Kaiser Permanente Medicare Advantage 2021 Review

Kaiser Permanente is the fifth-largest supplier of Medicare Benefit plans [1], and the insurer scores greater than all different main Medicare Benefit suppliers by way of Medicare star scores and member satisfaction.

It’s additionally the most important not-for-profit well being upkeep group within the U.S. Kaiser makes use of an built-in care mannequin, which implies that members can get all their care in a single place and all of the suppliers are related.

Though Kaiser will get high marks, its plans are solely out there in eight states and Washington, D.C., and the corporate solely presents HMO plans. Right here’s what you need to find out about Kaiser Permanente Medicare Benefit.

Kaiser Permanente’s choices have benefits and downsides.

• Members are joyful: Kaiser Permanente earned 846 factors out of 1,000 in J.D. Energy’s newest U.S. Medicare Benefit research, netting it the highest spot for buyer satisfaction out of 9 suppliers measured.

• Prime scores general: Solely seven Medicare well being plans acquired a 5 out of 5 ranking from the Nationwide Committee for High quality Assurance in 2021, and 4 of them are Kaiser Permanente plans. Kaiser’s 2021 plans additionally acquired excessive Medicare star scores.

• Prescription advantages: Most of Kaiser’s MA plans embrace drug protection.

• Restricted availability: Kaiser Permanente plans are solely out there in eight states and Washington, D.C., so the vast majority of U.S. adults can’t entry them. (Kaiser sells plans in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state.)

• Restricted plan sorts: Kaiser solely presents HMO plans, so members should work inside Kaiser’s community of medical suppliers.

Kaiser Permanente presents solely HMO Medicare Benefit plans. Many plans supply dental, imaginative and prescient and listening to advantages, and worldwide emergency care. Kaiser does not supply any stand-alone Medicare prescription drug plans.

Plan availability could fluctuate by county. Plan choices could embrace the next sorts:

Kaiser Permanente Medicare Benefit presents many members entry to routine imaginative and prescient, dental and listening to protection. Some plans supply different advantages as properly. Listed here are just a few standouts, though their availability varies by plan:

• Over-the-counter allowance: Some plans embrace an OTC profit that lets you buy sure objects, like nutritional vitamins and chilly drugs, at no further value by putting an order over the telephone or from Kaiser’s on-line catalog. The allowance quantity varies by plan and resets every quarter.

• Dwelling-delivered meals: Some plans embrace the choice to have meals delivered to your own home after you’ve been discharged from the hospital on account of congestive coronary heart failure.

• Silver&Match Wholesome Getting old and Train Program: Some plans embrace entry to native collaborating health facilities together with house health instruments.

• Benefit Plus: For an extra month-to-month premium, members can entry extra advantages equivalent to an eyewear allowance, listening to support allowance and complete dental advantages if the plan doesn’t already cowl them.

Kaiser Permanente Medicare Benefit members can contact their plan’s customer support in just a few methods:

• Name a customer support consultant. The telephone quantity and hours of obtainable assist will depend upon location.

• Chat with a member providers consultant, Monday to Friday from 8 a.m. to five p.m. of their time zone, besides on main holidays.

• Ship an e mail with nonurgent questions or feedback.

Kaiser Permanente presents Medicare Benefit plans in eight states and Washington, D.C., together with 109 counties [2].

General, Kaiser Permanente is the second-largest well being insurer within the nation [3], and it’s the largest by way of nonprofit well being plans [4]. Some 1.7 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Benefit plans, and the corporate added 59,000 new members for the 2021 plan 12 months.

Prices for Medicare Benefit plans will rely in your plan, your geographic location and your well being wants. One of many prices to think about is the plan’s premium, and a couple of quarter (26%) of Kaiser Permanente’s Medicare Benefit plans are $0-premium plans in 2021 [5].

For Medicare Benefit plans with a premium, the month-to-month consolidated premium (together with Half C and Half D) ranges from $10 to $295. For Twin-Eligible Particular Wants Plans, or SNPs, month-to-month premiums vary from $25.40 to $30.50 [6].

At the same time as a Medicare Benefit person, you’ll nonetheless be chargeable for paying your Medicare Half B premium, which is $148.50 in 2021. Nevertheless, some plans cowl half or all of this value.

Different out-of-pocket prices to think about embrace:

• Whether or not the plan covers any a part of your month-to-month Medicare Half B premium.

• The plan’s yearly deductibles and some other deductibles, equivalent to a drug deductible.

• Copayments and/or coinsurance for every go to or service. For example, there could also be a $10 copay for seeing your main physician and a $45 copay for seeing a specialist.

• The plan’s in-network and out-of-network out-of-pocket maximums.

• Whether or not your medical suppliers are in-network or out-of-network, or how typically chances are you’ll exit of community for care.

• Whether or not you require further advantages, and if the plan prices for them.

To get a way of prices, use Medicare’s Plan Finder to check info amongst out there plans in your space. You possibly can choose by insurance coverage provider to see solely Kaiser Permanente plans, or evaluate throughout carriers. It’s also possible to store straight from Kaiser Permanente’s web site by coming into your ZIP code.

If you need Medicare’s tackle Kaiser Permanente’s plans, look no additional than the Facilities for Medicare & Medicaid Providers’ personal star scores, which rank every plan from finest (5 stars) to worst (1 star). The company bases these scores on plans’ high quality of care and measurements of buyer satisfaction, and scores could change from 12 months to 12 months.

Primarily based on the newest 12 months of knowledge, Kaiser Permanente’s Medicare Benefit (Half C) plans get a mean ranking of 4.8, and the corporate’s prescription drug plans (Half D) get a mean rating of 4.9 [7]. The typical star ranking for plans from all suppliers was 4.06 [8]. In follow, all of Kaiser Permanente’s contracts rating 5 stars apart from one contract — the Kaiser Basis Well being Plan of Washington — which will get 4.5 stars.

That implies that of the Kaiser Permanente members who’re in contracts with a Medicare star ranking, 100% are in contracts rated 4.0 or above in 2021.

There are just a few firms that weigh in on well being plans or on the energy of the corporate in query, and we’ve included three right here:

See how Medicare Benefit opponents stack as much as Kaiser Permanente.

Kaiser Permanente, headquartered in Oakland, California, was based in 1945 and serves 12.5 million individuals throughout eight states and Washington, D.C. The corporate is made up of Kaiser Basis Well being Plan, Kaiser Basis Hospitals and its subsidiaries, and the Permanente Medical Teams.

Kaiser Permanente presents insurance coverage for people and households, employer group plans, Medicaid/Medi-Cal and Medicare Benefit. In 2020, Kaiser posted annual working income of $88.7 billion.

• What are the plan’s prices? Do you perceive what the plan’s premium, deductibles, copays and/or coinsurance will likely be? Are you able to afford them?

• Is your physician in-network? When you’ve got a most well-liked medical supplier or suppliers, be sure that they take part within the plan’s community.

• Are your prescriptions coated? In case you’re on medicine, it’s essential to grasp how the plan covers it. What tier are your prescribed drugs on, and are there any protection guidelines that apply to them?

• Is there dental protection? Does the plan supply routine protection for imaginative and prescient, dental and listening to wants?

• Are there extras? Does the plan supply any further advantages, equivalent to health memberships, transportation advantages or meal supply?

When you’ve got extra questions on Medicare, go to Medicare.gov or name 800-MEDICARE (800-633-4227, TTY 877-486-2048).