Kaiser Permanente Medicare Review

Pros Explained

• Top-ranked for customer satisfaction by J.D. Power: Kaiser took the top spot in the 2022 J.D. Power U.S. Medicare Advantage Study, beating the runner up (Humana) by 20 points. This is one of many reasons we consider it one of the best Medicare Advantage plans in 2023.
• Highest Medicare star rating: All Kaiser Medicare Advantage plans have a 5-star Medicare star rating from the Centers for Medicare and Medicaid Services (CMS). This is the highest possible rating and beats all other major providers in the industry.
• Higher average NCQA rating than all companies reviewed: The National Committee for Quality Assurance (NCQA) rates Medicare plans on a five-star scale based on their combined HEDIS and CAHPS scores and NCQA accreditation status. Kaiser’s plans average 4.75 stars, outperforming all other plan providers.
• Very low drug deductibles: Kaiser’s average drug deductible for 2023 is $5.60, making it the lowest (by far) of all major MA providers. Many Kaiser plans have a $0 drug deductible.

Cons Explained

• Limited geographic availability: Kaiser operates in eight states and the District of Columbia. Though it has a strong presence regionally in California, Colorado, the Pacific Northwest, and the Mid-Atlantic, Kaiser is not available in most of the country.
• HMOs are the only available plan type: Kaiser only offers MA plans in the HMO variety. If you want more flexibility with a PPO or other plan type, you’ll need to go elsewhere. If you’re looking for a standalone Part D prescription drug plan or a Medicare Supplement (Medigap) plan, Kaiser does not have options for you. 
• Relatively high premiums: In comparison to other companies we researched, Kaiser’s premiums are the highest at $42.46 per month, on average. And while the ultra-low drug deductibles help, out-of-pocket maximums are about average and increased in 2023. 

Third-Party Ratings

Kaiser Permanente’s Medicare Advantage plans rank very highly for customer satisfaction and quality. Both the CMS and NCQA confer their highest star ratings on Kaiser’s MA plans, and the company took the top spot in the 2022 J.D. Power Medicare Advantage Study.

• Kaiser’s plans have earned the highest possible Medicare star rating—5 stars—from the CMS (published at medicare.gov). No other company offers plans that are as highly rated. 
• Kaiser’s plans have the highest rating among the companies included in the 2022 J.D. Power U.S. Medicare Advantage Study. They earned a score of 844, well above the industry average of 806. 

Kaiser has eight plans that were rated by the National Committee for Quality Assurance (NCQA) in 2022. Kaiser’s plans ranged from 4.5 to 5 out of 5, with four of the eight plans earning the top score.

Policies Available

Unlike most other Medicare providers, Kaiser only offers Medicare Advantage plans. It does not offer standalone Part D prescription drug plans or Medicare Supplement (Medigap) insurance. 

Medicare Advantage HMO Plans

Medicare Advantage covers Part A and Part B Medicare benefits, and most plans provide Part D prescription drug coverage as well. Kaiser is known for its HMO plans which leverage Kaiser’s own healthcare facilities and employed healthcare providers to provide Medicare benefits. 

Kaiser MA plans also offer a host of additional perks that Original Medicare does not, such as coverage for vision and hearing care. However, Kaiser is the only plan provider we reviewed that doesn’t offer non-emergency transportation benefits with some of its plans. Another important consideration when looking at MA plans is drug coverage, especially in the Medicare coverage gap or donut hole. For 2023, 71% of Kaiser’s MA plans with drug coverage offer additional drug coverage in the Medicare gap. 

Dual-Eligible Special Needs Plans (D-SNP)

Kaiser offers Dual-Eligible Special Needs Plans (D-SNP) for members who qualify for both Medicare and Medicaid. These plans have no monthly premiums and low or no copayments for doctor visits and hospitalizations. They also include Part D prescription drug coverage with low copayments and extra coverage for dental, vision, and hearing services.

Cost

Overall, Kaiser offers average value—there are more expensive MA plans, but there are also much cheaper ones. Health plan costs include premiums, deductibles, copayments, and coinsurance. Rates vary by plan and geography. But unlike Original Medicare, MA plans have an out-of-pocket maximum, which is the most you have to pay per year for covered healthcare services.

Kaiser’s Medicare Advantage 2023 price ranges include:

• Average monthly premiums are $42.46. These are the highest premiums among the companies we researched. 
• On the other hand, Kaiser’s average drug deductible is far lower than those for other providers—just $5.60. Some other providers charge nearly $200, on average, for drug deductibles.
• In terms of out-of-pocket maximums, Kaiser offers fairly average value. The average out-of-pocket maximum in 2023 is $5,088.01. 

Customer Service

You can speak with a Kaiser Permanente Medicare specialist from 8 a.m. to 8 p.m. seven days a week, by calling 1-855-832-0353. Medicare members can call 1-888-777-5536 during the same days and hours.

Kaiser also offers live chat, available Monday to Friday 8 a.m. to 5 p.m., except on major holidays, available from the company’s support page.

If you have a non-urgent question or comment for Kaiser, and can wait up to 3 business days for a response, you can email the company after logging in to your Kaiser account on their website.

Methodology 

Literature Review

We identified top companies by market share within the industry offering Medicare plans from various business and market insight databases including Statistia, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans. 

Data Collection and Verification

Our data was collected from third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicare and Medicaid Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s plan types. Factors considered for companies offering Medicare plans were: 

• Plan quality and customer satisfaction: CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment. 
• Cost to value: This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
• Additional coverage offered in the Medicare gap: The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
• State availability: This measure indicates how widely available plans are across the U.S.
• Additional plan benefits: This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth. 
• Types of plans available: Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
• Special needs plans: This is a measure of whether the company offers plans designed for those with specific diseases.
• Financial strength: This measure accounts for each company’s AM Best financial strength rating to understand how well it’s positioned to pay insurance claims. 

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