Kaiser Permanente accepts both Medicare and Medicaid, but coverage depends on your location and the specific plan you choose

Kaiser Permanente is a large health insurance provider that offers plans in both Medicare and Medicaid in many states. However, Kaiser does not operate in every state, and the plans available to you depend on where you live. If you are looking at Kaiser for Medicare coverage, you will find Medicare Advantage plans (also called Part C) in most regions where Kaiser operates. For Medicaid, Kaiser offers managed care plans in select states, though availability is much more limited than for Medicare.

The key point: just because Kaiser Permanente operates in your state does not mean they offer Medicare or Medicaid plans there. You need to check what Kaiser plans are actually sold in your specific county or service area. A plan available in one part of your state may not be available in another.

Key Takeaways

  • Kaiser Permanente offers Medicare Advantage plans in most states where it operates, but you must live in a Kaiser service area to enroll.
  • Kaiser Medicaid plans are available in only a handful of states and counties, making them much harder to find than their Medicare options.
  • You can check Kaiser's website or call 1-800-464-4000 to see which plans are offered in your zip code.
  • If Kaiser does not serve your area, other Medicare Advantage and Medicaid managed care plans may be available through your state or the federal marketplace.

How Kaiser Medicare Advantage Plans Work

Kaiser's Medicare Advantage plans combine your Medicare Part A (hospital) and Part B (doctor visits) coverage into one plan. You pay a monthly premium to Kaiser instead of to Medicare directly, and Kaiser becomes your main insurance company. Most Kaiser Medicare Advantage plans also include prescription drug coverage (Part D) and dental or vision benefits, which Original Medicare does not cover.

When you use a Kaiser Medicare Advantage plan, you must see doctors and use hospitals within the Kaiser network in your area. If you go outside the network, you will pay more out of pocket, and some services may not be covered at all. This is different from Original Medicare, where you can see any doctor who accepts Medicare anywhere in the country. Kaiser Medicare Advantage plans work best if you are willing to stay within their network and if Kaiser has a strong presence in your region.

You can enroll in a Kaiser Medicare Advantage plan during the annual Medicare open enrollment period (October 15 to December 7 each year) or if you are newly may be able to access for Medicare. You cannot switch plans at will during the year unless you have a may have access to life event.

Kaiser Medicaid Plans and Where They Are Available

Kaiser Medicaid coverage is far less common than Kaiser Medicare Advantage. Kaiser operates Medicaid managed care plans in California, Colorado, Georgia, Hawaii, Ohio, Oregon, Texas, and Washington, but not in all counties within those states. Some states have Kaiser Medicaid plans in only one or two counties, while others have broader coverage.

If you are on Medicaid and Kaiser operates in your state, you may be able to choose Kaiser as your managed care plan during your state's open enrollment period, or you may be automatically assigned to Kaiser depending on your state's rules. Medicaid rules vary widely by state, so the process for joining a Kaiser Medicaid plan is different in each location. You will need to contact your state Medicaid office or check your state's Medicaid website to see what plans are offered in your county.

Kaiser Medicaid plans typically cover doctor visits, hospital care, prescription drugs, and preventive services at no cost or low cost. Like Medicare Advantage, you must use Kaiser's network providers. If you move out of a Kaiser service area, you will need to switch to a different Medicaid plan.

How to learn about Kaiser Serves Your Area

The fastest way to check if Kaiser has Medicare or Medicaid plans in your zip code is to visit Kaiser's website and use their plan finder tool. You can also call Kaiser directly at 1-800-464-4000 and tell them your zip code; they will tell you which plans are available to you.

For Medicare, you can also use the official Medicare plan finder at Medicare.gov. Enter your zip code and the tool will show you all Medicare Advantage plans available in your area, including Kaiser plans if they are offered. This tool also shows you the monthly premium, deductible, and out-of-pocket costs for each plan so you can compare.

For Medicaid, contact your state Medicaid office directly. Your state's Medicaid website will list all managed care plans available in your county, including Kaiser if it operates there. Some states also have a phone line where you can ask which plans serve your address.

What Happens If Kaiser Does Not Serve Your Area

If Kaiser does not offer plans in your location, you have other options. For Medicare, you can enroll in a different Medicare Advantage plan offered by another insurance company, or you can stay with Original Medicare and buy a Medigap supplemental policy to cover costs that Medicare does not pay. Many people in rural areas or smaller cities find that Kaiser is not available but other Medicare Advantage plans are.

For Medicaid, your state will have other managed care plans available, or you may be able to stay in fee-for-service Medicaid (also called traditional Medicaid), where you can see any doctor who accepts Medicaid. The plans available depend entirely on your state and county. Your state Medicaid office can tell you what your options are.

Costs and Out-of-Pocket Limits

Kaiser Medicare Advantage plans have monthly premiums that vary by plan and location. Some Kaiser plans have a $0 premium, meaning you pay nothing monthly beyond your regular Medicare Part B premium. Others charge $50 to $200 or more per month. You will also pay a deductible before Kaiser starts to pay for most services, and you will have copays or coinsurance when you use doctors or hospitals.

Medicare Advantage plans have an annual out-of-pocket limit, which means once you have paid a certain amount in deductibles, copays, and coinsurance, Kaiser pays for the rest of your covered services for the rest of that year. This limit protects you from very high costs. In 2024, the out-of-pocket limit for Medicare Advantage plans is $7,550 for in-network care, though this amount changes each year.

Kaiser Medicaid plans have much lower or no out-of-pocket costs because Medicaid is designed for people with low income. Most Kaiser Medicaid plans charge $0 or very small copays for doctor visits and prescription drugs. Costs vary by state and plan.

Common Reasons Kaiser May Not Be Available

Kaiser Permanente operates as a closed network, meaning it owns its own hospitals and employs many of its own doctors. This model works well in areas with high population density where Kaiser can build and staff its own facilities. In rural areas or regions with low population, Kaiser often does not have the infrastructure to operate, so they do not offer plans there.

Kaiser also makes business decisions about which states and regions to enter or exit. Over the past decade, Kaiser has expanded in some areas and pulled back in others. If Kaiser recently left your state or county, you may have been a member but are no longer able to enroll in new Kaiser plans.

For Medicaid specifically, state governments control which insurance companies can offer plans. Some states have not contracted with Kaiser to provide Medicaid coverage, even in areas where Kaiser operates Medicare Advantage plans. This is why you may see Kaiser Medicare plans available in your county but no Kaiser Medicaid plans.

Frequently Asked Questions

Can I use my Kaiser Medicare plan if I travel or move?

Kaiser Medicare Advantage plans only cover care within Kaiser's network in your service area. If you travel, you can use Kaiser emergency services anywhere, but routine care must be in-network. If you move out of a Kaiser service area, you will need to switch to a different Medicare plan during the annual open enrollment period or within 60 days of moving.

What is the difference between Kaiser Medicare Advantage and Original Medicare?

Kaiser Medicare Advantage is an all-in-one plan run by Kaiser that includes hospital and doctor coverage plus often dental and vision. Original Medicare is run by the federal government and lets you see any doctor anywhere. Kaiser has lower out-of-pocket costs and includes extras, but you must use their network. Original Medicare has higher out-of-pocket costs but more freedom to choose providers.

Do I have to enroll in Kaiser if it is offered in my area?

No. If Kaiser is available in your area, you can choose to enroll, but you are not required to. You can pick any other Medicare Advantage plan or stay with Original Medicare. The choice is yours during the annual open enrollment period.

Can I switch from Kaiser Medicaid to a different plan anytime?

Most states allow Medicaid members to change plans during the annual open enrollment period. Some states also allow you to switch plans if you have a may have access to reason, such as moving or losing access to your doctor. Check with your state Medicaid office about when you can make changes.

How do I know if Kaiser Medicaid is better than staying in fee-for-service Medicaid?

Kaiser Medicaid plans often have lower copays and include extra benefits like dental care. Fee-for-service Medicaid gives you more freedom to choose any doctor who accepts Medicaid. Compare the doctors and hospitals in Kaiser's network to the ones you use now, and check the copay amounts before deciding.