Does Kaiser Permanente Accept Medicare? What You Need to Know

Yes, Kaiser Permanente accepts Medicare, but coverage depends on which Kaiser plan you choose and where you live

Kaiser Permanente is one of the largest health insurance providers in the United States and does work with Medicare. However, not every Kaiser plan accepts Medicare beneficiaries, and availability varies significantly by state and region. Kaiser offers Medicare coverage through two main routes: Medicare Advantage (also called Medicare Part C) and Medigap (supplemental insurance). Understanding which option Kaiser offers in your area and how each one works is the first step toward deciding if Kaiser is right for you.

Kaiser's Medicare plans are regional. The company operates in nine states: California, Colorado, Georgia, Hawaii, Idaho, Oregon, Virginia, Washington, and the District of Columbia. If you live outside these areas, Kaiser Medicare plans are not an option for you, though you can still use Kaiser facilities if you have Original Medicare and pay out of pocket.

Key Takeaways

Kaiser Permanente offers Medicare Advantage and Medigap plans in California, Colorado, Georgia, Hawaii, Idaho, Oregon, Virginia, Washington, and Washington D.C. only.
Medicare Advantage plans through Kaiser typically include prescription drug coverage, dental, vision, and hearing benefits that Original Medicare does not cover.
You must enroll in a Kaiser Medicare plan during the annual enrollment period (October 15 to December 7) or when you first turn 65 and sign up for Medicare.
Kaiser Medicare Advantage plans usually require you to use Kaiser doctors and hospitals, with limited coverage for care outside the Kaiser network.
If you already have Original Medicare, you can switch to a Kaiser plan during open enrollment, but switching back to Original Medicare later may be difficult.

Medicare Advantage plans through Kaiser

Kaiser's Medicare Advantage plans replace Original Medicare (Parts A and B) with coverage through Kaiser instead. You pay a monthly premium to Kaiser, and the plan covers hospital stays, doctor visits, and other medical services. Most Kaiser Medicare Advantage plans include prescription drug coverage (Part D), dental benefits, vision benefits, and hearing aids — things Original Medicare does not pay for.

The trade-off is that Kaiser Medicare Advantage plans are network plans. You must use Kaiser doctors, hospitals, and other providers. If you see a doctor outside the Kaiser network, you will pay much more out of pocket, and in some cases the plan will not cover the visit at all. Emergency care is covered anywhere, but routine care must happen within Kaiser's network.

Kaiser Medicare Advantage plans vary by region. Some plans have no monthly premium beyond what you already pay for Medicare Part B. Others charge a monthly premium on top of that. Copays and deductibles also differ by plan and location. You can view the specific plans available in your area on Medicare.gov during the annual enrollment period.

Medigap supplemental plans through Kaiser

Kaiser also offers Medigap plans in some regions. Medigap is supplemental insurance that works alongside Original Medicare. You keep your Original Medicare coverage and add a Medigap plan to cover costs that Medicare does not — like copays, coinsurance, and deductibles.

If you choose a Kaiser Medigap plan, you can see any doctor or hospital that accepts Medicare, not just Kaiser providers. This gives you more flexibility than a Medicare Advantage plan. However, Medigap plans do not include prescription drug coverage, dental, vision, or hearing benefits. You would need to enroll in a separate Part D prescription drug plan.

Medigap availability through Kaiser is more limited than Medicare Advantage. Not all Kaiser regions offer Medigap plans, so check with Kaiser directly or on Medicare.gov to see what is available where you live.

How to enroll in a Kaiser Medicare plan

You can enroll in a Kaiser Medicare plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage begins January 1 of the following year. You can also enroll when you first turn 65 and sign up for Medicare, or if you experience a may have access to life event (such as losing employer coverage or moving to a Kaiser service area).

To enroll, visit Medicare.gov, call 1-800-MEDICARE, or contact Kaiser directly. You will need your Medicare number, which appears on your Medicare card. During enrollment, you can compare Kaiser plans side by side with other Medicare plans in your area to see which fits your needs and budget.

If you already have Original Medicare and want to switch to a Kaiser Medicare Advantage plan, you can do so during the Annual Enrollment Period. Be aware that switching back to Original Medicare later is not always straightforward — you may face waiting periods or higher premiums with a Medigap plan if you switch back.

What to know about Kaiser's network and coverage area

Kaiser Medicare plans are available only in specific regions within the nine states where Kaiser operates. For example, Kaiser may offer Medicare plans in the San Francisco Bay Area but not in rural Northern California. Before you enroll, confirm that Kaiser has a network in your area and that your current doctors and hospitals participate in that network.

You can search Kaiser's provider directory on Kaiser.org or by calling Kaiser's Medicare line. Ask whether your primary care doctor, any specialists you see regularly, and your preferred hospital are in-network. If your doctors are not Kaiser providers, a Kaiser Medicare Advantage plan may not be the right fit.

If you travel frequently or spend part of the year in another state, ask Kaiser about out-of-area coverage. Medicare Advantage plans typically cover emergency care anywhere, but coverage for routine care outside your home region varies by plan.

Costs and premiums for Kaiser Medicare plans

Kaiser Medicare Advantage plan premiums vary by plan, region, and year. Some plans have zero monthly premium, meaning you pay only your Part B premium to Medicare. Others charge an additional monthly premium ranging from roughly $20 to $200 or more, depending on the plan and your location. Premiums change each year, so review your options during the Annual Enrollment Period.

In addition to premiums, you will have copays for doctor visits, urgent care, emergency room visits, and hospital stays. These copays vary by plan. Some Kaiser plans have low copays but higher deductibles; others are structured differently. Prescription drug copays also vary. Review the plan's Summary of Benefits and Coverage document to understand all costs before you enroll.

If you may have access to for Extra Help (a federal program that helps people with limited income pay for prescription drugs) or Medicare Savings Programs (which help pay Medicare premiums and cost-sharing), you may be able to reduce your out-of-pocket costs. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.

Switching between Kaiser and other Medicare plans

If you enroll in a Kaiser Medicare Advantage plan and later decide it is not right for you, you have limited windows to switch. During the Annual Enrollment Period (October 15 to December 7), you can switch to another Medicare Advantage plan, a Medigap plan, or back to Original Medicare. Any change takes effect January 1.

If you switch from a Kaiser Medicare Advantage plan back to Original Medicare, you may want to enroll in a Medigap plan to cover costs that Medicare does not pay. However, if you did not enroll in Medigap when you first became may be able to access for Medicare, you may face higher premiums or waiting periods when you try to enroll later. Some states have protections against this, but not all.

If you move out of a Kaiser service area, you can switch plans outside the Annual Enrollment Period. This is considered a may have access to life event. Contact Medicare or Kaiser to report your move and explore your options.

Frequently Asked Questions

Can I use Kaiser if I have Original Medicare but did not enroll in a Kaiser plan?

Yes, you can use Kaiser facilities and providers if they accept Original Medicare. However, you will likely pay higher out-of-pocket costs than if you had enrolled in a Kaiser Medicare Advantage plan. Call Kaiser ahead of time to confirm that the specific doctor or facility you want to visit accepts Original Medicare.

What happens if I need care outside the Kaiser network?

If you have a Kaiser Medicare Advantage plan, emergency care is covered anywhere in the United States. For non-emergency care outside the network, coverage is limited or nonexistent, and you will pay out of pocket. Some Kaiser plans offer limited out-of-area coverage for routine care; check your plan documents to see what applies to you.

Can I enroll in a Kaiser Medicare plan if I am not yet 65?

No. Kaiser Medicare plans are available only to people who are 65 or older and enrolled in Medicare. If you are under 65 and have a disability or end-stage renal disease, you may be may be able to access for Medicare; contact Social Security or Medicare.gov to learn more.

Do Kaiser Medicare Advantage plans cover prescription drugs?

Most Kaiser Medicare Advantage plans include prescription drug coverage (Part D). However, coverage varies by plan — some drugs may not be covered, or you may pay higher copays for certain medications. Review the plan's formulary (list of covered drugs) before you enroll to make sure your medications are covered.

What if Kaiser does not operate in my state?

If you live outside Kaiser's service areas, you cannot enroll in a Kaiser Medicare plan. You can explore Medicare Advantage and Medigap plans from other insurers on Medicare.gov, or continue with Original Medicare. Call 1-800-MEDICARE to discuss your options.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.