Kaiser Permanente accepts Medicare, but not in all states and not in all plan types

Kaiser Permanente is a large health insurance company that does work with Medicare, but the details depend on where you live and which type of Medicare plan you choose. Kaiser offers both Medicare Advantage plans (Part C) and Medicare Supplement plans (Medigap) in certain states. Not every Kaiser region accepts Medicare, and the plans available to you depend on your zip code.

If you live in an area where Kaiser operates and offers Medicare plans, you can enroll during Medicare's annual open enrollment period (October 15 to December 7 each year) or when you first turn 65. You will need to contact Kaiser directly or work with Medicare.gov to see what plans are available in your specific location.

Key Takeaways

  • Kaiser Permanente offers Medicare Advantage and Medicare Supplement plans in select states, but not nationwide.
  • Your zip code determines whether Kaiser Medicare plans are available to you, so you must check your specific service area.
  • You can enroll in a Kaiser Medicare plan during the annual open enrollment period (October 15 to December 7) or when you first turn 65.
  • Medicare.gov and Kaiser's own website both show which plans are offered in your area and what they cover.

Which states and regions have Kaiser Medicare plans

Kaiser Permanente operates in nine states: California, Colorado, Georgia, Hawaii, Idaho, Oregon, Texas, Virginia, and Washington. However, Kaiser does not offer Medicare plans in every part of every state where it operates. Even within states where Kaiser has a presence, Medicare plans may only be available in certain counties or metropolitan areas.

The easiest way to learn about Kaiser Medicare plans are available where you live is to enter your zip code on Medicare.gov's plan finder tool. You can also call Kaiser directly at 1-800-464-4000 to ask whether Medicare plans are offered in your area. If Kaiser does not serve your zip code, the Medicare.gov tool will show you other plans that do.

Medicare Advantage plans through Kaiser

Medicare Advantage (also called Part C) is an alternative to Original Medicare. Kaiser offers Medicare Advantage plans in the states and regions where it operates. These plans bundle hospital coverage, doctor visits, and prescription drug coverage into one plan, usually with a lower monthly premium than a Medigap plan.

Kaiser Medicare Advantage plans typically include a network of Kaiser doctors and hospitals. If you go to a doctor or hospital outside the Kaiser network, you may pay more or the visit may not be covered at all. Some Kaiser Medicare Advantage plans include dental, vision, and hearing coverage, though this varies by plan and location.

When you enroll in a Kaiser Medicare Advantage plan, you are still covered by Medicare, but Kaiser becomes your insurance company and manages your benefits. You will receive a Kaiser insurance card and use Kaiser's doctors and facilities for most of your care.

Medicare Supplement (Medigap) plans through Kaiser

Medicare Supplement plans, also called Medigap, work alongside Original Medicare to cover costs that Medicare does not pay, such as copayments and coinsurance. Kaiser offers Medigap plans in some of its service areas. With a Medigap plan from Kaiser, you keep Original Medicare and can see any doctor or hospital that accepts Medicare.

Medigap plans are standardized by the federal government, which means that a Plan G from Kaiser covers the same things as a Plan G from any other insurance company. The main difference between companies is the monthly premium. You can compare Kaiser's Medigap prices with other insurers to see which offers the best rate for the plan you want.

Unlike Medicare Advantage, a Medigap plan does not restrict you to a network. You can use any doctor, hospital, or specialist that accepts Medicare, anywhere in the country. This gives you more flexibility if you travel or want to see doctors outside of Kaiser's network.

How to check if Kaiser Medicare plans are available in your area

Start by visiting Medicare.gov and using the "Find Care Providers & Suppliers" or "Find Health & Drug Plans" tool. Enter your zip code and the tool will show you all Medicare plans available in your area, including any Kaiser plans. You can compare coverage, costs, and networks side by side.

You can also call Kaiser directly at 1-800-464-4000 to ask what Medicare plans they offer in your zip code. Kaiser's customer service team can walk you through the differences between their Medicare Advantage and Medigap options and answer questions about coverage and costs.

If you are already a Kaiser member with commercial insurance and are turning 65, Kaiser may send you information about Medicare plans automatically. However, you should still verify what is available in your area using Medicare.gov, because Kaiser's mailing may not include all your options.

Enrollment timing and important date

You can enroll in a Kaiser Medicare plan during your Initial Enrollment Period, which is the seven-month window that includes the month you turn 65, the three months before, and the three months after. If you miss this window, you can still enroll during the annual open enrollment period from October 15 to December 7 each year.

If you enroll during the annual open enrollment period, your coverage will start on January 1 of the following year. If you enroll during your Initial Enrollment Period, your coverage start date depends on which month you enroll. For example, if you enroll in the month you turn 65, coverage starts the first of that month.

You cannot change Kaiser Medicare plans outside of these enrollment windows unless you have a may have access to life event, such as moving out of Kaiser's service area, losing other health coverage, or getting married. If a may have access to event happens, you have 60 days to make a change.

What to ask Kaiser before you enroll

Before you choose a Kaiser Medicare plan, ask these questions: Which doctors and hospitals are in the Kaiser network in my area? What is the monthly premium, and what are the copayments for doctor visits and prescriptions? Does the plan cover the medications I take? If I need to see a specialist, do I need a referral? What happens if I travel out of state?

For Medicare Advantage plans specifically, ask: What is the out-of-pocket maximum, and what does it include? Are there any restrictions on emergency care outside the network? For Medigap plans, ask: What is the deductible? Does the plan cover preventive care at no cost?

You can also ask Kaiser for a copy of the plan's Summary of Benefits and Coverage, which is a document that explains exactly what the plan covers and what you pay. This document is required by law and will give you the clearest picture of what to expect.

When to contact Kaiser or Medicare for help

Contact Kaiser directly if you have questions about their specific plans, want to know if they serve your area, or need help understanding what a plan covers. You can reach Kaiser at 1-800-464-4000 or visit their website.

Contact Medicare at 1-800-MEDICARE (1-800-633-4227) if you have general questions about how Medicare works, need help comparing plans, or want to report a problem with a plan you are already enrolled in. Medicare can also help you understand your rights and what to do if you disagree with a coverage decision.

If you are having trouble affording your Medicare premiums or out-of-pocket costs, ask Kaiser or Medicare about programs that may help, such as the Low-Income Subsidy program or the Medicare Savings Programs. These are run by your state and can reduce what you pay.

Frequently Asked Questions

Does Kaiser accept Medicare in my state?

Kaiser offers Medicare plans in California, Colorado, Georgia, Hawaii, Idaho, Oregon, Texas, Virginia, and Washington, but not in every zip code within those states. Use Medicare.gov's plan finder tool and enter your zip code to see if Kaiser Medicare plans are available where you live. You can also call Kaiser at 1-800-464-4000.

What is the difference between a Kaiser Medicare Advantage plan and a Medigap plan?

A Medicare Advantage plan bundles hospital, doctor, and drug coverage into one plan and usually has a lower monthly premium, but you must use Kaiser's network of doctors and hospitals. A Medigap plan works with Original Medicare and lets you see any doctor that accepts Medicare anywhere in the country, but the monthly premium is usually higher.

Can I switch from Kaiser Medicare Advantage to Medigap?

Yes, but only during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event. If you switch from Medicare Advantage to Medigap, you may have to answer health questions, and some plans may charge you more based on your health history. Some states have protections that limit this, so ask Kaiser about your state's rules.

What happens if I move out of Kaiser's service area?

If you move out of the area where Kaiser offers Medicare plans, you can change to a different Medicare plan without waiting for the annual open enrollment period. You have 60 days from the date you move to make a change. Contact Medicare at 1-800-MEDICARE to find plans available in your new location.

Do I need a referral to see a specialist with Kaiser Medicare?

This depends on the specific Kaiser Medicare Advantage plan you choose. Some plans require a referral from your primary care doctor before you see a specialist, while others do not. Check your plan's Summary of Benefits and Coverage or call Kaiser to find out what your plan requires.