Kaiser Permanente Medicare health plans, 2025

See how our plans are rated by Centers of Medicare & Medicaid Services.

2025 Medicare Plan Rating Sheet (updated 10/31/2024) (PDF)

Contract H3138 is too new to be measured.

Our Summary of Benefits provides an overview of what our plan covers and what you pay. You can download a copy below.

Colorado - Denver/Boulder

Summary of Benefits for Senior Advantage Core DM (HMO), Senior Advantage Bronze DM (HMO-POS), Senior Advantage Silver DM (HMO-POS), and Senior Advantage Gold (HMO-POS) (updated 10/01/24) (PDF)

Summary of Benefits for Dual Essential (HMO D-SNP) (updated 10/01/24) (PDF)

Summary of Benefits for Dual Complete (HMO D-SNP) (updated 10/01/24) (PDF)

Summary of Benefits for Senior Advantage Choice DM (PPO) (updated 10/01/24) (PDF)

Colorado – Northern

Summary of Benefits for Senior Advantage Core North (HMO), Senior Advantage Bronze North (HMO-POS), and Senior Advantage Silver North (HMO-POS) (updated 10/01/24) (PDF)

Summary of Benefits for Senior Advantage Choice North (PPO) (updated 10/01/24) (PDF)

Colorado – Southern

Summary of Benefits for Senior Advantage Core South (HMO) and Senior Advantage Enhanced (HMO-POS) (updated 10/01/24) (PDF)

Summary of Benefits for Senior Advantage Choice South (PPO) (updated 10/01/24) (PDF)

Summary of Benefits for Dual Complete Pueblo (HMO D-SNP) (updated 10/01/24) (PDF)

Our Evidence of Coverage (EOC) documents include detailed benefit information and how to get coverage. You can download a copy below.

We encourage you to read this information and hold onto it because it explains your benefits and rights. If you have questions or would like to request a hard copy, please call Member Services at 1-800-476-2167 (toll free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

Colorado – Denver/Boulder

EOC for Senior Advantage Core DM, Senior Advantage Bronze DM, Senior Advantage Silver DM, and Senior Advantage Gold Plan (updated 10/01/24) (PDF)

EOC for Senior Advantage Choice DM Plan (updated 10/01/24) (PDF)

EOC for Dual Essential Plan (updated 10/01/24) (PDF)

EOC for Dual Complete Plan (updated 10/01/24) (PDF)

Colorado – Northern

EOC for Senior Advantage Core North, Senior Advantage Bronze North, and Senior Advantage Silver North Plan (updated 10/01/24) (PDF)

EOC for Senior Advantage Choice North Plan (updated 10/01/24) (PDF)

Colorado – Southern

EOC for Senior Advantage Core South and Senior Advantage Enhanced Plan (updated 10/01/24) (PDF)

EOC for Senior Advantage Choice South Plan (updated 10/01/24) (PDF)

EOC for Dual Complete Pueblo Plan (updated 10/01/24) (PDF)

The Annual Notice of Changes (ANOC) describes any changes to coverage, costs, or service area from the previous year, effective January 1. You can download a copy below.

Colorado – Denver/Boulder

ANOC for Senior Advantage Core DM Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Silver DM Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Gold Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Bronze DM Plan (updated 10/01/24) (PDF)

ANOC for Dual Essential Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Choice DM Plan (updated 10/01/24) (PDF)

Colorado – Northern

ANOC for Senior Advantage Core North Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Silver North Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Bronze North Plan (updated 10/01/24) (PDF)

Colorado – Southern

ANOC for Senior Advantage Core South Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Enhanced Plan (updated 10/01/24) (PDF)

ANOC for Dual Complete Pueblo Plan (updated 10/01/24) (PDF)

ANOC for Senior Advantage Choice South Plan (updated 10/01/24) (PDF)

We make it easy to find a doctor or pharmacy to meet your needs. We are the only Medicare PPO plan in Colorado that includes access to high-quality care from Kaiser Permanente and you can change to another available Kaiser Permanente doctor at any time, for any reason. Additionally with our PPO, you can see any licensed provider who accepts Medicare. You can download a provider directory below. 

Colorado - Denver/Boulder

Provider directory (updated 10/28/24) (PDF)

Provider directory for Senior Advantage Choice (updated 10/28/24) (PDF)

Colorado - Northern

Provider directory (updated 10/28/24) (PDF)

Provider directory for Senior Advantage Choice (updated 10/28/24) (PDF)

Colorado - Southern

Provider directory (updated 10/28/24) (PDF)

Provider directory for Senior Advantage Choice (updated 10/28/24) (PDF)

We operate our own pharmacies and contract with affiliated pharmacies that meet or exceed Medicare requirements for pharmacy access. Additionally, with our PPO, you will have access to a national network of pharmacies. You can download a pharmacy directory below.

The following pharmacy directory only applies to our Medicare Part D group plan (PDP) for Postal Service Health Benefits (PSHB) members.

Pharmacy Directory for National Medicare Part D Group Plan (PDP) (updated 10/28/24) (PDF)

Colorado - Denver/Boulder

Pharmacy directory (updated 10/01/24) (PDF)

Pharmacy directory for Senior Advantage Choice (updated 10/01/24) (PDF)

Colorado - Northern

Pharmacy directory (updated 10/01/24) (PDF)

Pharmacy directory for Senior Advantage Choice (updated 10/01/24) (PDF)

Colorado - Southern

Pharmacy directory (updated 10/01/24) (PDF)

Pharmacy directory for Senior Advantage Choice (updated 10/01/24) (PDF)

If you would like a directory sent to you by mail, call 1-800-476-2167 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.

Throughout the year, the Centers for Medicare & Medicaid Services sends out updates about additional covered services or changes to existing covered services. These notifications are called National Coverage Determinations (NCDs).

View the NCDs for the current plan year (updated 10/01/24) (PDF)

If you would like help understanding these documents, call Member Services at 1-800-476-2167 (toll-free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

Kaiser Foundation Health Plan of Colorado
10350 E. Dakota Ave.
Denver, CO 80247

To find out more about Medicare, visit the following government websites:

Medicare.gov

Find general information, plan comparisons, a prescription drug plan finder, search tools, and reference materials.

You also may send a complaint directly to Medicare by using the online Medicare Complaint Form.

Social Security

Search information about Medicare eligibility and enrollment, order a replacement Medicare card, and dig deeper into topics like retirement and disabilities.

Protect your identity. Know the signs of schemes and questionable offers involving Medicare.

An identity thief could try to use your Medicare information to get paid for care you never received.

Watch out for people who ask for your Medicare claim number or plan information, or try to bribe you to see an unfamiliar doctor or use services you don’t need.

Visit the Medicare website for more information on preventing fraud. To report suspected fraud, call 1-877-7SAFERX (1-877-772-3379) (toll free).

Organization determinations

An organization determination is a coverage decision that involves your medical care or asks us to reimburse you or pay a bill. To ask for a coverage decision on health care you want but haven’t received or to pay a bill, you can call, write, or fax Member Services.

If you need a quick answer about care or services because waiting too long could be a health risk, ask for a fast coverage decision. You, your doctor, or your representative can ask for this, and we’ll respond within 72 hours. Otherwise, we’ll respond to requests for care or services within 14 days and requests for payment within 30 days.

If we turn down your request, you can make an appeal. (See "Making an appeal" below.) For more details, refer to chapter 9 in your Evidence of Coverage.

Making an appeal

If we turn down your request, you’ll get written notice of our decision. You can ask us to reconsider by making a Level 1 Appeal within 60 days of the date on that notice.

• For a standard appeal, write to Member Services. If you need a quick response for health reasons, you must ask for a fast appeal (also called an expedited reconsideration) by writing or calling Member Services. You, your doctor, or your representative can do this. If a representative is appealing our decision for you, the appeal must include an Appointment of Representative (updated 10/01/24) (PDF) form authorizing this person to represent you. 
• We’ll respond to fast appeal requests within 72 hours, standard appeals for care you haven’t received within 30 days, and standard appeals about payment within 60 days.
• If we say no to all or part of your appeal, your case will be sent to Level 2 of the appeals process. To make sure our decision was fair, we will send your appeal to the Independent Review Organization, who will carefully review it and explain the decision to you in writing.
  

For more details, refer to chapter 9 in your Evidence of Coverage.

How do I appoint a representative?

You can appoint a representative to help you. Your representative can be a family member, friend, advocate, attorney, doctor, or someone else who will act on your behalf. Fill out an Appointment of Representative form (updated 10/01/24) (PDF) and send it in with your appeal.

Filing a grievance

If you’re unhappy with your care or services or with our processes, you can make a complaint. This is known as filing a grievance. Contact Member Services within 60 days of the incident, by phone or in writing.

We’ll look into your complaint and respond within 30 days. For more details, refer to chapter 9 in your Evidence of Coverage.

You can look at appeals and grievances other plan members have filed with Kaiser Permanente. To get this information, please contact Member Services.