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 $6,350 to $6,550.
  • Copayments for certain services will increase slightly for low-income subsidy-eligible Medicare enrollees.
  • A meal benefit (2 meals a day for 4 weeks) has been added for patients discharged from the hospital with a primary diagnosis of congestive heart failure. This benefit is available once in a calendar year.
  • Outpatient prescription drugs with an over-the-counter equivalent will be excluded from coverage. This change will be applied in phases throughout 2021. This exclusion does not apply to insulin, preventive drugs (such as tobacco cessation), or to an entire class of drugs when one drug within the class becomes available over-the-counter.

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 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

If you are a prospective member and you’d like to speak to a Kaiser representative, call 800-443-0815 and reference UC Group Number: 102624, Enrollment Unit 10.

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