Kaiser Permanente Medicare Advantage Review

Licensed Insurance Agent and Medicare Expert Writer
August 13, 2019
  • Pro Bullet
    HMO
  • Pro Bullet
    HMO SNP
  • Pro Bullet
    Medicare Cost Plan

Even though Kaiser Permanente’s Medicare Advantage plans are only available in eight states and DC, its enrollment numbers are high. With 8% of all Medicare Advantage (MA) recipients enrolled in a Kaiser Permanente plan, this not-for-profit firm is the fourth-largest in the country (tied with Aetna).1

And despite their limited availability across the country, it’s easy to see why so many choose an MA plan from Kaiser Permanente. Consistently above-average Medicare Star Ratings and relatively low prices create a high demand for its policies.

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States Kaiser Permanente serves

Kaiser Permanente plans are offered only in these states, but they could be a great option for the residents in these locations:

  • California
  • Colorado
  • Georgia
  • Hawaii
  • Maryland
  • Oregon
  • Virginia
  • Washington
  • Washington, DC

Is a Kaiser Permanente Medicare Advantage plan right for you?

  • World-Travelers: All plans, besides the MA basic option (Medicare Cost plan), provide emergency or urgent care outside the US.
  • RVers and snowbirds: Kaiser Permanente offers Medicare Cost plans that provide flexibility for enrollees who live in different locations around the country during the year.
  • Dual eligibles: Kaiser Permanente has plans for individuals who qualify for both Medicare and Medicaid (or similar state-run assistance programs, such as Medi-Cal).
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Kaiser Permanente Medicare Advantage plan overview

Depending on your region, Kaiser Permanente offers three different types of policies:

  • HMO (Health Maintenance Organization)
  • HMO-SNP (Health Maintenance Organization Special Needs Plan)
  • Medicare Cost plan

In a Medicare Cost plan, the health provider covers you when you are inside its network, and Medicare covers you if you’re outside of it. It’s a lot like a hybrid of Medicare Advantage and Original Medicare.

Every Kaiser Permanente plan has a $0 deductible, and most of its plans can include drug coverage. Many plans also include dental, vision, hearing benefits, and a membership to the Silver&Fit or SilverSneakers program. If a plan doesn’t include these benefits, they may be added (or increased) with Advantage Plus for an additional fee.

Kaiser Permanente sample plans

Senior Advantage (HMO)
Senior Advantage Medicare Medicaid Plan (HMO SNP)
Medicare Plus Standard Option w/Part D (Medicare Cost)
Medicare Plus Basic Option w/Part D (Medicare Cost)
Senior Advantage Gold (HMO)
Location Fullerton, CA, 92832Honolulu, HI 96817Arlington, VA, 22201Huntingtown, MD 20639Englewood, CO 80110
Drug coverage YesYesYesYesYes
Deductible $0$0$0$0$0
Maximum Out-of-Pocket $4,900$4,900$4,900$4,900$4,900
Doctor visit$10$0$10$35$10
Specialist visit $15$0$45$50$40
Network Must stay in networkMust stay in networkIn-network: covered by planOut-of-network: covered by Original MedicareNo networkMust stay in network
Medicare Star Rating 5/55/55/55/54.5/5
Plan # H0524-003H1230-008H2150-009H2150-033H0630-016

Sample plans based on medicare.kaiserpermanente.org and are for illustration purposes only. Actual quotes may vary. Data effective 5/7/19.
Sample plans based on Medicare.gov and are for illustration purposes only. Actual quotes may vary. Data effective 5/7/19.

A note on Kaiser Permanente’s Star Ratings

Each year, Medicare releases star ratings for Medicare Advantage and Part D plans. Kaiser Permanente consistently receives above-average ratings, with many of its plans scoring 4.5 to 5 out of 5 possible stars. Not only is this above average, but it's also a somewhat rare sight in the full scope of Medicare Advantage plans. For reference, only 14 out of 400 Medicare Advantage Prescription Drug plans scored 5/5 stars in 2019, and Kaiser Permanente accounts for four of those 5-star plans.2

Kaiser Permanente Senior Advantage (HMO)

In a Health Maintenance Organization (HMO), you are required to use doctors, specialists, and any other health care providers within Kaiser Permanente’s network. The only exception to this is emergency or urgent situations, such as an out-of-state car accident requiring surgery.

While HMOs can potentially feel limiting because of in-network rules, the Senior Advantage plan we sampled should be more than adequate for many—it received Medicare’s highest rating (5/5 stars overall) for 2019. This impressive rating signifies top-level quality that only 4% of MA plans achieved in 2019.3

The Senior Advantage plan we sampled included hearing, vision, and mental health services, with an option to add dental and Silver&Fit with Advantage Plus.

Kaiser Permanente’s Senior Advantage plan could be a great value for people in the plan’s service area who tend to live in one place most of the year and want a highly rated plan and network. Due to the nature of HMOs, however, this plan may not work for RVers or those who travel for significant durations.

Kaiser Permanente Senior Advantage Medicare Medicaid Plan (HMO SNP)

Individuals who qualify for both Medicare and Medicaid (the state-run assistance program) may qualify for a Health Maintenance Organization Special Needs Plan (HMO SNP). In HMO SNP plans, enrollees are limited to the plan’s network. However, with significant financial subsidies from the state, medical costs are generally lower.

While this may be an excellent option for a lot of enrollees—because of lower costs and a high Medicare Star Rating (5/5)—anyone who wants to enroll in this HMO SNP plan must qualify for both Medicaid and Medicare.

Kaiser Permanente Medicare Plus Standard Option w/Part D (Medicare Cost)

A unique plan type by Medicare Advantage standards, a Medicare Cost plan is like a hybrid between Medicare Advantage and Original Medicare. In a Medicare Cost plan, members can get health care services through Kaiser’s network and pay Kaiser’s copays like any MA plan. But Medicare Cost plan members also have the option to go out of network and have Original Medicare cover their costs instead.

In this plan, enrollees must have at least Part B, but may also have Part A.

Beyond the interesting mechanics of a Medicare Cost plan, the specific plan we sampled is highly rated—5/5 stars, according to Medicare's Star Rating. Not only is this unique for Medicare Advantage plans, but any 5-star plan also comes with an additional benefit: Medicare enrollees can switch to it at any time without qualifying for an enrollment period.

This plan could be a good option for Medicare enrollees who like the services offered by Medicare Advantage or Kaiser Permanente’s network but want the flexibility of going out of network as well. This flexibility can be especially beneficial for snowbirds and RVers.

The Plus Standard plan can also be a good option for those who want hearing, vision, and dental, as it provides all three benefits (with the opportunity to add even more coverage to all three). This plan comes with Part D prescription drug coverage but is also available without drug coverage for a lower monthly premium.

Kaiser Permanente Medicare Plus Basic Option w/Part D (Medicare Cost)

The Plus Basic plan is like the Plus Standard plan in that members can get their health care covered through Kaiser Permanente's network or Original Medicare out of the network. But, where the Plus Standard plan offers more middle-of-the-road coverage, this one is a little more basic (like the name suggests).

The plan we sampled provides hearing, vision, and mental health services, but not dental. It also provides Part D prescription drug coverage. Additionally, this plan scored the outstanding 5/5 stars according to the Medicare Star Rating, meaning top-notch quality and service. It’s worth noting that every Kaiser Permanente Medicare plan in the service area we sampled also scored 5 stars.

This plan could be a great option for people who travel but may not use their healthcare a whole lot. The basic option provides good coverage, but Kaiser Permanente has other plans offering better coverage (typically for higher premiums). It could also be suitable for people who want extra benefits. But for those needing dental benefits, this may not be the best choice.

Kaiser Permanente Senior Advantage Gold (HMO)

As an HMO, the Senior Advantage Gold plan requires members to use Kaiser Permanente's network of doctors and facilities, except in emergencies.

While there were three options for plans in this service area, the Gold plan that we sampled offers the most coverage, with lower copays and coinsurance than the other two. Also included were dental, vision, hearing, mental health services, Part D prescription drug coverage, and a membership for the SilverSneakers program. Additionally, there is an option to add even more coverage for dental, vision, hearing, and even acupuncture with Advantage Plus.

This plan could be valuable for people who use their health insurance frequently and for multiple services. As a 4.5/5 star rated plan by Medicare, enrollees can be confident of a high-quality network and services. However, for people who reside in different areas throughout the year, an HMO may not be the best option as enrollees are limited to the network.

Bottom line: great coverage—if it’s available to you

Kaiser Permanente’s Medicare Advantage plans are crowd-pleasers—evidenced by the Medicare Star Ratings—but aren't available in most of the US.

Clearly, Kaiser Permanente puts a lot of care into its plans—seen through its consistently above-average Medicare Star Ratings. Its HMO and more unique Medicare Cost plans offer great benefits with a high-caliber network of providers. The downside is they're not available in most of the US, but if you're in one of their services areas, Kaiser Permanente can be a great choice.


Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Written by
Alex Enabnit
Medicare and geriatric care expert, Alex has one motivation behind every word he writes, and that’s finding you the best medical coverage for your situation. Alex has been featured on Bloomer Boomer, Best Company, HealthPopuli.com, the Daily Ledger on the One America News Network, WBAP News radio, and more. Outside of work, you can find him hiking with his wife and pup or (occasionally) going to the gym.
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