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Kaiser Permanente Medicare Review

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UPDATED: Nov 30, 2018

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One of the biggest names in HMO health plans, Kaiser Permanente is a California-based company serving eight states. They offer individual and group plans as well as Medicare Advantage.

About Kaiser Permanente

The roots of Kaiser Permanente are found in the creation of Industrial Indemnity in 1933, which was founded by Henry J. Kaiser to provide worker’s compensation insurance for his employees. The new insurance company partnered with a hospital also recently founded in Desert City, CA by Dr. Sidney Garfield. The partnership provided access to health care for workers on the California Aqueduct. By 1942 Permanente Health Plan was officially established, serving workers and their families.

Expansion came with the end of the second World War, and the company added the name of one of its founders to become Kaiser Permanente. By 1977 the managed health care system was operating in six regions, but expansion slowed and eventually the company scaled back, withdrawing from Texas and North Carolina in the 90s.

Today the company operates in California, Oregon, Washington, Hawaii, Colorado, Georgia, Maryland, Virginia, and D.C. They have around 12 million members with the vast majority of those located in California.

Kaiser operates as a consortium made up of three separate companies, forming a blend of for-profit and not for profits. The company’s headquarters is located in Oakland, CA. They are very active in group health insurance plans, but also sell individual plans and Medicare Advantage; all of their plans are HMO.

Kaiser Medicare Advantage

Kaiser’s plan options vary depending on the state and even by county. For the purpose of this review we used our usual sample area in Southern California to take a look at plans and rates.

In our sample area, Kaiser has only one Medicare Advantage plan available, which includes Part D prescription drug coverage.

The Senior Advantage plan is a $0 premium plan (you pay nothing but your usual Original Medicare premiums) with no deductible. Copays are $10 for primary care and $15 for specialists. Inpatient hospital stays with this plan have a copay of $285 a day for the first seven days.

The plan does not have a pharmacy deductible either, and Tier 1 drugs start at a $5 copay.

The plan includes basic dental and some hearing coverage, and there is the option to add on Advantage Plus, which increases those benefits for a monthly premium. It also adds on dental coverage and a fitness benefit.

As with all plans, the Senior Advantage is an HMO plan with no out of network coverage except in the event of an emergency; providers are limited to the Kaiser network.

Rates

As already noted, the plan available by Kaiser does not have a premium beyond what you pay for Original Medicare Part A & B. If you wish to add on the Advantage Plus endorsement, the monthly cost is $20.

This is really affordable compared to the other options out there, and it includes low copays for office visits. Even the add-on for supplemental benefits is reasonably priced. As far as zero premium plans go, it is quite basic, and we have seen some that include dental, hearing, and vision with no added premium. Overall, however, Kaiser is one of the least expensive options.

HMO plans usually have lower premiums than do PPO plans; keeping coverage within a limited network is what helps managed care companies keep the premiums lower.

Claims

Kaiser is an HMO plan, which means that everything is in-network and there should be no difficulty with claims for covered services being paid. As with all health insurance companies, claims are generally handled directly with the provider, and unless there is a coverage issue the insured should not need to be involved in claims filing or processing.

Ratings and Consumer Reviews

There are a number of Better Business Bureau (BBB) files for various Kaiser locations, but the file for the headquarters location has an A+ rating with a total of 49 complaints on file. Other complaints are scattered throughout the local BBB files, but we saw a very low volume of complaints overall considering the size of this company.

Each of Kaiser’s state branches has its own record with the National Committee for Quality Assistance. In most states they have earned the highest rating – 5 out of 5, with 4.5 out of 5 in Georgia and part of Washington. These are impressive scores that are not often seen.

Kaiser also earned a 5 out of 5-star rating from Medicare for their 2019 plans, which is again the highest rating and again not an accomplishment we see very often. They appear to consistently rank well with consumer surveys.

Consumer Affairs, a common site for insurance company complaints, has a total of 923 reviews of the company. Of the 161 reviews submitted in the past year, 122 were one-star ratings and 22 were five-star, with the rest in between. The complaints are mainly focused on poor customer service and denial of claims. Considering the number of members Kaiser has, this is not a high complaint volume.

The Bottom Line

Kaiser gets high marks for its Medicare Advantage plans from the top rating services, and their complaint volume is not high for a huge company. They do not have much to choose from in terms of plans, and some may find the limitations of an HMO network problematic, but if such things would work for you, Kaiser is a good bet.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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Kaiser Permanente Medicare
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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

2 Comments

  1. Kaiser is horrible I have been with them for two years and I have Multiple Sclerosis, Fibromyalgia, Herniated, Bulging Discs, Spinal Stenosis and Spondylolithesis where my Vertebra slipped forward in front of the one beneath it and I feel it through my skin. I have Low back pain so bad I can’t get up or bend I have no quality of life. I have right side Sciatic Nerve, Right knee slips out of joint resulting from Kaiser Pain Management and Orthopedic Dr. not ordering Physical Therapy or Laminectomy to fix my back. The doctor compared me to Michal Jackson, WOW really?
    They don’t care I am in pain and can’t do anything they just want to take away the Fentanyl 25 Micrograms and tell me to take more pills when they already have me on 1150 mg of Neuropathic medication that is not all. They won’t explain anything and they can read all your emails you send other doctors and they do then stick together. Just because there are bad people who abuse the Medication that sick people really need we should not be punished and have it taken from us when we hurt so bad and need it. No matter how many health problems we have and can validate Kaiser does not want to help us have a pain free life, not even a comfortable life. I tried to switch dr.’s then they said I could not which Kaiser says you can change as many times as may dr.’s as you want. They are not letting me change and going against their own policy. I filed two complaints it has been 120 hours and I have not heard a thing.
    That is false advertisement, How is that Kaiser Thriving???

    Reply
  2. Very helpful information.

    Reply

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