Kaiser Permanente Medicare Advantage 2021 Review

Kaiser Permanente is the fifth-largest provider of Medicare Advantage plans [1], and the insurer scores higher than all other major Medicare Advantage providers in terms of Medicare star ratings and member satisfaction.

It’s also the largest not-for-profit health maintenance organization in the U.S. Kaiser uses an integrated care model, which means that members can get all their care in one place and all the providers are connected.

Although Kaiser gets top marks, its plans are only available in eight states and Washington, D.C., and the company only offers HMO plans. Here’s what you should know about Kaiser Permanente Medicare Advantage.

Kaiser Permanente’s offerings have advantages and disadvantages.

• Members are happy: Kaiser Permanente earned 846 points out of 1,000 in J.D. Power’s latest U.S. Medicare Advantage study, netting it the top spot for customer satisfaction out of nine providers measured.

• Top scores overall: Only seven Medicare health plans received a 5 out of 5 rating from the National Committee for Quality Assurance in 2021, and four of them are Kaiser Permanente plans. Kaiser’s 2021 plans also received high Medicare star ratings.

• Prescription benefits: Most of Kaiser’s MA plans include drug coverage.

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

• Limited plan types: Kaiser only offers HMO plans, so members must work within Kaiser’s network of medical providers.

Kaiser Permanente offers only HMO Medicare Advantage plans. Many plans offer dental, vision and hearing benefits, and worldwide emergency care. Kaiser doesn’t offer any stand-alone Medicare prescription drug plans.

Plan availability may vary by county. Plan offerings may include the following types:

Kaiser Permanente Medicare Advantage offers many members access to routine vision, dental and hearing coverage. Some plans offer other benefits as well. Here are a few standouts, although their availability varies by plan:

• Over-the-counter allowance: Some plans include an OTC benefit that allows you to purchase certain items, like vitamins and cold medications, at no extra cost by placing an order over the phone or from Kaiser’s online catalog. The allowance amount varies by plan and resets each quarter.

• Home-delivered meals: Some plans include the option to have meals delivered to your home after you’ve been discharged from the hospital due to congestive heart failure.

• Silver&Fit Healthy Aging and Exercise Program: Some plans include access to local participating fitness centers along with home fitness tools.

• Advantage Plus: For an additional monthly premium, members can access additional benefits such as an eyewear allowance, hearing aid allowance and comprehensive dental benefits if the plan doesn’t already cover them.

Kaiser Permanente Medicare Advantage members can contact their plan’s customer service in a few ways:

• Call a customer service representative. The phone number and hours of available support will depend on location.

• Chat with a member services representative, Monday to Friday from 8 a.m. to 5 p.m. in their time zone, except on major holidays.

• Send an email with nonurgent questions or comments.

Kaiser Permanente offers Medicare Advantage plans in eight states and Washington, D.C., including 109 counties [2].

Overall, Kaiser Permanente is the second-largest health insurer in the country [3], and it is the largest in terms of nonprofit health plans [4]. Some 1.7 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Advantage plans, and the company added 59,000 new members for the 2021 plan year.

Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and about a quarter (26%) of Kaiser Permanente’s Medicare Advantage plans are $0-premium plans in 2021 [5].

For Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $10 to $295. For Dual-Eligible Special Needs Plans, or SNPs, monthly premiums range from $25.40 to $30.50 [6].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $148.50 in 2021. However, some plans cover part or all of this cost.

Other out-of-pocket costs to consider include:

• Whether the plan covers any part of your monthly Medicare Part B premium.

• The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

• Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

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

• Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

• Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only Kaiser Permanente plans, or compare across carriers. You can also shop directly from Kaiser Permanente’s website by entering your ZIP code.

Average star rating: 4.9

If you want Medicare’s take on Kaiser Permanente’s plans, look no further than the Centers for Medicare & Medicaid Services’ own star ratings, which rank each plan from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, Kaiser Permanente’s Medicare Advantage (Part C) plans get an average rating of 4.8, and the company’s prescription drug plans (Part D) get an average score of 4.9 [7]. The average star rating for plans from all providers was 4.06 [8]. In practice, all of Kaiser Permanente’s contracts score 5 stars except for one contract — the Kaiser Foundation Health Plan of Washington — which gets 4.5 stars.

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

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:

See how Medicare Advantage competitors stack up to Kaiser Permanente.

Kaiser Permanente, headquartered in Oakland, California, was founded in 1945 and serves 12.5 million people across eight states and Washington, D.C. The company is made up of Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and its subsidiaries, and the Permanente Medical Groups.

Kaiser Permanente offers insurance for individuals and families, employer group plans, Medicaid/Medi-Cal and Medicare Advantage. In 2020, Kaiser posted annual operating revenue of $88.7 billion.

• What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

• Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

• Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

• Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

• Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).