Kaiser Permanente is the fifth-largest supplier of Medicare Advantage plans , and the insurer scores larger than all different main Medicare Advantage suppliers when it comes to Medicare star rankings and member satisfaction.
It’s additionally the biggest not-for-profit well being upkeep group within the U.S. Kaiser makes use of an built-in care mannequin, which signifies that members can get all their care in a single place and all of the suppliers are linked.
Although Kaiser will get high marks, its plans are solely accessible in eight states and Washington, D.C., and the corporate solely presents HMO plans. Here’s what you need to find out about Kaiser Permanente Medicare Advantage.
Kaiser Permanente Medicare Advantage execs and cons
Kaiser Permanente’s choices have benefits and drawbacks.
Members are completely happy: Kaiser Permanente earned 846 factors out of 1,000 in J.D. Power’s newest U.S. Medicare Advantage research, netting it the highest spot for buyer satisfaction out of 9 suppliers measured.
Top scores total: Only seven Medicare well being plans acquired a 5 out of 5 score from the National Committee for Quality Assurance in 2021, and 4 of them are Kaiser Permanente plans. Kaiser’s 2021 plans additionally acquired excessive Medicare star rankings.
Prescription advantages: Most of Kaiser’s MA plans embody drug protection.
Limited availability: Kaiser Permanente plans are solely accessible in eight states and Washington, D.C., so the vast majority of U.S. adults can’t entry them. (Kaiser sells plans in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state.)
Limited plan varieties: Kaiser solely presents HMO plans, so members should work inside Kaiser’s community of medical suppliers.
Available Medicare Advantage plans
Kaiser Permanente presents solely HMO Medicare Advantage plans. Many plans provide dental, imaginative and prescient and listening to advantages, and worldwide emergency care. Kaiser does not provide any stand-alone Medicare prescription drug plans.
Plan availability might fluctuate by county. Plan choices might embody the next varieties:
Kaiser Permanente Medicare Advantage presents many members entry to routine imaginative and prescient, dental and listening to protection. Some plans provide different advantages as properly. Here are a couple of standouts, though their availability varies by plan:
Over-the-counter allowance: Some plans embody an OTC profit that means that you can buy sure objects, like nutritional vitamins and chilly drugs, at no additional value by putting an order over the cellphone or from Kaiser’s on-line catalog. The allowance quantity varies by plan and resets every quarter.
Home-delivered meals: Some plans embody the choice to have meals delivered to your house after you’ve been discharged from the hospital as a result of congestive coronary heart failure.
Silver&Fit Healthy Aging and Exercise Program: Some plans embody entry to native taking part health facilities together with residence health instruments.
Advantage Plus: For a further month-to-month premium, members can entry extra advantages comparable to an eyewear allowance, listening to support allowance and complete dental advantages if the plan doesn’t already cowl them.
Kaiser Permanente Medicare Advantage members can contact their plan’s customer support in a couple of methods:
Call a customer support consultant. The cellphone quantity and hours of accessible assist will depend upon location.
Chat with a member companies consultant, Monday to Friday from 8 a.m. to five p.m. of their time zone, besides on main holidays.
Send an e-mail with nonurgent questions or feedback.
Kaiser Permanente Medicare Advantage service space
Kaiser Permanente presents Medicare Advantage plans in eight states and Washington, D.C., together with 109 counties .
Overall, Kaiser Permanente is the second-largest well being insurer within the nation , and it’s the largest when it comes to nonprofit well being plans . Some 1.7 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Advantage plans, and the corporate added 59,000 new members for the 2021 plan 12 months.
Costs for Medicare Advantage plans will rely in your plan, your geographic location and your well being wants. One of the prices to think about is the plan’s premium, and a few quarter (26%) of Kaiser Permanente’s Medicare Advantage plans are $0-premium plans in 2021 .
For Medicare Advantage plans with a premium, the month-to-month consolidated premium (together with Part C and Part D) ranges from $10 to $295. For Dual-Eligible Special Needs Plans, or SNPs, month-to-month premiums vary from $25.40 to $30.50 .
5 Popular Kaiser Permanente Plans in 2021
Monthly consolidated premium (consists of Parts C + D)
In-network most out-of-pocket quantity
Kaiser Permanente Senior Advantage Los Angeles and Orange Counties (California)
Kaiser Permanente Senior Advantage Enhanced (Oregon)
Kaiser Permanente Senior Advantage Core (Colorado)
Kaiser Permanente Medicare Advantage Standard MD (Maryland)
Kaiser Permanente Medicare Advantage Vital (Washington state)
Even as a Medicare Advantage consumer, you’ll nonetheless be answerable for paying your Medicare Part B premium, which is $148.50 in 2021. However, some plans cowl half or all of this value.
Other out-of-pocket prices to think about embody:
Whether the plan covers any a part of your month-to-month Medicare Part B premium.
The plan’s yearly deductibles and some other deductibles, comparable to a drug deductible.
Copayments and/or coinsurance for every go to or service. For occasion, there could also be a $10 copay for seeing your major physician and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical suppliers are in-network or out-of-network, or how usually you might exit of community for care.
Whether you require additional advantages, and if the plan costs for them.
To get a way of prices, use Medicare’s Plan Finder to check info amongst accessible plans in your space. You can choose by insurance coverage provider to see solely Kaiser Permanente plans, or evaluate throughout carriers. You may also store straight from Kaiser Permanente’s web site by coming into your ZIP code.
Medicare star rankings
If you need Medicare’s tackle Kaiser Permanente’s plans, look no additional than the Centers for Medicare & Medicaid Services’ personal star rankings, which rank every plan from finest (5 stars) to worst (1 star). The company bases these rankings on plans’ high quality of care and measurements of buyer satisfaction, and rankings might change from 12 months to 12 months.
Based on the latest 12 months of information, Kaiser Permanente’s Medicare Advantage (Part C) plans get a median score of 4.8, and the corporate’s prescription drug plans (Part D) get a median rating of 4.9 . The common star score for plans from all suppliers was 4.06 . In observe, all of Kaiser Permanente’s contracts rating 5 stars aside from one contract — the Kaiser Foundation Health Plan of Washington — which will get 4.5 stars.
That signifies that of the Kaiser Permanente members who’re in contracts with a Medicare star score, 100% are in contracts rated 4.0 or above in 2021.
There are a couple of corporations that weigh in on well being plans or on the energy of the corporate in query, and we’ve included three right here:
Compare alternate options
See how Medicare Advantage opponents stack as much as Kaiser Permanente.
Compare Medicare Advantage suppliers
Percent in a 4-star plan or larger
Average Medicare star score
46 states and Washington, D.C.
50 states, Washington, D.C., and Puerto Rico.
8 states and Washington, D.C.
50 states and Washington, D.C.
About Kaiser Permanente
Kaiser Permanente, headquartered in Oakland, California, was based in 1945 and serves 12.5 million folks throughout eight states and Washington, D.C. The firm is made up of Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and its subsidiaries, and the Permanente Medical Groups.
Kaiser Permanente presents insurance coverage for people and households, employer group plans, Medicaid/Medi-Cal and Medicare Advantage. In 2020, Kaiser posted annual working income of $88.7 billion.
Find the proper Medicare Advantage plan
What are the plan’s prices? Do you perceive what the plan’s premium, deductibles, copays and/or coinsurance shall be? Can you afford them?
Is your physician in-network? If you may have a most popular medical supplier or suppliers, be certain they take part within the plan’s community.
Are your prescriptions coated? If you’re on treatment, it’s essential to know how the plan covers it. What tier are your prescribed drugs on, and are there any protection guidelines that apply to them?
Is there dental protection? Does the plan provide routine protection for imaginative and prescient, dental and listening to wants?
Are there extras? Does the plan provide any additional advantages, comparable to health memberships, transportation advantages or meal supply?
If you may have extra questions on Medicare, go to Medicare.gov or name 800-MEDICARE (800-633-4227, TTY 877-486-2048).