Kaiser Permanente Health Insurance (Complete Guide)

What is Kaiser Permanente? And what kind of health insurance and Medicare services do they provide?

Kaiser Permanente is a Californian-based healthcare provider that was founded in 1945. It is one of the top Medicare provider companies. In 2020, KP was rated a 5-star company by the Center for Medicare and Medicaid in America.

Kaiser Permanente Medicare services consist of Medicare Advantage Plans and Prescription Drug Coverages. Medicare Advantage plans will cover for original Medicare and other important medical costs left out by original Medicare. Medical advantage plans may also include prescription drug coverages.

All information provided by this guide was gotten from online sources and cross-checked against Kaiser Permanente Medicare coverage plans to be true.

Medicare Overview

Medicare is one of the Social Security Administration programs designed for its beneficiaries’ health insurance. However, the program is not meant for only seniors. People who are not yet 65 years old but have disabilities that qualify them for social security can also qualify for Medicare.

Medicare is divided into four various parts namely;

• Part A
• Part B
• Part C and
• Part D

Every one of these Medicare parts has various health services and costs that they will cover for. Before you enroll for Medicare, it is important that you understand every aspect and how they operate.

Part A Medicare, Hospital Coverage

Part A Medicare is also known as Hospital Coverage because it will cover all inpatient expenses when you are admitted into a hospital or any other medical facility. Part A is also a part of Original Medicare, which is the combination of both Part A and B. Every aspect of original Medicare is covered by the Social Security Administration.

What will Part A Medicare Cover?

Various aspects of inpatient care and services that you can expect Part A Medicare to cover include the following:

• Hospital and rehabilitation center services
• Care from skilled nursing homes
• Hospices care
• Care and service offered to a beneficiary at home

Eligibility for Part A

The criteria to qualify for Part A Under Social Security Administration includes the following:

• You must be at least 65 years old and above and get Social security benefits or any other retirement entitlement like the one from Railroad Retirement Board.
• You must qualify for benefits from the Social Security or Railroad Retirement Board, but you are yet to enroll for them.
• You must have paid for a minimum of 10 years of Medicare taxes, either by yourself or through your spouse.
• You must receive social security disability benefits.
• You have been diagnosed with an end-stage health issue that makes you meet the necessary requirements to qualify for Part A Medicare.

If you do not meet these requirements, you will not have the cost of Part A Medicare covered by the Government. However, you can choose to pay for your own Part A Medicare personally if:

• You are a citizen or a permanent resident in the USA
• You are at least 65 years old but have not worked or paid the needed amount for Medicare taxes
• You suffer from any kind of disability but you are still able to continue working.

Cost for Part A Medicare?

Part A Medicare rarely involves any monthly premium cost. It is fully covered by Social Security and if you will have to pay any premium, the state will cover it.

Anybody that qualifies for Social security or RRB benefits will be enrolled for Medicare automatically. If you are not yet retired, regardless of if you will qualify for Social security benefits after retirement, you will still have to pay for Part A Medicare to enroll.

How To Verify that You Have Part A Medicare

To know if you have Part A Medicare coverage, check for an imprint of the words “HOSPITAL (PART A)” on your Medicare Card.

Part B, Medical Coverage

Just as Part A will cover all costs of inpatient services, Part B will cover the cost of all medical services and that is why it is also known as Medical Coverage.

One of the costs that your Part B Medicare will cover is outpatient services. An example of this is when you pay a visit to the doctor. It does not matter if it is an appointment in a hospital, as long as you are not admitted, it will not count as inpatient costs.

If you do not qualify for Medicare, you will be able to sign up for Part B Medicare as a standalone. However, if you are eligible for Medicare, you will qualify for Part A and B Medicare automatically. Both of them are called Original Medicare, and the government, through the Social Security Administration will cover their costs.

What Costs Will Part B Medicare Cover?

Some of the Medical and outpatient services you can expect your Part B Medicare to cover include the following:

• A visit to the doctor’s office
• A visit to a Health expert or specialist
• Preventative health services like flu shots and mammograms
• Lab examination and test scores like X-rays
• Medical enabling devices and equipment like wheelchairs
• Mental health care services and rehabilitation
• Physical therapies
• Emergency transportation costs like Ambulance and
• Yearly health and wellness visits.

Cost of Part B, Medicare

Part B Medicare will include some monthly premium costs, but this will be paid from a beneficiaries’ social security benefit. The premium benefits will be withdrawn on an annual basis, and it is dependent on the amount of your annual income. High-earning beneficiaries will pay high premiums and low-earning beneficiaries will pay low premiums.

There are also some deductible costs attached to Part, B Medicare.

Eligibility for Part B

Seniors that are 65 years old or more will be eligible for Part B Medicare coverage from the federal government. However, if you are already receiving benefits from either social security or RRB, you will qualify for Part B Medicare automatically.

If you are less than 65 years old and you collect disability benefits from the social security department, or you have end-stage renal diseases, you will also be eligible for Part B Medicare.

If you are eligible for Part A Medicare, then you will also be eligible for Part B Medicare.

How to Verify that You Have Part B Medicare

If you are an eligible Part B Medicare beneficiary, there will be an imprint on your Medicare Card with the words “Medical (PART B)”.

Part C Medicare Advantage

Even though the Original Medicare covered by the federal government is a good health insurance scheme, it is usually not enough to cover all your medical costs.

This is where Kaiser Permanente comes in with more private health coverage plans to help you cater for other medical costs you will incur.

Part C is known as Medicare Advantage. It is a Medicare plan from a private insurer in the USA, and it is approved by the federal government. KP Medicare Advantage Plans will cover for your Part A and Part B original Medicare, and will provide more benefits too.

KP has 2 types of Medicare Advantage Plans, and they are

• Health Maintenance Organization (HMO) plans and
• Medicare Cost Plans

Kaiser Permanente HMO Plans

With these plans, you Original Medicare costs will be covered and you will have special benefits that will cover other medical costs. Here, KP will give a large network of health providers for your care. This network will reduce your out of pocket expenses and every other costs you may accrue. However, the plan does not mean that you cannot visit other providers out of your KP network, but you will have to cover the extra cost for that.

Medicare Cost Plans

KP Medicare cost plan is available in some regions. With these plans, you will be allowed to visit any health provider that is not under KS Medicare. But you will settle for your Part B premium costs, all monthly health costs available, and any other cost that you may accrue from deductibles and coinsurance under your Original Medicare.

What Other Costs Will Kaiser Permanente Part C Cover

Apart from your original Medicare costs, KP Part C will also provide coverage for the following:

• Every urgent and emergency services
• Vision and eyes care and services
• Hearing and ear care and services
• Dental and teeth care and services
• Various health and wellbeing programs
• Part D Medicare also known as Prescription Drug Medicare.

How to Determine the Cost of Your Kaiser Permanente Part C Medicare?

The cost of your Medicare Advantage Plan with KP will the determined by the following:

• If the KP Medicare Advantage Plan you enroll for has a monthly premium cost in addition to your Part B premium cost.
• If the plan will provide coverage for your Part B monthly premium cost
• If you have to pay a fine for your Part D late enrollment.
• If your original Medicare cost already has an annual deductible that your KP Medicare Advantage plan will cover.
• If your Original Medicare already has copayments and coinsurance that your plan will cover.
• Other additional KP services that you want your Medicare Advantage plan to cover.
• If your plan has any restriction on the out-of-pocket costs for you.

Eligibility for Kaiser Permanente Medicare Advantage

Before you can sign up for KP Medicare advantage, ensure the following:

• You already have Part A and Part B Medicare (Original Medicare)
• The KP Medicare Advantage plan you are enrolling for is offered in the state and region you live in.
• You do not have an end-stage renal disease. There may be exceptions for these cases.
• You sign up with KP in a valid period when the company is receiving new Medicare members.

For Kaiser Permanente Medicare Cost Plans, take note of the following:

• You can sign up even if it is only Part B Medicare that you have
• Sign up for any KP Part D plan whenever the company is receiving new Medicare members.
• Sign up for any KP Medicare Advantage plan without Part D benefits at any period of the year.
• Go back to your Original Medicare at any time you want to.

Part D, Drug Prescription Drug Coverage

Part D Medicare is also another coverage that is offered by private insurers in the USA. The coverage is approved by the Center for Medicare and Medicaid Services, and you can sign up with the plan if you have any or both Original Medicare.

What Cost Will Plan D Cover

Kaiser Permanente consists of standalone drug plans. This means that the prescription plan that you choose will strictly cover your medication cost. Each of KP’s Part D plans has a formulary, and this is what you will base your pick on.

The formulary consists of the list of drugs that a plan contains. Every drug in all KP’s Part D plans is approved by the Medicare services in the USA. If the drug you need is not available on any of KP’s formulary, then you may request coverage for that particular drug.

All KP’s Medicare Advantage Plans that include prescription drug coverage will provide you with even more benefits and features than a regular Part D plan.

How To Determine Kaiser Permanente Part D Cost

For any plan under KP that you choose, the cost will be determined by the following:

• Premium cost: This is a monthly cost that you will pay on for your Plan D coverage and it varies for every plan under Part D.
• Deductible: This is an annual cost that you will pay on a prescription drug plan before the plan will begin to offset your drug costs. When you complete your deductible payment, you will only be left with copayments and coinsurance. However not every plan under KP’s Part D will have deductible costs.
• Copayments and Coinsurance: These are the costs you will pay before the prescription drug plan starts covering your medication. The cost for copays and coinsurance are different based on the benefits and features of KP’s Part D plans.

Your Part D plan will also depend on the cost payable at a particular coverage window. They include the following:

• Initial cost: Here you will first pay for coinsurance and copayments before the prescription drug plan settles its once share. KP provides a dollar limit that you can reach at this stage before you will move the coverage stage cost
• Coverage Cost: With these costs, you will have to pay more for your prescription.
• Catastrophic Cost: After moving from coverage cost, you will get a reduced cost share payment. When you pay for this cost, your prescription will be valid for a lifetime.

Some of the benefits you will get from KP’s Part D include the following:

• Reduced deductible costs
• Enhancing the share of your cost
• Providing you with certain drugs that are important to your healthiness.

Kaiser Permanente Generic Drugs

Most of the drugs on a formulary will contain generic drugs, and this refers to drugs required by the Federal and Drug Administration to match their brand name with their health benefits such as:

• Strength drugs
• Quality drugs
• Drug ingredients
• Drug strength
• Safety of the drugs and
• Performance of the drug.

One strategy you can deploy to reduce your Part D cost is by requesting that your provider comes up with a list of generic drugs for your health care. Also, as much as possible, keep checking KP's list for generic drugs and see if any of them is available.

Eligibility for Kaiser Permanente Part D

If you have one of Part A and Part B Medicare or both of them, you will be able to sign up for KP prescription drug plans. As a new beneficiary, if you do not sign up for the plan during the Initial Enrollment Period, then you will have to pay a penalty.

How to Enroll for Kaiser Permanente Part D Medicare

You can get KP Medicare in 2 ways, either by signing up for a Part C plan that covers prescription drugs or any of the Part D prescription drug plans.

Some of the things you should know before enrolling for Kaiser Permanente Medicare include the following:

• If you do not have a Part D plan, you will only be able to sign up at the special enrollment windows in a year. If you already have a Part D plan, you can change to another plan or stop the plan during these enrollment periods too.
• It is impossible for you to have more than one Part D plan
• If you already have a Medicare Advantage plan that covers your prescription drug. Enrolling for another standalone KP Part D plan will make you completely lose the Medicare Advantage plan.

Why You Should Choose Kaiser Permanente Medicare Health Plan.

Kaiser Permanente is one of the private insurers that produces top-quality care for seniors and Medicare beneficiaries. Their various Medicare plans will cover some important health costs left out by original Medicare. Kaiser Permanente will provide you with predictable costs and the most suitable health provider. The Medicare plans are tailored in such a way that everyone will get one that will help meet their health care and attain their goals.

Most KP Medicare advantage plans cover every aspect of Medicare including original Medicare and Prescription drug coverage. This means that with just one plan from KP, you can get coverage for all aspects of and Medicare parts.

Some of the special features and benefits you can get from KP include the following:

Various Services at a go

You can get a lot of services in KP facilities nationwide. Some of these services include visiting a health provider or doctor, getting your lab examinations and X-rays, and getting your drug medication in one visit to the facility. A wide network of health specialists and hospitals that you can choose from.

Care Around the World

Kaiser Permanente has plans that will provide health coverage for you anywhere you go, so even if you are traveling out of your coverage area, you can get emergency services nationwide and worldwide.

Telecare

In case of health conditions that do not require you to physically see a doctor or health care provider, KP plans will provide you with phone care. You can do this by just scheduling an appointment with your health provider. Telecare is accessible 24/7 and without restriction.

Reliable Coverage for Top-Notch Care

Kaiser Permanente will provide you with consistent coverage costs for your monthly premiums, deductibles, coinsurance, and copayments. All these will not attract any other extra cost for preventative care services such as flu and cholesterol shots, annual checkups, prostate diagnosis, mammograms, etc.

Large Network of Provider

Kaiser Permanente has a large network of doctors, specialists, skilled nurses, and pharmacies to keep you in the healthiest state possible.

KP care provider network is well connected to members of KP Medicare plans via an online-based health record system. The providers are kept abreast with your health issues and they know the details about the care you need. They know when it is time for you to get a diagnosis and what type of drug you are using. This will make sure that you get the best care available for you.

Online Healthcare

If you do not need to physically be in a hospital, then KP plans will ensure that you get everything you want out of an online service. With this service, you will be able to send mails to your provider and doctor, access your diagnosis and examinations online, get a refill for your drug prescription when the time is right. All these are made possible with a KP mobile app that you can download on Android and iOS devices. The app comes at a zero cost and will help you easily manage your health whenever you like.

Get Care Around You

Kaiser Permanente has various plans accessible in various regions of the country and you can check their website to find a KP emergency health center where you live.

Choosing a Kaiser Permanente Health Provider

Every health provider under the KP network will accept any plan you have with the company. You have the option of choosing a KP doctor from the onset and changing your existing provider to one that is within the KP network.

All the health providers under the KP network have their profiles accessible online and you can check to see if a provider will be suitable for you based on the detail of his or her profile. Some of what you should look for in the profile before selecting a healthcare provider are their education level, the language they speak, the aspect of health they specialize in, etc.

If you choose a provider and do not like the person in the long run, you can easily change to another KP provider anytime you want, with no cost attached.

Quality Care

Kaiser Permanente does not only focus on preventive health care. They will also help you if you fall sick or require any urgent care. Your health provider will be able to refer you to specialists such as Audiologists and cardiologists.

Doctors and health providers under the KP network are well trained, renowned, and experienced with medical situations. Above all, they are most concerned about providing you with the important health care you require.

Prescription Drug Benefits

Most KP Medicare advantage plans will cover your drug prescription which is one of the most common Medicare costs.

What Prescription Drug Benefits Will Cover?

Every KP plan with drug coverage will come with a list of approved drugs to make sure that you are getting a safe drug that is approved by the Center for Medicare and Medicaid Services.

KP has a team of experts whose job is to select these drugs carefully and help with the management of cost that you will accrue from purchasing drugs on your own.

All KP Part D plans come with drugs that are categorized into 6 tiers based on if they are a generic or branded drug, if they are vaccines or if they are injectable. Your medication tier will have a long way in determining the cost of your drugs.

However, you should know that your KP drug prescription plan will not cover up the following costs:

• Nonprescription drugs
• Medications that are purchased over the counter
• Medications for weight loss ‘
• Medications to solve the issue of erectile or any sexual dysfunction
• Any other drug that is not covered by Medicare.

How to Make Order for Your Prescription with Kaiser Permanente?

If You are a member of any KP Medicare plan that will cover your drug costs, you can order refills or do a review of the list of drugs available to you. With KP mobile app, you can order for your prescription and choose from either two options, either picking up your drug at a pharmacy close to you that is under the KP network. The second option is getting your prescription or drug refill by mail. However, mail orders will attract more charges, but you will be able to track the order online.

With mail-order, your drug will be delivered to you at home, and with just 2 copayments costs, you can get as much as 3 months’ drug supply when you choose a pharmacy mail order.

Managing Your Drug Prescription Online

It is easy to manage your drug prescription without leaving your home. KP equips its member website with the necessary information and details you will need like prescriptions, drug history, price details, and choosing a provider from the large network available.

Some of Kaiser Permanente Additional Coverage

As a member of KP Medicare plans, some of the additional health coverages, features, and benefits that you will enjoy include the following:

Optional Supplements Benefits

Various plans offer you the choice of adding more benefits such as vision, dental, and hearing care. The possibility to choose the healthcare benefits you can add to your KP Medicare plan will make you fully in charge of your wellbeing. However, not all KP Plans permit supplemental benefits.

Dental Care

Dental care is one of the most important aspects of healthiness, and this is not covered by your original Medicare. But KP Medicare Advantage plans offer dental care via Delta Dental, one of the most renowned Dental health companies in the country.

Some of the coverage that KP’s dental care will cover includes the following:

• Allow you to select from wide network coverage of dental services provided by KP. However, KP will not provide coverage for any dental care that is not from a provider within its network.
• Cover the full cost for biannual dental checkups and examinations.
• Ensure that your dental issues are detected as early as possible.

You can sign up for KP dental coverage with any of its Medicare Advantage plans, but this will only be possible when it is time for annual enrollment. If you want to withdraw from dental coverage in a Medicare plan, you can do so anytime.

Hearing Care Benefits

Hearing care benefits covered by some KP Medicare advantage plans will allow you to get free hearing examinations. Most plans will also have a hearing aid feature if need be.

Vision Care Benefits

These benefits will come with an allowance for eyes examination, and provide you with contact lenses and eyeglasses if you need them.

Fitness Care

Some KP Medicare advantage plans come with a membership to a fitness program that will give you access to many facilities that are within the KP network available nationwide. Fitness and wellbeing programs will ensure that you remain active at all times, and this comes with no extra cost. There is also a home fitness program for you if you would love to work out from your home.

There are healthcare and wellbeing classes, coaching, and other similar webinars that will provide you with tips and other necessary information you need to remain healthy at all times. KP will also provide you with accessible resources to live a healthier and smarter life. For those that suffer from chronic health issues like diabetes, heart diseases, etc., KP will help you with necessary resources to manage your health. All these come at no cost.

Kaiser Permanente Network Coverage Locations

States in the USA where you can access services and providers within KP’s network such as pharmacies, doctor’s offices, laboratories, etc., includes the following:

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