This plan generally replaces your Medicare coverage. You agree to let Kaiser manage your Medicare benefits. It is an HMO (health maintenance organization) with a closed network of providers.

Plan changes

  • Prescription Drug Part D TrOOP (True Out-Of-Pocket) costs will increase from $4,950 to $5,000
  • Copayments for certain services will change for low-income subsidy-eligible Medicare enrollees

How the plan works

  • You choose a primary care physician (PCP) from Kaiser’s network.
  • The PCP coordinates your care and refers you to specialists.
  • The plan covers the cost of services only when your primary care physician authorizes it.
  • Kaiser provides coverage for services outside of the Kaiser network only in cases of emergency.
  • Kaiser provides behavioral health services.
  • The Centers for Medicare and Medicaid Services must approve the service area for each Medicare plan. If your home zip code is outside of the Kaiser Senior Advantage service area, you will not be eligible to enroll. Eligible zip codes can change throughout the year. Please contact the Retirement Administration Service Center, Kaiser or Medicare.gov if you have a question about the eligibility of a particular zip code.

Best fit for you if:

  • You want lower out-of-pocket costs
  • You like having one doctor manage your care
  • You are comfortable with out-of-network coverage only in emergencies

Plan costs

Retiree plan costs chart »

Typical out-of-pocket costs

  • Office visit/urgent care visit: $20 (preventive care has no charge)
  • Emergency room: $65
  • Hospital stay: $250
  • Prescription drugs: $5 generic; $25 brand name