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Nonprofit Kaiser Permanente is considered a pioneer and national leader in managed care. It has the most five-star Medicare Advantage plans of any carrier and scores high on other quality measures as well. These exceptionally high-quality plans include low-cost options in eight states and the District of Columbia, making many Kaiser plans an excellent value. Though you can only get an HMO or a Special Needs Plan (if you qualify), the quality of available plans makes up for the lack of choice or flexibility.
- Pros & Cons
- Key Takeaways
- Company Overview
Top-rated Medicare Advantage plans
Integrated with Kaiser’s own healthcare providers and facilities
Limited geographic availability
Limited plan type options
- High-quality, nonprofit health plan with the most five-star Medicare plans than any other carrier
- Low-cost Medicare Advantage HMO options
- Long history in managed care, founded as a prepaid health plan
- Known for its integrated model, offering seamless care and coverage
Kaiser Permanente was founded in 1945 based on a novel approach to providing construction and shipyard workers access to healthcare services and coverage. Based in Oakland, California, Kaiser Permanente is the entity formed out of the collaboration between the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups. The organization operates 39 hospitals and employs more than 24,000 physicians. The nonprofit health plan now serves 12.4 million members in employer, individual, Medicaid, and Medicare plans. It’s one of the largest Medicare Advantage plans in Washington, D.C., and six of the states in which it operates.
Kaiser operates in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C.
- Year Founded 1945
- Kinds of Plans Medicare Advantage HMO and Dual-eligible Special Needs Plans
- Number of Plans 2
- Payment Options Online, telephone; mail; automatic credit or debit card payments; or automatic withdrawals from a bank account, Social Security or Railroad Retirement Board benefits
- Customer Service Telephone, email, live chat, webinar, local agent
- Phone Number Prospective Members: 866-973-4584; Current Members: 866-973-4588
- Official Website www.medicare.kaiserpermanente.org
- Top-rated Medicare Advantage plans: Kaiser plans consistently have a high-performing rating on CMS Star Ratings. You can be sure you’re getting a high-quality health plan when you sign up for Kaiser.
- Low-cost plans: Most Kaiser Medicare Advantage plans have no deductible, and many have monthly premiums less than $50 for 2022.
- Integrated with Kaiser’s own healthcare providers and facilities: Kaiser Permanente operates 39 hospitals and more than 700 medical offices. Kaiser health plan members get most of their healthcare from Kaiser’s network of providers.
- 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.
- Limited plan type options: Kaiser offers only Medicare Advantage HMOs, and Dual-Eligible Special Needs Plans. If you’re looking for a standalone prescription drug plan or a Medicare Supplement (Medigap) Insurance plan, Kaiser does not have options for you.
Medicare Advantage Plans
Kaiser is known for its HMO plans which leverage its own healthcare facilities and employed healthcare providers. For Medicare Advantage members, Kaiser offers plans with and without prescription drug coverage. In 2021, Kaiser offered 264 HMO plans with prescription drug coverage and 36 plans without.
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.
Kaiser offers Advantage Plus, which is optional dental, hearing, and extra vision coverage that members can add to their Medicare Advantage coverage.
Kaiser members can add dental, hearing, and extra vision coverage that their Medicare Advantage plans may not include.
Most Medicare plans offer extra benefits such as dental, vision, hearing, fitness, and other benefits. Though extras are available, Kaiser deemphasizes extra benefits and focuses on offering lower-cost, high-quality plans.
Prospective members can call 1-855-832-0353 between 8 a.m. and 8 p.m., seven days a week.
Current members can call 1-855-832-0353 or the specific Member Services number for their state or region between 8 a.m. and 8 p.m. local time, seven days a week.
Georgia: 404-233-3700 or 800-232-4404 (toll free)
Maryland, Virginia, and Washington, D.C.: 888-777-5536
Washington (Vancouver/Longview area): 877-221-8221
Washington (Outside Vancouver/Longview area): 206-630-4600 or 888-901-4600 (toll free)
The Kaiser Permanente Insurance Company received three complaints in 2020 for a complaint index of 0.74 with the National Association of Insurance Commissioners. It received eight complaints in 2019 and one in 2018, for complaint indexes of 1.28 and 0.16, respectively.
The NAIC evaluates insurers of all types based on the number of complaints. The NAIC complaint index reflects the ratio of complaints to market share. A complaint index greater than 1.0 suggests the company received more complaints than expected based on its size, and less than 1.0 indicates the company has received disproportionately fewer complaints than expected.
AM Best is the credit rating agency that assesses insurance companies’ financial strength but it does not rate Kaiser Permanente or any of the Kaiser Foundation Health Plans.
Kaiser Permanente has eight plans rated by the National Committee for Quality Assurance (NCQA) in 2021. Kaiser’s plans ranged from 4.5 to 5 out of 5, with three of the eight plans earning the top score.
Kaiser scored 846 points out of 1,000 in J.D. Power’s 2021 U.S. Medicare Advantage Study. The study measures member satisfaction with coverage and benefits, healthcare provider options, customer service, communications, and billing. Kaiser beat out all of the other plans including Humana, UnitedHealthcare, Aetna, and other major national Medicare plans.
Medicare Star Ratings
Kaiser’s plans are highly rated by the Centers for Medicare and Medicaid Services (CMS), which rates Medicare Advantage plans on a five-point star rating system. Of seven Kaiser plans rated by CMS in the 2022 star ratings, six earned a perfect 5 stars. These ratings reflect how well members rate the health plan on measures such as customer service experience and the experience of accessing needed healthcare services.
Kaiser plans are among the highest-rated plans in the nation, with the most 5-star plans of any carrier.
Health plan costs include premiums, deductibles, copayments, and other cost-sharing elements. Rates vary by plan and geography. Kaiser’s Medicare Advantage 2022 price ranges include:
HMO plans with prescription drug coverage:
- Monthly premiums range from $0 to $295, averaging $60.31; 30% of these plans have no monthly premium.
- Deductibles range from $0 to $445, averaging $17.69; most (84%) of these plans have no deductible.
- Annual out-of-pocket maximums for in-network services range from $2,900 to $7,550, averaging $5,283.
HMO plans without prescription drug coverage:
- Monthly premiums range from $10 to $40, averaging $20.
- There are no deductibles for Kaiser plans without prescription drug coverage.
- Annual out-of-pocket maximums for in-network services range from $4,200 to $6,900, averaging $6,000.
Competition: Kaiser Permanente vs. UnitedHealthcare
In every state where Kaiser is one of the biggest Medicare Advantage players, UnitedHealthcare is also one of the biggest plans. Though UnitedHealthcare is bigger overall and available in more places, on a head-to-head basis, Kaiser offers significantly higher-rated plans. Costs vary by plan and location, but on average, UnitedHealthcare plans have lower monthly premiums while Kaiser plans have lower deductibles. UnitedHealthcare focuses more on extra benefits, but for the most essential value of a health plan—the quality of coverage and providers—Kaiser comes out on top.
|Number of States Available||8||47|
|Customer Service Options||Telephone, online, in person, chat||Telephone, online, in person, chat|
|AM Best Rating||Not rated||A- (Excellent)|
|Average CMS Star Rating||4.93||3.78|
Kaiser Permanente is a great option if it's available in your area. It offers consistently high-quality Medicare Advantage plans with low-cost options. So long as you're comfortable in an HMO with comprehensive coverage and don't need standalone supplemental coverage, Kaiser may be the choice for you.
How We Reviewed Medicare Providers
Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.