on the Kaiser Permanente website.

What Other Options Exist to Pay for Senior Care?

Many seniors may turn to their health insurance policy to help pay for senior care. If this is not an option, it may be possible to get coverage through your state’s Medicaid policy. This is available based on your income qualifications. In most cases, Medicaid can cover health-related needs that are not otherwise covered by Medicare or commercial health insurance policies.

Aside from Medicaid, many older adults use their savings and retirement accounts to cover many of their senior care needs. Some people sell their homes and downsize to pay for these needs as well. Private payment for senior care, especially non-essential care, is very common. Individuals may also tap into an existing life insurance policy or turn to third parties for help in paying for these needs. Those who are getting older may wish to start planning for long-term care now when it may be more accessible and affordable to purchase.