Kaiser Permanente Medicare Benefit 2021 Overview

Kaiser Permanente is the fifth-largest supplier of Medicare Benefit plans [1], and the insurer scores increased than all different main Medicare Benefit suppliers when it comes to Medicare star scores and member satisfaction.

It’s additionally the most important not-for-profit well being upkeep group within the U.S. Kaiser makes use of an built-in care mannequin, which implies that members can get all their care in a single place and all of the suppliers are related.

Though Kaiser will get high marks, its plans are solely obtainable in eight states and Washington, D.C., and the corporate solely presents HMO plans. Right here’s what you need to learn about Kaiser Permanente Medicare Benefit.

Kaiser Permanente Medicare Benefit professionals and cons

Kaiser Permanente’s choices have benefits and downsides.


  • Members are glad: Kaiser Permanente earned 846 factors out of 1,000 in J.D. Energy’s newest U.S. Medicare Benefit research, netting it the highest spot for buyer satisfaction out of 9 suppliers measured.

  • Prime scores general: Solely seven Medicare well being plans obtained a 5 out of 5 ranking from the Nationwide Committee for High quality Assurance in 2021, and 4 of them are Kaiser Permanente plans. Kaiser’s 2021 plans additionally obtained excessive Medicare star scores.

  • Prescription advantages: Most of Kaiser’s MA plans embrace drug protection.


  • Restricted availability: Kaiser Permanente plans are solely obtainable in eight states and Washington, D.C., so the vast majority of U.S. adults can’t entry them. (Kaiser sells plans in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state.)

  • Restricted plan varieties: Kaiser solely presents HMO plans, so members should work inside Kaiser’s community of medical suppliers.

Accessible Medicare Benefit plans

Kaiser Permanente presents solely HMO Medicare Advantage plans. Many plans provide dental, imaginative and prescient and listening to advantages, and worldwide emergency care. Kaiser does not provide any stand-alone Medicare prescription drug plans.

Plan availability could fluctuate by county. Plan choices could embrace the next varieties:

Extra advantages

Kaiser Permanente Medicare Benefit presents many members entry to routine vision, dental and hearing coverage. Some plans provide different advantages as nicely. Listed below are a number of standouts, though their availability varies by plan:

  • Over-the-counter allowance: Some plans embrace an OTC profit that permits you to buy sure objects, like nutritional vitamins and chilly drugs, at no further value by inserting an order over the telephone or from Kaiser’s on-line catalog. The allowance quantity varies by plan and resets every quarter.

  • Dwelling-delivered meals: Some plans embrace the choice to have meals delivered to your own home after you’ve been discharged from the hospital because of congestive coronary heart failure.

  • Silver&Match Wholesome Ageing and Train Program: Some plans embrace entry to native collaborating health facilities together with residence health instruments.

  • Benefit Plus: For a further month-to-month premium, members can entry further advantages similar to an eyewear allowance, listening to assist allowance and complete dental advantages if the plan doesn’t already cowl them.

Customer support

Kaiser Permanente Medicare Benefit members can contact their plan’s customer support in a number of methods:

  • Name a customer support consultant. The telephone quantity and hours of accessible help will depend upon location.

  • Chat with a member companies consultant, Monday to Friday from 8 a.m. to five p.m. of their time zone, besides on main holidays.

  • Ship an electronic mail with nonurgent questions or feedback.

Kaiser Permanente Medicare Benefit service space

Kaiser Permanente presents Medicare Benefit plans in eight states and Washington, D.C., together with 109 counties [2].

Total, Kaiser Permanente is the second-largest well being insurer within the nation [3], and it’s the largest when it comes to nonprofit well being plans [4]. Some 1.7 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Benefit plans, and the corporate added 59,000 new members for the 2021 plan yr.


Prices for Medicare Benefit plans will rely in your plan, your geographic location and your well being wants. One of many prices to contemplate is the plan’s premium, and a couple of quarter (26%) of Kaiser Permanente’s Medicare Benefit plans are $0-premium plans in 2021 [5].

For Medicare Benefit plans with a premium, the month-to-month consolidated premium (together with Half C and Half D) ranges from $10 to $295. For Twin-Eligible Particular Wants Plans, or SNPs, month-to-month premiums vary from $25.40 to $30.50 [6].

5 Common Kaiser Permanente Plans in 2021

Month-to-month consolidated premium (contains Components C + D)

In-network most out-of-pocket quantity

Kaiser Permanente Senior Benefit Los Angeles and Orange Counties (California)

Kaiser Permanente Senior Benefit Enhanced (Oregon)

Kaiser Permanente Senior Benefit Core (Colorado)

Kaiser Permanente Medicare Benefit Normal MD (Maryland)

Kaiser Permanente Medicare Benefit Important (Washington state)

Whilst a Medicare Benefit person, you’ll nonetheless be liable for paying your Medicare Half B premium, which is $148.50 in 2021. Nonetheless, some plans cowl half or all of this value.

Different out-of-pocket prices to contemplate embrace:

  • Whether or not the plan covers any a part of your month-to-month Medicare Half B premium.

  • The plan’s yearly deductibles and some other deductibles, similar to a drug deductible.

  • Copayments and/or coinsurance for every go to or service. As an illustration, there could also be a $10 copay for seeing your main physician and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether or not your medical suppliers are in-network or out-of-network, or how usually chances are you’ll exit of community for care.

  • Whether or not you require further advantages, and if the plan prices for them.

To get a way of prices, use Medicare’s Plan Finder to match data amongst obtainable plans in your space. You possibly can choose by insurance coverage service to see solely Kaiser Permanente plans, or examine throughout carriers. You too can store straight from Kaiser Permanente’s website by coming into your ZIP code.

Medicare star scores

If you need Medicare’s tackle Kaiser Permanente’s plans, look no additional than the Facilities for Medicare & Medicaid Providers’ personal star ratings, which rank every plan from finest (5 stars) to worst (1 star). The company bases these scores on plans’ high quality of care and measurements of buyer satisfaction, and scores could change from yr to yr.

Primarily based on the latest yr of knowledge, Kaiser Permanente’s Medicare Benefit (Half C) plans get a mean ranking of 4.8, and the corporate’s prescription drug plans (Half D) get a mean rating of 4.9 [7]. The common star ranking for plans from all suppliers was 4.06 [8]. In observe, all of Kaiser Permanente’s contracts rating 5 stars aside from one contract — the Kaiser Basis Well being Plan of Washington — which will get 4.5 stars.

That implies that of the Kaiser Permanente members who’re in contracts with a Medicare star ranking, 100% are in contracts rated 4.0 or above in 2021.

Third-party scores

There are a number of corporations that weigh in on well being plans or on the power of the corporate in query, and we’ve included three right here:

Evaluate alternate options

See how Medicare Benefit opponents stack as much as Kaiser Permanente.

Evaluate Medicare Benefit suppliers

P.c in a 4-star plan or increased

Common Medicare star ranking

46 states and Washington, D.C.

50 states, Washington, D.C., and Puerto Rico.

8 states and Washington, D.C.

50 states and Washington, D.C.

About Kaiser Permanente

Kaiser Permanente, headquartered in Oakland, California, was based in 1945 and serves 12.5 million individuals throughout eight states and Washington, D.C. The corporate is made up of Kaiser Basis Well being Plan, Kaiser Basis Hospitals and its subsidiaries, and the Permanente Medical Teams.

Kaiser Permanente presents insurance coverage for people and households, employer group plans, Medicaid/Medi-Cal and Medicare Benefit. In 2020, Kaiser posted annual working income of $88.7 billion.

Discover the precise Medicare Benefit plan

  • What are the plan’s prices? Do you perceive what the plan’s premium, deductibles, copays and/or coinsurance will likely be? Are you able to afford them?

  • Is your physician in-network? In case you have a most well-liked medical supplier or suppliers, be certain that they take part within the plan’s community.

  • Are your prescriptions coated? For those who’re on treatment, it’s essential to know how the plan covers it. What tier are your pharmaceuticals on, and are there any protection guidelines that apply to them?

  • Is there dental protection? Does the plan provide routine protection for imaginative and prescient, dental and listening to wants?

  • Are there extras? Does the plan provide any further advantages, similar to health memberships, transportation advantages or meal supply?

In case you have further questions on Medicare, go to Medicare.gov or name 800-MEDICARE (800-633-4227, TTY 877-486-2048).


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