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Kaiser HMO for retirees
Kaiser HMO for retirees
A Kaiser Permanente – California plan
Kaiser is an HMO (Health Maintenance Organization) with a closed network of providers.
Changes for 2025:
- Doula services will be covered with no copay, for up to 11 visits per pregnancy.
- The Kaiser HMO network will expand into Monterey County.
- Cost-sharing increases
- Office visit and urgent care copays will increase from $20 to $30 and Kaiser group mental health visits are increasing from $10 to $15.
- Prescription drug copays will increase by $5 for a 30-day supply on existing tiers, and there will be 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), is increasing 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
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.
Best fit for you if:
- You and the family members you cover live in California
- You want low monthly premiums
- You want low, predictable out-of-pocket costs
- You like having one doctor manage your care
- You are happy with the selection of providers within the Kaiser system
Understanding your costs
When choosing a plan, make sure to consider all your costs — including your monthly premiums and what you can expect to pay out-of-pocket for care. For employees, ALEX will ask you a few questions to help you estimate how much you may need to spend.
| 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 |
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 2024 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