Kaiser Permanente Medicare Review 2022Read our review of Kaiser Permanente plans and how they compare with other leading Medicare Advantage providers.
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Taking A Look At Kaiser Permanente Medicare Plans
Kaiser Permanente offers the largest nonprofit health plan in the United States. It is a California-based company that serves the following eight states:
With around 12 million members, Kaiser Permanente is rated as one of the top health insurance providers and is the fifth largest provider of Medicare Advantage Plans in the U.S.
This insurer has the highest star rating and member satisfaction of all other major Medicare Advantage providers in the U.S.
Here is why Kaiser Permanente may be a good choice for your health insurance needs.
Medicare - What Do All the Parts Mean?
Before we jump into our review, here’s a quick roundup of the Medicare plans in the U.S.
Part A (Hospital Insurance): Covers in-hospital, nursing, and hospice care. It also covers home health care.
Part B (Medical Insurance): This helps you cover services from your doctors. It includes cover for medical equipment like wheelchairs, walkers, crutches, and so on. Part B also covers preventative services like screenings and vaccines.
Part C (Medicare Advantage Plans): These plans include all the benefits of Part A and Part B, plus dental, vision and hearing care, as well as wellness programs or fitness center memberships.
Part D (Drug Coverage): This is the part of Medicare that pays for prescription drug coverage.
Note: Original Medicare includes Part A and Part B. Medicare Advantage covers Parts A, B and C. Part D is an optional coverage that you can include with Original Medicare or Medicare Advantage.
Terms You Need To Know:
Deductibles are costs you will pay for your medical tests, items, and services before your Medicare plan covers your expenses.
Coinsurance payments are expenses that you must pay yourself for medical treatment, services, and items. These are different for Medicare Parts A and B, and can either be a percentage of the cost or a fixed amount.
Co-payments or co-pays are amounts that you will pay for medical services, tests, or items. These amounts are set by your health insurance company and can range between $1.00 and a few hundred dollars.
Out-of-pocket expenses are the costs that your health insurance doesn’t cover, which you will have to pay for. Deductibles, co-payments, and coinsurance are all examples of out-of-pocket expenses.
Zero premium medicare plans are Medicare Advantage Plans which have no monthly premiums. You may need to pay deductibles, coinsurance, or co-pays if you need medical care.
What Are The Pros And Cons Of Kaiser Permanente?
Although Kaiser Permanente operates in only a few states, it’s considered a major insurance company because of the number of policies it offers.
Kaiser Permanente is available in:
✅ Lower premiums: Their basic plan offers lower premiums than its competitors.
✅ Financially strong: Kaiser Permanente has received several high ratings from Fitch and Standard & Poor, two of the most significant credit rating agencies in the world. They rate the creditworthiness of countries and private enterprises.
✅ Easy to apply for cover: You can get a quote for a health insurance policy and apply for your insurance online.
✅ Prescription benefits: Most of Kaiser Permanente’s Medicare Advantage Plans include drug coverage.
Limitations of Kaiser Permanente
❌ Limited plan types: Kaiser Permanente offers health maintenance organization (HMO) plans only.
An HMO plan is a type of health insurance plan that only covers care from doctors who are part of the HMO and does not cover care from doctors outside of the health organization network.
❌ Limited availability: Kaiser Permanente is available in just 8 states and Washington D.C., so the majority of U.S. adults can’t access its benefits.
❌ Network only provider: Kaiser Permanente only offers health care through its network of doctors and hospitals.
What Is Kaiser Permanente's Medicare Star Rating?
Kaiser Permanente has earned the highest possible rating of 5 out of 5 stars for 12 consecutive years.
Kaiser Permanente’s average star rating (2022): ⭐⭐⭐⭐⭐
Here’s what the different star ratings mean:
(No stars): New Plan
⭐⭐: Below average
What Are Medicare Star Ratings?
The Centers for Medicare and Medicaid Services (CMS) uses a star rating system to measure the performance of Medicare Advantage and Part D health plans.
The aim is to make it easy for buyers to compare the quality of the health plans on offer.
They also provide an overall star rating score for each health insurance company that offers Medicare Advantage and Part D prescription drug plans.
The rating for Medicare Part C considers 28 different factors.
The rating for Medicare Part D considers 12 factors.
The rating for Medicare Advantage Plans with Part D coverage considers 38 factors.
The CMS rates health insurance companies and their plans on:
How Medicare providers keep their beneficiaries healthy (for example, preventive services and other health benefits).
How they manage long-term or chronic conditions.
Their members’ experience (overall customer satisfaction).
Member complaints (complaints submitted and whether members are leaving the health plan).
The plan’s overall customer service (call center services, claims processing, appeals, and enrollments).
Other Third-Party Ratings
There are a few companies that provide ratings for Medicare health insurance providers every year. These companies provide ratings for Medicare health insurance providers in the U.S. based on customer satisfaction, reviews, and finances.
Here is what three of them said about Kaiser Permanente.
Consumer Affairs provides star ratings based on customer reviews. Their ratings are awarded on a scale of one to five, with five being the highest score.
Consumer Affairs asks for contact information to make sure the reviewers are real and each review is moderated to verify quality.
In August 2022, Kaiser Permanente received a 1-star customer satisfaction rating. This rating is based on actual customer service experiences with Kaiser Permanente.
Generally, customers were unhappy about Kaiser Permanente’s services. It is important to note that there were only 31 ratings on Consumer Affairs at the time of writing this article.
In the latest U.S. Commercial Member Health Plan Study, J.D. Power, a global leader in consumer insights, measured satisfaction among members of 147 health plans in 22 regions throughout the U.S.
They examined six factors including:
Billing and payment.
Coverage and benefits.
Information and communication.
Based on a 1,000-point scale, Kaiser Permanente received 714 points, which was above the average satisfaction level of 671 points.
AM Best is a credit rating agency that reviews insurance companies based on their financial strength.
A health insurance company’s financial stability influences how quickly and easily claims are settled.
Kaiser Permanente achieved an A+ rating from AM Best, or 5/5 for their financial strength.
How Does Kaiser Permanente Compare To Other Health Insurance Providers?
Kaiser Permanente operates in only eight states across the U.S. This means that we will be doing a comparison based on how Kaiser Permanente stacks up against the competition in those states only.
Kaiser Permanente vs. UnitedHealthcare
UnitedHealthcare ranks first in the country by size, but at 26 million members, Kaiser Permanente has a solid reputation and excellent ratings in the U.S.
Both companies offer Individual and Family plans, as well as Medicare and small business solutions. Kaiser Permanente does not cover dental or vision care.
UnitedHealthcare contracts with independent doctors, hospitals, and medical groups for their health maintenance organization (HMO) plans. Kaiser Permanente uses its own network of doctors and hospitals.
In fact, Kaiser Permanente owns the hospitals and employs the doctors within its network.
Members of Kaiser Permanente may only visit doctors and hospitals within its network.
For an insurance quote with United Healthcare you can visit their website at https://www.uhc.com/ and for Kaiser Permanente, you can access their plan search facility at https://healthy.kaiserpermanente.org/front-door.
Kaiser Permanente vs. Aetna
Aetna is one of the largest insurance carriers with 39 million members and has a vast network of providers.
Kaiser Permanente provides health care solely through its in-house network of doctors and hospitals.
While Aetna is available throughout the U.S., it’s very hard to sign up. Their plans are often only accessible through companies that offer Aetna Medicare plans. Although Kaiser Permanente is available in only eight U.S. states, it is open to everyone.
Kaiser Permanente offers plans through their health insurance marketplace. Search for plans on their Kaiser Permanente website.
Aetna offers its plans only through participating employers, although you can review Aetna’s individual and family pla
Kaiser Permanente vs. Humana
Founded in 1961, Humana scores a Medicare Star Rating of three out of five, as opposed to Kaiser Permanente’s rating of five out of five.
Humana no longer offers individual and family plans, but does offer Medicare, small business, dental and vision plans. Kaiser Permanente does not offer dental or vision plans.
Humana has 14 million members across the country and has been recognized by Forbes as the most socially responsible health insurer in the U.S.
Kaiser Permanente is only slightly smaller in overall membership numbers, with around 12 million members across just eight states.
To find more information about the medical plans on offer from Humana, visit the shop Medicare plans page on their website and for Kaiser Permanente, you can find more information on kaiserpermanente.org.
Medicare Advantage Plans Offered by Kaiser Permanente
Kaiser Permanente offers specific Medicare Advantage Plans.
A Medicare Advantage Plan offers hospital care, doctors’ consultations, assistive devices (such as wheelchairs, crutches, and walkers), dental, vision, and hearing care, as well as wellness programs, or fitness center membership.
The actual coverage you get will depend on the plan you select and the state, as well as the county where you live.
The Kaiser Permanente Medicare Advantage Plans include the following types:
Kaiser Permanente HMO Plans
Kaiser’s health maintenance organization (HMO) plans require you to have an in-network primary care doctor.
You will need to visit this doctor for any preventative care or if you are ill. If you need to see a specialist, your primary care doctor will refer you.
The standard Kaiser Permanente HMO plan offers benefits such as a SilverSneakers membership, which gives you access to participating gyms and home fitness programs.
Kaiser Permanente also offers a mail-order pharmacy for the delivery of your prescription medication.
Kaiser Permanente PPO Plans
Preferred provider organization or PPO plans, provide more freedom in choosing health care providers that will accept your insurance.
A preferred provider organization is a managed-care network consisting of doctors, hospitals, and other health care services.
These contract with insurance companies to provide services to members.
Some Kaiser Permanente PPO plans partially cover the cost of seeing out-of-network doctors and specialists.
The plan is provided in two tiers.
The first is ‘Participating Provider’ which has lower out-of-pocket costs.
The second is ‘Nonparticipating Provider’ where you can visit any provider, but you will need to pay in full upfront before you submit your claim.
Kaiser Permanente Special Needs Plans (SNPs)
Kaiser Permanente offers health care plans for those with special needs. There are a few different types of SNPs available and they include:
Institutional special needs plans (I-SNPs)
This suits people living in a network nursing home, assisted living community, or any other approved facility.
Chronic condition special needs plans (C-SNPs)
This has been designed for people with certain chronic conditions such as diabetes, congestive heart failure, and so forth.
Dual-eligible special needs plans (D-SNPs)
This is the SNP option for people who are entitled to Medicare and who also qualify for assistance from the Medicaid program.
How Much Do Kaiser Permanente’s Medicare Advantage Plans Cost?
The cost of Kaiser Permanente’s Medicare Advantage Plans vary according to your individual circumstances, location, and the actual plan that you enroll in.
As an example, the rates below are the average that you can expect to pay living in Washington state:
|Doctor visits||(Primary care doctor) $5 |
|(Primary care doctor) $5|
|Ambulance service (one way)||$200||$150|
To find out how much you can expect to pay for health insurance coverage with Kaiser Permanente by visiting the shop our plans page on their website.
What Medicare Part D Plans Does Kaiser Permanente Offer?
While many Kaiser Medicare Advantage Plans include prescription drug coverage, you can also opt for prescription drug plans (Part D) separately.
These plans include a list of covered medications that is divided into tiers.
Low or generic tier medications are the least expensive, while the premium tiers are usually the more expensive name-brand drugs.
By choosing the Kaiser Permanente mail-order pharmacy service, you can benefit from reduced drug rates.
What Medicare Supplement Plans Does Kaiser Permanente Offer?
Kaiser Permanente offers Medicare Advantage Plans, as well as a supplemental plan called the ‘Advantage Plus’ plan.
This plan covers dental, vision, and hearing benefits.
To find out more about the specific plans that Kaiser Permanente has on offer in your region, have your 5-digit ZIP code ready and visit their Medicare Advantage Plus page.
Tips for Finding the Right Medicare Advantage Plan
If you’re shopping around for a Medicare Advantage Plan, you may be wondering how to choose the best plan for your needs.
What you end up choosing will depend on what you can afford and your medical needs.
Here are some pointers to help make your decision easier:
Research CMS Star Ratings
The CMS or Centers for Medicare and Medicaid Services, implemented a 5-star rating system to help measure the quality of health care and drug services provided by Medicare Advantage and Medicare Part D plans.
Every year the CMS releases the star ratings to the public and you can download the 2022 data HERE.
Decide on your budget
One of the most important considerations when it comes to choosing a Medicare plan is what the premium will be per month. Find a plan that lists the following information for you:
Part B premium.
In-network annual deductible.
In and out of network out-of-pocket max.
Co-pays and coinsurance.
Review the benefits you already have
If you already receive any other health care benefits, remember them when you’re deciding what you will need out of a new plan.
Consider what is important in terms of coverage
All Medicare Advantage Plans cover what Original Medicare covers, which includes hospital coverage (Part A) and medical coverage (Part B).
When choosing a Medicare Advantage Plan, first consider what type of coverage you need in addition to the coverage you are already getting.
Most Medicare Advantage Plans cover the following:
Prescription drug coverage.
Where Can I Learn More about Medicare Advantage Plans?
For complete information on Medicare Advantage Plans, visit the Medicare.gov website.
Here you will learn all that you need to know about the various plans and plan structures, as well as how to join a good health care provider.
You will also find the ‘Rules for Medicare health pplans’, which is an excellent resource.
Frequently Asked Questions (FAQs) about Kaiser Permanente Plans
How do I enroll in a Kaiser Permanente health insurance policy?
You can enroll for a Medicare Advantage Plan at several points during the year.
Initial enrollment period
When you turn 65, the initial enrollment period is your first chance to sign up. This period lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after you turn 65.
General enrollment period
You can sign up between January 1st to March 31st each year. This is called the general enrollment period. Your coverage starts July 1st.
Open enrollment period
This period runs from October 15th through December 7th. You can join a plan, switch between original Medicare and Medicare Advantage Plans, or drop a plan.
Medicare Advantage open enrollment period
This period runs from January 1st through March 31st. During this time, you can make one change to your existing Medicare Advantage Plan. These changes include:
Moving to a different Medicare Advantage Plan.
Dropping your Medicare Advantage Plan and staying with original Medicare.
Medicare special enrollment period (SEP)
Special circumstances trigger this enrollment period. For example, a person could have delayed enrollment while applying for extra help, or they may have relocated to another state or moved jobs. In these cases, an SEP is applicable.
Is Kaiser Permanente better than UnitedHealthcare?
Choosing an insurer for your Medicare needs is highly personal and depends on the area in which you live, as well as your age and lifestyle.
Both Kaiser Permanente and Unitedhealthcare offer a wide range of health plans and both are outstanding organizations with excellent ratings.
UnitedHealthcare has the upper hand in some instances as they are available nationwide, offer out-of-network coverage, and provide health care plans for individuals and families that do not qualify for Medicaid or Medicare.
Remember that Kaiser Permanente is the biggest and most popular provider in the eight states in which it operates. While it offers primarily in-network plans, it also owns the hospitals and employs the doctors within that network.
Is Kaiser Permanente a good option for Medicare?
Kaiser Permanente is a great option if you have it available in your area. The company offers consistently high-quality Medicare Advantage Plans with low-cost options.
As long as you are comfortable with a health maintenance organization (HMO) plan, then Kaiser Permanente may be a really good option for you.
What is the best Kaiser Permanente Medicare Advantage Plan?
Choosing the right Medicare Advantage Plan for your needs will depend on your individual health circumstances, your age, and your budget.
Kaiser Permanente offers more than the basic Part A and Part B benefits. These can include:
Prescription drug coverage (mail-order pharmacy included).
Wellness benefits, such as free gym memberships.
Over-the-counter wellness medications.
If you are looking for extra benefits, Kaiser Permanente may be the solution for you.
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