Kaiser’s Medicare Advantage Plans Review
Comprehensive Medicare Advantage Coverage for Medicare Beneficiaries in Certain States
Kaiser Permanente is a large consortium of medical services and facilities. While many of Kaiser’s services include direct doctor-to-patient care, they also offer private insurance to consumers in several locations across the country.
For people who qualify for Medicare, Kaiser has a few Medicare Advantage (Part C) plans available with competitive pricing and benefits. In this review, we will examine Kaiser’s Medicare Advantage plans and evaluate their pros and cons.
Pro Tip: Looking for a carrier with more nationwide availability? Check out our top pick Humana. Humana’s Medicare Advantage plans are available in all 50 states.
Pros About Kaiser Medicare Advantage
- No copays for preventive care: Regardless of the plan you choose, you will not pay copays for qualifying preventive care. That means if you need to go to the doctor for vaccines, blood tests, checkups, or similar care, you might not have to pay anything. This could end up saving you hundreds of dollars per year in out-of-pocket medical expenses.
- Emergency coverage abroad: One of Kaiser’s biggest advantages over other carriers is its coverage for those who travel abroad. With Kaiser, you can travel anywhere in the world with the peace of mind that you have emergency health coverage if you need it.
- Comprehensive telehealth care: Many seniors struggle with mobility issues, which can make even routine doctor’s visits a challenge. Kaiser offers various telehealth services so Part C enrollees can call or video chat with providers from the comfort of their own homes.
- Multifaceted Kaiser Permanente app: Kaiser has a mobile app to make communication and scheduling even easier. You can ask non-routine medical questions and schedule appointments with your doctor. This way, you do not need to wait on hold to speak to a medical professional or representative at your local clinic. If you forget when you have an appointment or need to review medical information, you can open the app to view or change appointments, read test results, and look over notes from your doctor.
Cons About Kaiser Medicare Advantage
- Some services limited to Kaiser facilities: Kaiser limits some of its Medicare Advantage services to treatments received at Kaiser Permanente medical facilities. For example, if you want to schedule appointments through the Kaiser app, the appointment will have to be at a Kaiser-affiliated clinic or hospital.
- Telehealth available at Kaiser’s discretion: Telehealth may not be available depending on your location or other factors. In fact, it is difficult to know exactly how often patients can access them. Kaiser states that telehealth care can be used when “appropriate and available.”1 This means that you may or may not be able to use telehealth regularly, even if you have a plan that offers it as a standard benefit.
- Mostly HMO plans: Many Medicare Advantage companies offer a wide range of plan types, including HMO, PPO, and PFFS. Kaiser offers only HMO plans (or SNPs for those who qualify). Patients will have to get care within their local network to have their treatment covered (except in the event of a medical emergency).
- Limited availability: While many Medicare Advantage carriers have widespread availability across the country, Kaiser Part C plans are only available in eight states and the District of Columbia.
Available Kaiser Medicare Advantage Plans
Kaiser is mostly limited to health maintenance organization (HMO) plans. While you will have to get treatment within a network and choose a primary care physician, you can change your PCP at any time. You can also add “riders” to your plan via the Advantage Plus add-on. For a small monthly fee, Advantage Plus provides dental coverage and discounts on eyewear and hearing aids. Below, we’ll take a closer look at the two primary Part C plan types Kaiser Permanente offers.
Kaiser HMO plans limit all non-emergency health coverage to a network of doctors, specialists, and facilities. In-network care is far cheaper, while out-of-network, non-emergency care costs the same as going to the doctor with no insurance at all. Most Kaiser HMO plans include Part D prescription drug coverage. You can add Advantage Plus (as noted above) for even more coverage. While many of Kaiser’s HMO plans include worldwide emergency coverage, they are still best for older adults and other Medicare beneficiaries who do not travel frequently, as your standard coverage extends to a specific network of health care providers only.
FYI: Enrolling in Medicare for the first time? Visit our guide to Medicare enrollment for everything you need to know.
A special needs plan (SNP) is available to older adults and other Medicare beneficiaries who qualify based on specific diseases, health circumstances, financial situation, or a combination of all three. Kaiser offers one kind of SNP (a dual-eligible SNP) that is specifically designed to meet the needs of those with unique health conditions and an income below a designated threshold.
However, SNPs and D-SNPs are available only to a small number of applicants under special circumstances. If you want a Kaiser Part C plan, you will most likely have to choose an HMO plan.
Extra Perks and Benefits
Advantage Plus is one of the best ways to get extra benefits with your Kaiser Medicare Advantage plan. It provides varying degrees of dental, hearing, and vision coverage in one insurance plan. Kaiser offers a few other extra perks and benefits worth noting:
- OTC benefit: With some Kaiser plans, you can get common over-the-counter products like vitamins and cold medicine at no extra cost. You simply need to place an order through Kaiser’s online catalog of products. Kaiser offers a quarterly allowance on OTC products that varies by plan.
- Fitness benefit: The Kaiser Silver&Fit Healthy Aging and Exercise Program includes access to free or discounted services at local gyms and some types of home exercise equipment.
- Home meal delivery: Certain plans allow enrollees to get meals delivered directly to their homes after a hospital visit involving serious medical conditions like heart failure. Though this applies in limited situations only, it is a great feature that is included at no extra cost.
- MinuteClinic: While traveling, members can visit approved MinuteClinics for urgent care needs.
Did You Know? Almost all Kaiser plans come with prescription drug coverage, which means that you won’t have to spend more on a stand-alone Part D plan.
Like most Medicare Advantage companies, Kaiser offers these benefits only with certain plans. You will need to review the plans available in your area to see which benefits they offer. You can either apply online through Kaiser’s website or reach out to a Kaiser agent by phone.
How Much Do Kaiser Medicare Advantage Plans Cost?
Medicare Advantage plan costs vary widely based on your location and health requirements, regardless of the insurance carrier you choose. Nearly half of all Kaiser plans have no monthly premium and offer $0 copays for most routine services. For those that do have a premium, the nationwide average is a little over $70 per month. However, this will inevitably vary based on where you live and the details of your plan.
Did You Know? Kaiser prides itself on offering plans with low or no annual deductibles, which could save you on medical expenses every year!
Whether or not your plan has a premium, you will still have to pay your Part B premium, which (as of 2023) averages about $164.90 per month. The following factors can also affect the overall cost of your insurance and healthcare:
- Deductible: The deductible is the amount you have to pay out of pocket before your Medicare Advantage plan starts splitting the cost with you (your insurance pays 80 percent for most types of care). Many Kaiser plans have no annual deductible. This means you will be covered as soon as your plan begins.
- Copay: Kaiser offers $0 copays on many routine treatments. For non-routine treatments or doctor’s visits that otherwise do not qualify, you may pay roughly $30 per visit. Keep in mind that this amount can vary between doctors, specialists, and facilities.
- Out-of-network costs: Since all Kaiser plans have networks, you will need to consider where you get your non-emergency treatment. In-network treatment is much cheaper, while out-of-network treatment can be far more expensive, even when it is partially covered by your Medicare Advantage plan.
- Advantage Plus: If you want extras like dental, hearing, and vision coverage, you may need to pay a small monthly fee for Kaiser’s Advantage Plus offering. Fortunately, this will not significantly raise your medical expenses, as you can get all three major benefits for as little as $16 per month.
Where Are Kaiser Medicare Advantage Plans Available?
As of 2023, you can get Kaiser Permanente Part C coverage only if you live in one of the following locations: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington state, or the District of Columbia. While Kaiser will likely expand its coverage area in the future, the vast majority of American older adults cannot access Kaiser Part C at this time.
Reviews and Ratings
Even if you live in a location that offers Kaiser Medicare Advantage plans, it’s important to do your research before purchasing a plan. Fortunately, various agencies specialize in analyzing the quality of Medicare Advantage carriers and their services. Here are a few of the most reputable reviews and ratings of Kaiser Permanente and its Part C offerings:
- Better Business Bureau (BBB): A-
- National Committee for Quality Assurance (NCQA): 4.5 out of 5 stars
- Centers for Medicare and Medicaid Services (CMS): 5 out of 5 stars
If you already have a Kaiser Medicare Advantage plan, you can sign up to use the Kaiser mobile app with your Kaiser account. The application will allow you to ask questions and send messages directly to your local doctor’s office. For additional customer service, you can call a Kaiser Permanente Medicare specialist seven days a week between the hours of 8 a.m. and 8 p.m. If you are interested in acquiring a Part C plan with Kaiser, you can also search for a local agent on their website.
About Kaiser Permanente
Kaiser Permanente is the largest not-for-profit health maintenance organization in the United States. They’re also the fifth-largest carrier of Medicare Advantage plans. Kaiser scores well in Medicare star ratings. Although it is only available in eight states and Washington D.C., its members report high levels of satisfaction with their plans.
Final Thoughts on Kaiser Medicare Advantage Plans
Kaiser offers high-quality Medicare Advantage plans. Even though you can get affordable and customizable care with Kaiser, the company’s Medicare Advantage plans are available only to a relatively small percentage of the population. Moreover, Kaiser offers few options beyond traditional HMO plans. Nonetheless, if you live within the provider’s network and are in the market for Medicare Advantage, you can get great service and relatively low out-of-pocket expenses with a Kaiser Permanente Medicare Advantage plan.
Kaiser Permanente. (2022). Why choose Medicare Advantage.