Does Kaiser Accept Medicare Patients — and How to Enroll

Yes, Kaiser takes Medicare patients, but only through specific plans and only in certain regions

Kaiser Permanente does accept Medicare patients, but not everywhere and not through every plan type. Kaiser offers Medicare Advantage plans (also called Part C) in select states and service areas. If you live in a Kaiser service region and want to join Kaiser on Medicare, you must enroll in one of their Medicare Advantage offerings — you cannot use Original Medicare (Part A and B) with Kaiser as your primary coverage.

The catch is geography. Kaiser operates in nine states: California, Colorado, Georgia, Hawaii, Idaho, Oregon, Texas, Virginia, and Washington. Even within those states, Kaiser only serves specific counties and cities. If you live outside a Kaiser service area, you cannot join Kaiser on Medicare at all, regardless of your plan type.

Kaiser also does not accept Medicare patients who want to use Original Medicare with a Medigap supplemental plan. If you are on Original Medicare, Kaiser will not be your primary insurer. You can see Kaiser doctors as out-of-network providers under Original Medicare, but you will pay higher out-of-pocket costs and Kaiser will not be your main coverage.

Key Takeaways

Kaiser accepts Medicare patients only through Medicare Advantage plans in nine states: California, Colorado, Georgia, Hawaii, Idaho, Oregon, Texas, Virginia, and Washington.
You must live in a Kaiser service area within one of those states to enroll; Kaiser does not serve all counties or cities in every state.
Kaiser does not accept Original Medicare patients; if you use Original Medicare, Kaiser doctors are out-of-network and you pay higher costs.
To enroll in a Kaiser Medicare Advantage plan, you must be age 65 or older, a U.S. citizen or permanent resident, and live in a Kaiser service area.
Enrollment windows are limited: the general window is October 15 to December 7 each year, though you may have other windows if you are newly may be able to access or move.

What Medicare Advantage plans Kaiser offers

Kaiser's Medicare Advantage plans vary by region. In California, Kaiser offers several Medicare Advantage options, including HMO plans with different deductible and premium levels. In other states, the plan names and benefits differ. Some Kaiser Medicare Advantage plans include prescription drug coverage (Part D) built in; others do not.

All Kaiser Medicare Advantage plans require you to use Kaiser doctors and hospitals as your primary network. If you see a doctor outside Kaiser's network, you typically pay much more or the plan does not cover the visit at all — this is the main trade-off of an HMO structure. Kaiser Medicare Advantage plans also have annual out-of-pocket maximums, which means your costs are capped once you reach a certain amount in a calendar year.

To see what plans Kaiser offers in your area, you need to check Kaiser's website or call their Medicare enrollment line. Plan offerings change year to year, and availability depends on your exact zip code. Some zip codes may have only one or two Kaiser Medicare Advantage options; others may have more.

How to enroll in Kaiser Medicare

Enrollment in a Kaiser Medicare Advantage plan happens during specific windows. The main window is October 15 to December 7 each year — this is called the Annual Enrollment Period (AEP). Plans you enroll in during this window start on January 1 of the following year.

If you are turning 65 and becoming may be able to access for Medicare for the first time, you have a separate window: your Initial Enrollment Period (IEP) runs for seven months, starting three months before the month you turn 65 and ending three months after. During this window, you can enroll in a Kaiser Medicare Advantage plan without waiting for October.

To enroll, you can call Kaiser directly, visit their website, or use Medicare.gov. You will need your Social Security number, date of birth, and information about any current coverage. Kaiser will ask you to confirm you live in a service area and will show you which plans are available to you based on your zip code.

Costs and coverage details

Kaiser Medicare Advantage plan costs vary by plan and region. Most plans have a monthly premium (in addition to your Part B premium, which you still pay to Medicare). Some Kaiser plans have zero premium, meaning you pay only your Part B premium and any out-of-pocket costs when you use care. Others have a monthly premium ranging from roughly $50 to $200 or more, depending on the plan and your location.

All Kaiser Medicare Advantage plans have an annual deductible and an out-of-pocket maximum. The deductible is what you pay before the plan starts to cover care; the out-of-pocket maximum is the most you will pay in a year for covered services. Once you reach the out-of-pocket maximum, Kaiser covers 100 percent of covered care for the rest of that year.

Prescription drug coverage is included in most Kaiser Medicare Advantage plans, but the formulary (the list of covered drugs) and your copays vary by plan. If you take specific medications, you should check the plan's formulary before enrolling to make sure your drugs are covered and at what cost.

What happens if you move out of a Kaiser service area

If you are enrolled in a Kaiser Medicare Advantage plan and move to a location outside Kaiser's service area, you can switch to a different plan during a Special Enrollment Period (SEP). An SEP allows you to change plans outside the normal October to December window when you have a may have access to life event — moving is one of them.

You typically have 60 days from the date you move to request an SEP and switch plans. You will need to provide proof of your move, such as a utility bill or lease showing your new address. Once your SEP is approved, you can enroll in a different Medicare Advantage plan, a Medigap plan, or return to Original Medicare, depending on what is available in your new location.

If you do not request an SEP and your Kaiser plan is no longer available in your new area, Kaiser will automatically disenroll you at the end of the year. You will then need to choose a new plan during the next Annual Enrollment Period or through another SEP if you have a may have access to event.

Kaiser vs. Original Medicare with Medigap

If you live in a Kaiser service area, you have a choice: enroll in a Kaiser Medicare Advantage plan or use Original Medicare with a Medigap supplemental plan. Each approach has different costs and trade-offs. Kaiser Medicare Advantage typically has lower or no monthly premiums but requires you to use Kaiser's network and may have higher copays for some services. Original Medicare with Medigap gives you the freedom to see any doctor who accepts Medicare but usually costs more in total premiums.

If you choose Original Medicare instead of Kaiser, you can still see Kaiser doctors, but they will be out-of-network. You will pay higher costs, and Kaiser will not be your primary insurer. This is rarely the best financial choice if you live in a Kaiser service area and want Kaiser to be your main coverage — in that case, a Kaiser Medicare Advantage plan is usually the better option.

Frequently Asked Questions

Can I switch from Original Medicare to Kaiser Medicare Advantage mid-year?

No, not during the regular year. You can only switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event, such as losing other coverage or moving. If you miss the enrollment window, you will have to wait until the next October.

Does Kaiser Medicare Advantage cover out-of-network doctors?

Kaiser Medicare Advantage plans are HMOs, which means out-of-network care is usually not covered except in emergencies. If you see a non-Kaiser doctor for a non-emergency visit, you will likely pay the full cost yourself. This is a key difference from Original Medicare, which covers any doctor who accepts Medicare.

What if I have a pre-existing condition — can Kaiser deny me?

No. Medicare law prohibits Kaiser and all other insurers from denying you coverage or charging you more based on pre-existing conditions. If you meet the basic requirements (age 65 or older, U.S. citizen or permanent resident, living in a service area), Kaiser must accept you during an enrollment period.

Can I have Kaiser Medicare Advantage and Medigap at the same time?

No. If you are enrolled in a Kaiser Medicare Advantage plan, you cannot also have a Medigap policy. You must choose one or the other. If you want to switch from Kaiser Medicare Advantage to Original Medicare with Medigap, you can do so during the Annual Enrollment Period.

What if Kaiser is not available in my zip code?

If Kaiser does not serve your zip code, you cannot enroll in a Kaiser Medicare Advantage plan. You will need to choose from other Medicare Advantage plans in your area or use Original Medicare with a Medigap plan. You can check availability by entering your zip code on Medicare.gov or calling 1-800-MEDICARE.

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.