Kaiser HMO

A Kaiser Permanente – California plan

Kaiser is an HMO (Health Maintenance Organization) with a closed network of providers.

Changes for 2025:

Doula services are covered with no copay, for up to 11 visits per pregnancy.
The Kaiser HMO network has expanded into Monterey County.
Cost-sharing increases
- Office visit and urgent care copays have increased from $20 to $30 and Kaiser group mental health visits have increased from $10 to $15.
- Prescription drug copays have increased by $5 for a 30-day supply on existing tiers, and there is a new specialty drug tier with 30% coinsurance, up to $150 per prescription.
- Optum, which offers behavioral health coverage for Kaiser members (in addition to Kaiser’s coverage), has increased its emergency room copay to $125 to align with Kaiser’s current copay.

Full Full eligibility available
Mid Mid eligibility available
Core Core eligibility available
Retirees Retirees eligibility available

On this page:

How the plan works
Best fit for you?
Understanding your costs
Enrolling in Medicare

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 network only in cases of emergency and urgently needed services.
Behavioral health benefits are provided by Kaiser and Optum.
See updated information about coverage for COVID tests.
You’re covered for emergency and urgent care anywhere in the world if you get hurt or sick while traveling. Visit Care While Traveling on the Kaiser Permanente website or call the Away from Home Travel Line at 951-268-3900.

Monthly premium costs for faculty/staff

Pay Band (full-time salary rate)	Self	Self + Child(ren)	Self + Adult	Family
$71,000 and under	$39.77	$71.51	$120.26	$149.16
$71,001–$140,000	$92.31	$165.97	$285.74	$352.33
$140,001–$210,000	$148.97	$267.84	$442.16	$551.37
$210,001 and above	$205.85	$370.11	$598.70	$750.73

Monthly premium costs for retirees

Typical out-of-pocket costs

Kaiser HMO offers coverage within the Kaiser network only, with no deductible. The annual out-of-pocket maximum is $1,500 for individual coverage and $3,000 for coverage of a family of two or more.

Office visits/Urgent care: $30
Emergency room visits: $125
Hospital stay: $250
Prescription drugs:
- Generic: $10
- Brand name: $30
- Non-formulary: $50
- Specialty: 30% up to $150 maximum per prescription

Enrolling in Medicare

Kaiser Permanente Senior Advantage is considered the “partner plan” of Kaiser HMO. That means that if you are a retiree enrolled in Kaiser HMO, you’ll be transferred into Kaiser Permanente Senior Advantage when you turn 65, once Medicare has approved your enrollment form.

If you will be Medicare-eligible in 2025 and would like to learn more about Kaiser Senior Advantage, register for a virtual information session.

Plan documents (2025)

Plan contacts

Kaiser website
Kaiser (English): 800-464-4000
Kaiser (español): 800-788-0616
Kaiser (Chinese dialects): 800-757-7585
Kaiser (prospective members): 800-324-9208
Optum: 888-440-8225

Kaiser HMO

How the plan works

Best fit for you if:

Understanding your costs

Enrolling in Medicare

Plan documents (2025)

Plan contacts

More information