Does Kaiser Accept Medicare? (Plans Offer + More)

How Does Medicare Work With Kaiser Permanente? Do you know if Kaiser Permanente accepts Medicare? Well, you are at the perfect place to find the answer to such a question.

Kaiser Permanente is a health care system which is designed to work together, keeping all of your care teams, insurance, and more in one place. You may be wondering, however, if you can have Medicare if you are a member of Kaiser Permanente.

So, does Kaiser accept Medicare? According to Kaiser Permanente themselves, they are an HMO plan with a Medicare contract. So, yes, you can certainly be a member of Kaiser Permanente and retain your Medicare coverage. In fact, since Kaiser’s Medicare health plans are 5 star plans, you can enroll during their special enrollment period and become a Medicare member outside of the annual enrollment period.

The rest of this article is going to detail what Kaiser Permanente is, whether they accept Medicare, and how to get started with them.

Table of Contents

Does Kaiser accept Medicare?

Kaiser Permanente is not a doctor’s office where you need to use your insurance to pay. Rather, they are an HMO plan, or a Health Maintenance Organization plan.

Essentially, this is an insurance plan which helps to manage your medical care. If you become a member of Kaiser Permanente, you will receive your insurance coverage through them.

However, if you are a Kaiser member, you can still retain Medicare coverage, since Kaiser offers 5-star Medicare plans.

This means that not only can you remain a Medicare member, but you can also enroll outside of the typical annual enrollment period.

What is a Health Maintenance Organization?

An HMO plan is a type of managed care health insurance plan. This is a plan which works to streamline your medical needs, keeping everything in one place and as easily accessible as possible.

A managed care plan allows for lower costs than a private insurance plan, but the trade-off is that you will face a more restricted network of providers.

You will also need to coordinate all your medical care through your primary care doctor, or PCP.

These plans try their best to reduce the cost of care while keeping it at the same quality as other insurance options. They were originally created as lower-cost alternatives to more traditional insurance plans.

What is Medicare?

Medicare is a federal health insurance program for Americans who are 65 years old or older. You may also be eligible for Medicare if you have certain disabilities or other qualifying health conditions.

There are four parts of Medicare: A, B, C, and D.

Parts A and B are what is called Original Medicare. These cover about 80% of hospital expenses and medical expenses. They do not include prescription drug coverage. However, you must have parts A, B, or both before you are able to get part C.
Part C is also known as Medicare Advantage. This is another way to get parts A and B coverage. You can get Part C plans from private providers, such as Kaiser Permanente.
Part D is prescription drug coverage. This can be added to Original Medicare, and it is also available from private providers such as Kaiser Permanente.

When can I enroll in Medicare?

Medicare is generally available to individuals who are 65 years old or older. So, if you are approaching your 65th birthday, it is a good time to start researching Medicare and figuring out how you are going to enroll.

You will have seven months to choose your Medicare plan and get enrolled. This enrollment period begins three months before the month you turn 65, includes the month in which you turn 65 and extends for three months after the month you turn 65.

It is a good idea to learn all that you can about Medicare before getting enrolled. This will ensure that you are well educated and ready to proceed as soon as your enrollment period opens.

If you want to enroll in a Kaiser Permanente Medicare Advantage plan, you can do so once you are approved for Medicare parts A and B.

What if I missed my enrollment period?

If you missed the seven-month window in which you can get enrolled in Medicare, you are not totally out of luck. There are still other times throughout the year when you can get enrolled in Medicare, change your plan, or add other optional benefits.

Aside from your initial seven-month enrollment period, there is also a general annual enrollment period. This is every year from January 1 to March 31. There is also an annual open enrollment period every year between October 15 and December 7.

If you have special circumstances which have made it so you need to enroll or switch your Medicare plan, you may qualify for a special enrollment period.

You may qualify if you have a sudden life change, such as retiring after age 65 or losing insurance coverage through your employer.

Should I enroll in Kaiser Permanente?

The decision of whether to enroll in an HMO plan is a big one. The best thing you can do when deciding if you want to enroll in an HMO plan or stay with a PPO plan is to analyze the pros and cons of each service.

With an HMO plan, you will generally be paying less out of pocket than you would with a PPO plan. There is also the bonus of having your primary care doctor as your advocate to manage your care. However, some downsides are that the HMO plan will require you to stay in-network for care unless it is a medical emergency.

Conclusion

So, does Kaiser Permanente accept Medicare? Well, Kaiser is not a doctor’s office which “accepts” various insurance plans. They are what is known as an HMO, or Health Management Organization plan, with a Medicare contract.

If you choose to become a Kaiser member, then yes, you will be able to retain your Medicare coverage.

You will even be able to enroll in Medicare Advantage plans through Kaiser and can do so outside of the typical enrollment periods since Kaiser’s Medicare Advantage plans are rated 5 stars for 2022.

References

https://thrive.kaiserpermanente.org/thrive-together/health-care-101/hmo-vs-ppo-advantages

https://healthy.kaiserpermanente.org/shop-plans/ready-for-medicare/how-it-works