Kaiser Foundation Medicare Advantage Plan Review

Fact Checked
Expert reviewed by: Tammy Burns, insurance and healthcare consultant
Published: 5/7/2021

Tammy Burns Square Headshot
Tammy Burns
Medicare advisor and nursing consultant
Tammy Burns
Medicare advisor and nursing consultant

Tammy Burns is an experienced health insurance advisor specializing in Medicare and senior health issues, including Medicare Advantage Plans and prescription drug plans, as well as ACA certified for health insurance and other ancillary, life and annuity products.

Quick Kaiser Permanente Medicare Advantage plans review: Kaiser Permanente offers Medicare Advantage Plans that emphasize coordinated care, but options are limited to eight states.

Kaiser Permanente started in 1945 as a health care program for local workers in California. After WWII, the company expanded to include public members. Kaiser Permanente has several subsidiaries, all working together to provide affordable, premier health care to its members. The Foundation Health Plan manages the company’s insurance aspect, while the Kaiser Foundation Hospitals and Permanente Medical Groups provide expert medical care. The company works on a coordinated-care model, offering its members hospital, pharmacy, and doctor services, all of which accept Kaiser’s insurance offerings.

The company provides Medicare Advantage Plans in Colorado, California, Hawaii, Washington, Georgia, Virginia, Maryland, Oregon, and Washington D.C. Plan choices will vary by region and counties in some states, but all are HMO.

Pros and Cons of Kaiser Permanente Medicare Advantage Plans

What we like about Kaiser Permanente Medicare Advantage Plans:

  • High-performance ratings and customer reviews
  • Low premiums for the base plan
  • No annual deductible
  • Injectable Part D vaccines

The drawbacks of Kaiser Medicare Advantage Plans:

  • Coverage limited to eight states plus Washington D.C.
  • Only HMO options are available

What Do Kaiser Permanente Medicare Advantage Plans Cover?

Kaiser Permanente Medicare Advantage Plans pay for the same medical benefits as Original Medicare Parts A and B. That means your hospital expenses, doctor’s visits, and outpatient care needs are automatically covered, subject to deductibles, copays, and out-of-pocket limits. Additionally, many of the plan offerings pay for extras like dental, eyewear, routine podiatry, and fitness services, including SilverSneakers memberships.  Unlike Original Medicare, Medicare Advantage Plans are managed by private insurers, like Kaiser Permanente. Part D prescription drug coverage is included in Kaiser’s MA Plans, and the company operates a mail-order pharmacy.

Kaiser Permanente Medicare Advantage Plan Options

Kaiser Permanente offers three levels of its Medicare Advantage HMO Plans — Senior Advantage Core, Senior Advantage Silver, and Senior Advantage Gold. Since these are HMOs, you enjoy cost savings as compared to other more expensive plan types, such as PFFS and PPOs. However, you will need to choose a primary care physician, and you’ll have to stay in-network to receive coverage. Members of an HMO typically must get a referral from their PCP to visit a specialist.

All three of Kaiser’s HMO options have prescription drug coverage, no annual deductible, and telehealth visits are free. The Gold and Silver plans have free primary care doctor office visits, while the lower-tiered plan charges $5 for PCP visits. Monthly premiums range from $0 to $194 depending on your plan, and the out-of-pocket max on the least expensive plan is $4,400.

Compare your Kaiser Permanente Medicare Advantage plan options:

Plan Name Monthly premium Annual deductible Office visits Telehealth Emergency room Annual maximum out-of-pocket cost
Kaiser Permanente Senior Advantage Core (HMO) $0 None $5 primary/$3 5 specialist $0 $90 $4,400
Kaiser Permanente Senior Advantage Silver (HMO) $47 None $0 primary/$25 specialist $0 $90 $3,400
Kaiser Permanente Senior Advantage Gold (HMO) $193 None $0 primary/$15 specialist $0 $80 $3,000

*Based on pricing in Denver, CO

Kaiser Permanente Medicare Advantage Plans Reviews and Ratings

Kaiser Permanente isn’t just a health insurance company; it’s one of the largest managed care organizations in the United States with its own network of hospitals and medical providers. Your plan premiums directly fund the hospitals and medical offices, so there should be no issues with unexpected bills or denial of coverage for care that you receive within its network.

Kaiser has received high rankings from the National Committee for Quality Assurance. Colorado and California plans show a 5.0, and the remaining areas serviced by Kaiser have earned 4.5. Both place the insurer in the Higher Performance category.

Kaiser Permanente, while not accredited, has an A- rating with the Better Business Bureau with 67 complaints closed in the last three years.

Consumer Affairs, a noted review agency, collects and verifies customer experiences for many business enterprises. According to customer satisfaction ratings, Kaiser Permanente earns four out of five stars. Customers felt their premiums were reasonable and bills were reconciled correctly and in a timely fashion.

Learn More From Our Sources