How much is Kaiser Senior Advantage per month?

Kaiser is the largest not-for-profit healthcare organization in the United States, and it is ranked as the 5^th largest provider of Medicare Advantage plans. It uses an integrated healthcare system, where it provides health insurance and healthcare services under one organization. Here is what you should know about the Kaiser Medicare Advantage plan.

Most of Kaiser's Medicare Advantage plans are $0 premium plans, but members will still be responsible for paying their Medicare Part B premium, which is $174.70 per month in 2024. Out-of-pocket costs such as copays, coinsurance, and deductibles may vary based on location, plans, and the services you use. However, Kaiser’s Medicare Advantage plans have a maximum out-of-pocket cost ranging from $999 to 8,050.

What is Kaiser Senior Advantage?

Kaiser Senior Advantage refers to the Medicare Advantage plans provided by Kaiser Permanente, specifically for seniors who are eligible for Medicare coverage. Medicare Advantage plans, also known as Medicare Part C, are offered by private organizations as an alternative to the original Medicare (Part A and B).

The Kaiser Medicare Advantage plan includes all benefits offered by the Original Medicare, plus additional coverage. It offers Medicare Part A, Part B, and other benefits not covered by Original Medicare, such as prescription drugs, vision, and dental. Kaiser uses an integrated model, where members can get health insurance and healthcare services all in one place.

Kaiser operates a network of healthcare providers, which includes hospitals, doctors, and specialists. This helps seniors lower out-of-pocket costs compared to Original Medicare.

How much is Kaiser Senior Advantage per month?

The cost of Kaiser’s Medicare Advantage plans varies based on the location, your enrolled plan, and the services you get. Here is an estimate of the costs you will incur:

Premiums

One of the costs you will pay is the Medicare Advantage Part C premium, which is often a $0 premium for most carriers. Kaiser offers $0 premiums on nearly most of its Medicare Advantage plans. However, you will be required to pay your Medicare Part B, about $175 per month in 2024. Some plans may also cover this cost.

Copays, coinsurance, and deductibles

The amount you pay in out-of-pocket costs including copays, coinsurance, and deductibles varies depending on your location, plan, and services. You may also incur other out-of-pocket expenses depending on whether you require other paid benefits, the copayments for each visit, the plan's yearly deductibles, and whether the plan pays part or all of your Medicare Part B premiums.

Kaiser Permanente Medicare Advantage plan types

Some of the Medicare Advantage plans that Kaiser offers include the following:

Kaiser HMO plans

When you select a Kaiser health maintenance organization (HMO), you will be required to choose an in-network primary care physician (PCP). You may need a referral from your PCP to see an in-network specialist. Individuals are required to use the network of doctors and specialists unless there is an emergency. Kaiser's out-of-network services are usually limited.

Kaiser's HMO Plans provide prescription drug coverage, and individuals can get prescription drugs through mail-order pharmacies that provide home deliveries. They offer additional benefits including vision, hearing, dental care, and gym membership.

Kaiser HMO-POS plans

Kaiser offers an HMO point-of-service (POS) Plan that combines the option of using in-network doctors and prescription drugs with the option of getting some out-of-network services but at an extra cost. However, keep in mind that out-of-pocket expenses for Kaiser's HMO-POS may be higher than that of an HMO.  

The Medicare Advantage plans have maximum out-of-pocket costs ranging from $999 to $8.050, which is below the costs of most carriers, which can go up to $8,850. About 98% of Kaiser's plans that include Part D prescription drug coverage have a $0 deductible, while the remaining 2% may have a deductible ranging from $150 to $200.

Kaiser Part D plans

Some Kaiser plans come with or without Part D prescription drug coverage. The prescription drug coverage offers more enhanced coverage compared to the basic Part D coverage. Kaiser's $0 premium plans include prescription drug coverage, and most of them have a $0 deductible.

Kaiser coverage for dental, hearing aids, and more

Kaiser Medicare Advantage offers a supplemental plan known as Advantage Plus, which can be added to a Medicare Advantage plan. The Advantage Plus plan provides dental coverage, vision, and hearing benefits. Members may be able to access vision and dental exams as well as hearing aids.

What states does Kaiser cover?

Kaiser's Medicare Advantage plans account for about 6% of all Medicare Advantage enrollments in the United States. This represents about 1.8 million members around the country. However, Kaiser's Medicare Advantage plans have limited coverage, and are only available in Washington DC, and eight states including California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington.

When to enroll for Medicare Advantage Plans

If you want to enroll in a Medicare Advantage plan, you may have several enrollment options during the year. Here are the enrollment periods to be aware of:

Initial enrollment period

This is the period when you can enroll in the Original Medicare or Medicare Advantage, and it starts three months before the month you turn 65, the month of your 65^th birthday, and three months after your birthday month. This means you will have 7 months to enroll in the plan for the first time.

Open enrollment period

The open enrollment period runs from October 15 to December 7 of each year. People can switch from the Original Medicare plan to a Medicare Advantage plan, or switch from one Medicare Advantage plan to another. You can also take advantage of this enrollment period to enroll in a Medicare Advantage plan.

Medicare Advantage Open Enrollment Period

This enrollment period runs from January 01 to March 31 every year, and it is available to people who are already enrolled in a Medicare Advantage Plan. An individual can switch between Medicare Advantage plans or switch from Medicare Advantage to Original Medicare. However, you cannot switch from Original Medicare to a Medicare Advantage plan.

Special Enrollment Period

This enrollment period is triggered by special circumstances such as losing your current coverage, moving to a new address, getting Medicaid, or getting Extra Help to help with prescription drug costs. For example, people enrolled in Medicare and Medicaid or those who qualify for the Part D Extra Help program can change their Medicare Advantage or Medicare Part D coverage once every quarter.