This is a Medicare Advantage plan, which means that it 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. 

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.

See updated information about coverage for COVID tests.

Changes for 2024

  • Prescription Drug Part D TrOOP (true out-of-pocket) maximums will increase from $7,400 to $8,000 for 2024.
  • A provision of the Inflation Reduction Act (IRA) will enhance coverage such that Medicare participants who reach the TrOOP, or catastrophic coverage phase, will no longer be responsible for any Part D out-of-pocket drug costs.
  • Copayments for certain services will increase slightly for low-income subsidy-eligible Medicare enrollees.
  • The Post-discharge Meal Delivery Program for members with a principal diagnosis of congestive heart failure will be discontinued.

How the plan works

  • You choose a primary care physician (PCP) from Kaiser’s network, who coordinates your care and refers you to specialists. Your costs will only be covered for services authorized by your primary care physician.
  • The plan 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 if you have a question about the eligibility of a particular zip code.
  • 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. 

Best fit for you if:

  • You and the family members you cover live in California
  • 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

Learn more

If you will be Medicare-eligible in 2024 and would like to learn more about Kaiser Senior Advantage, register for a virtual information session.

2024 plan costs

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

Moving outside California?

UC offers a Medicare Coordinator Program (administered by Via Benefits) to retirees and to families whose members are all eligible for or enrolled in Medicare and live in a state outside California.