How Does Medicare Work with Kaiser? 

Kaiser Permanente, often referred to simply as Kaiser, is a managed care group that operates a number of hospitals and medical offices in addition to providing health insurance products. Kaiser was founded in 1945, and today, it operates as three separate and distinct entities: the Kaiser Foundation Health Plan, Inc, Kaiser Foundation Hospitals and Permanente Medical Groups.

Medicare benefits with Kaiser

Kaiser is a provider of Medicare Advantage plans, but Kaiser health plans are only available in select states, including Hawaii, Virginia and Georgia as well as the District of Columbia. This means that Kaiser contracts with the Centers for Medicare & Medicaid Services (CMS) to provide healthcare coverage for those eligible for Medicare. The Medicare insurance program is reserved for qualifying individuals. Some Americans can qualify for Medicare benefits prior to reaching age 65 if they have certain disabilities or health conditions.

Inpatient coverage through Kaiser

Inpatient coverage through a Kaiser Medicare plan will provide at least the same benefits as Medicare Part A. Inpatient coverage will pay for hospital care and care in skilled nursing facilities (SNF). Medicare coverage supplies 60 days of total coverage for hospital care and 20 days of SNF care each benefit period. Once you’ve reached these thresholds, additional days of inpatient coverage are available at a per-day rate or through the use of lifetime reserve days.

Outpatient care through Kaiser

A Kaiser Medicare Advantage plan will also supply Medicare Part B benefits for outpatient care. Part B covers things like doctor visits, surgery and durable medical equipment (DME). Medicare Part B is optional coverage under Original Medicare, but you must opt for Part B coverage in order to join a Kaiser health plan. Medicare Part B requires a monthly premium, and there is a deductible to meet before coverage applies to outpatient care.

Prescription drug coverage through Kaiser

Medicare coverage for prescription drugs is supplied through Medicare Part D. This is optional insurance under Original Medicare, but most Medicare Advantage plans include prescription drug coverage. Benefits vary by plan, and each plan includes a list of covered medications known as a formulary. Costs for prescription drug coverage and copays associated with various drugs listed in a plan’s formulary can also vary.

Additional benefits through Kaiser

Medicare Advantage plans are required to provide at least the same Part A and Part B benefits as Original Medicare, but Kaiser plans can offer access to additional coverage options. In some cases, Kaiser health plans provide access to benefits for services like hearing, dental and vision care. Plans that offer these benefits through Kaiser are known as Advantage Plus plans, and availability of these plans is limited.

In order to know your options, compare plans available in your area. You can also work with an independent Medicare insurance broker who can help you shop plans to help you find the Medicare coverage you need.

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