Kaiser Medicare Advantage Review
Kaiser offers numerous extra perks, such as wellness coaching, transportation to medical appointments (based on plan), gym access and support groups. Kaiser wins our No. 1 spot for its top-notch customer service, extensive benefits, and user-friendly online tools.
$0 premium and $0 deductible plans, including $0 deductible Part D coverage
Advantage Plus options with extra benefits
Low annual out-of-pocket maximums
Consistently high Medicare Star Ratings with the greatest number of 5-star plans
Only available in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia
Mainly offers HMO plans, which means you must receive care from network providers
Extra premium for Advantage Plus benefits
Referrals and preauthorization may be required for specialist care, tests, and procedures
With over 12 million plan members, Kaiser is one of the nation's largest nonprofit health plans. Roughly 8 percent of the nation's Medicare Advantage enrollees choose Kaiser plans. This is an impressive achievement considering the company only operates in eight states and the District of Columbia.
Kaiser's Medicare Advantage plans are among the most highly rated in terms of quality, overall value, and customer satisfaction. In 2020, seven of the country's 20 Medicare Advantage 5-star plans were Kaiser HMOs.
Kaiser is well known for its emphasis on preventive care and its holistic approach to health. Kaiser is also widely recognized as the pioneer of the modern HMO, which is the plan type chosen by nearly two-thirds of Medicare Advantage enrollees today. Kaiser also offered the first employer-sponsored health coverage in the country in 1957.
Today, Kaiser Medicare Advantage plans are rated best overall due to their combination of low out-of-pocket costs, extra perks, and high quality of care offered.
Who recommends Kaiser?
As the nation's largest integrated health system, Kaiser is at the forefront of quality of care initiatives and is recommended by:
Centers for Medicare and Medicaid Services (CMS) awarded Kaiser the agency's first Health Equity Award for helping to reduce disparities in quality of care between ethnic groups.
Pharmacy Quality Alliance has awarded Kaiser the Excellence in Quality award for its Part D prescription drug plans for 10 years in a row. This year (2020) was the first time all of Kaiser's plans in every state achieved this distinction.
U.S. News & World Report recognized Kaiser's hospital systems as among the best in the country for quality of care in multiple medical specialties.
The California Department of Managed Health Care recognized Kaiser for providing the fastest access to care for primary care, mental health, and specialty care.
NICE Satmetrix ranked Kaiser highest for customer loyalty in health plans for nine years in a row, earning the company a loyalty score nearly 2.5 times the insurance industry average.
How do Kaiser's Medicare Advantage plans work?
Medicare Advantage plans are an alternative way to get your Medicare benefits. When you sign up for a Kaiser Medicare Advantage plan, the Kaiser health system is responsible for your healthcare coverage and insurance claims.
Most Kaiser Medicare Advantage plans operate according to the HMO model. This means that you'll have to choose a primary care provider in your plan's network and receive all of your non-emergency health care from network providers. For this reason, you may need a referral for specialist care and prior authorization for certain tests and procedures.
Kaiser HMO plans include Part D prescription drug coverage, so you won't pay a separate monthly premium for your drug plan. Kaiser also offers a mail-order pharmacy option. This option allows members to get a 100-day supply of medications delivered to their home for the price of two copays.
While the $0 premium, basic HMO plan doesn't include extra benefits for vision, dental, and hearing, you have the opportunity to add low-cost Advantage Plus benefits to customize your coverage.
What Medicare Advantage plans does Kaiser offer?
Although specific plans vary depending on where you live, Kaiser Medicare Advantage plans fall into the following three general types:
Senior Advantage HMO
This is Kaiser's most popular flagship plan. It features a $0 premium and $0 annual deductible for healthcare services. In addition, you won't have an annual deductible for Part D prescription drug coverage, or any copays for preventive care.
You pay a copay at the time of service for primary and specialist care, urgent care and emergency room visits, and diagnostic tests and procedures. You're also required to use the Kaiser network for your healthcare services. The basic plan often includes a fitness membership such as SilverSneakers or Silver & Fit.
Members can add Advantage Plus coverage to the Senior Advantage HMO for a small monthly premium. Advantage Plus benefits include coverage for routine vision, dental, and hearing care, as well as prescription eyewear, hearing aids, non-medical transportation, and even acupuncture.
Senior Advantage HMO-SNP
SNP stands for "Special Needs Plan." Enrollment in these plans is limited to people who have certain serious or chronic health conditions such as heart disease or diabetes, live in a long-term care facility, or are dual-eligible for both Medicare and Medicaid. SNPs vary by location.
These plans are generally $0 premium plans with very low copays for medical services and prescription drugs. They may include additional benefits at no cost, such as coordination of care and medical social worker services . Many of these plans include the same additional benefits that are offered with Advantage Plus.
Medicare Plus plan
The Medicare Plus plan is a hybrid Medicare cost plan designed for people who want the flexibility to see providers outside the plan's network. They are not available in all areas where Kaiser plans are sold.
If you enroll in a Medicare Plus plan, you get Kaiser Senior Advantage coverage when you use network providers. If you go outside your plan network or service area, you're covered by Original Medicare, which means you're responsible for your Part A and Part B out-of-pocket costs, including deductibles and coinsurance.
Because they can get care anywhere in the country from any provider who accepts Medicare, people who travel frequently or are dual residents find Medicare Plus plans an attractive option.
How do Kaiser Medicare Advantage plans compare to other insurance providers?
Kaiser offers primarily HMO plans, which means they are often significantly less expensive overall than other Medicare Advantage plans. Across the board, Kaiser's annual out-of-pocket maximum is lower than the national average and well below the limit set by the Centers for Medicare and Medicaid Services.
Unlike other insurance companies that contract with independent hospitals and providers, Kaiser Permanente is an integrated health care system. This means that it operates its own hospitals, clinics, and health groups, all of which are consistently rated among the best in the country. For this reason, Kaiser plan members can have peace of mind knowing they have access to the highest quality of care.
Another thing worth mentioning? Kaiser has more 5-star rated Medicare Advantage plans than any other insurance provider, accounting for over a third of all 5-star plans in 2020.
What makes Kaiser Medicare Advantage plans stand out from the rest?
Kaiser's basic Medicare Advantage HMO is value-priced. You only need to pay your Part B premium to get low, predictable copays for most health services with no annual deductible. You also get high-quality, no-deductible Part D prescription drug coverage. Also noteworthy is the fact that Kaiser HMOs cover emergency care even when you're overseas.
Kaiser makes it easy for members to customize their health coverage with Advantage Plus options. Vision, dental, hearing, and fitness benefits are available for a low monthly premium.
Most people consider Kaiser's quality of care as its main differentiator. Plan members have low-cost access to some of the best doctors and hospitals in the country. Kaiser is consistently recognized as a quality leader for Medicare beneficiaries.
In addition, Kaiser has multiple 5-star Medicare Advantage plans. This means you don't need to wait for the Annual Election Period or Medicare Advantage Open Enrollment Period to enroll in a Kaiser plan. If a 5-star Kaiser plan is available in your area, you can use the 5-star Special Enrollment Period (SEP) at any time during the year to switch to that plan.
How does pricing work with Kaiser, and can I get any discounts?
Members generally pay no additional premium beyond the Part B premium for the Senior Advantage HMO. There is also typically no annual deductible for medical and prescription drug coverage. The premium for Advantage Plus benefits is around $20 a month in most areas.
In some service areas, Kaiser offers silver and gold plan options for the Senior Advantage HMO. You pay a small monthly premium for these plans in exchange for lower copayments and out-of-pocket limits.
For example, if the standard option has a $200 copay for outpatient surgery, the silver plan might charge $150, while the gold will charge you $100. The out-of-pocket maximum might be $4,400 for the standard option, $3,500 for the silver plan, and $3,000 for the gold option.
Be sure to read the summary of benefits for each plan in your area to ensure that you are aware of and understand the different costs. You'll then be able to determine the best fit for your health needs and budget.
How do I know if I'm eligible to enroll in a Kaiser Medicare Advantage plan?
Anyone who lives in one of the following states and is enrolled in Part A and Part B can enroll in a Kaiser Medicare Advantage plan:
District of Columbia
If you live in a state where Kaiser Medicare Plus plans are available, you can join one even if you are only enrolled in Part B. It is important to remember that not every plan type is available in every state or even every area of a state. Premiums and copays also vary from plan to plan and state to state.
The great thing about Medicare Advantage plans is that anyone can join, regardless of health status or preexisting condition. Unlike Medigap plans, which may require medical underwriting before you're approved, Kaiser Medicare Advantage plans are open to anyone who qualifies for Medicare.
If you want to enroll in a Kaiser plan when you first become eligible for Medicare, you can sign up during your Initial Enrollment Period. If you're currently in a Medicare Advantage plan, you can switch your coverage during the fall Annual Election Period or the new Medicare Advantage Open Enrollment Period that begins January 1 each year.
You can also take advantage of the 5-star SEP once each year to switch to a Kaiser 5-star plan if one is available in your area.
Since most Kaiser plans include Part D prescription drug coverage, be sure to check your plan's formulary (list of drugs covered by your plan) if you take daily medications. You can view available plans and check each plan's formulary using the Medicare Plan Finder tool.
Your choice of Medicare plan has a major impact on your physical and financial health and well-being. For this reason, it's extremely important to identify your coverage priorities and research your options. Contact your State Health Insurance Assistance Program or a licensed Medicare expert if you need help finding the best plan for you.
Outstanding customer service
Kaiser has a 94.2% customer retention rate, which is tops in the industry.
Accessible plan options
Kaiser offers many plans with $0 monthly premuims.
App for on-the-go use
Kaiser offers an integrated app for scheduling appointments and getting drug refills.
By: Sheila Olson
Sheila has over two decades of experience writing about Medicare, health, and personal finance. Her work has been featured on sites such as Investopedia, The Motley Fool, and Boomer Benefits. Sheila holds a MPH (Master of Public Health) from Northern Arizona University.