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Kaiser Permanente Senior Advantage

A Kaiser Permanente – California plan

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.

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. Attend a Kaiser webinar about how this plan works.

Changes for 2025:

  • The copay for office visits will change from $20 to $30.
  • The copay for group mental health visits is increasing from $10 to $15. 
  • Prescription drug copays will increase by $5 for a 30-day supply across all tiers.
  • Inflation Reduction Act provisions for 2025 will cap the out-of-pocket prescription drug cost limit at $2,000 for Medicare Part D members, eliminate the coverage gap phase (or the “donut hole”), and introduce an option to pay for prescription costs in monthly installments. 
  • Kaiser Senior Advantage members will have access to fitness benefits through One Pass.
  • Full Full eligibility not available
  • Mid Mid eligibility not available
  • Core Core eligibility not available
  • Retirees Retirees eligibility not available
On this page:

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 PDF, 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.
  • 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 the 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 Kaiser’s integrated care model in which your care across the Kaiser system is coordinated by your Primary Care Provider.
  • You are comfortable with out-of-network coverage only for urgent care and emergencies

Understanding your costs

Kaiser Permanente Senior Advantage has no deductible and the out-of-pocket maximum is $1,500.

Typical out-of-pocket costs:

  • Office visits/Urgent care: $20
  • Emergency room visits: $65
  • Hospital stay: $250
  • Prescription drugs: $5, generic; $25, brand name
Monthly premium costs for 2025 Monthly premium costs for retirees for 2024

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.

Retirees

Plan contacts

Plan documents (links to Kaiser website)

More information