Kaiser Permanente Medicare health plans, 2019

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Senior Advantage individual plans

Our Medicare health plans combine your Medicare coverage and Kaiser Permanente's membership benefits to create a single plan that fits your needs.

You can learn more about the Kaiser Permanente Senior Advantage (HMO) individual plans on the following pages:

  • Our Summary of Benefits page includes documents you can download, plus the latest information about services covered by your plan.

Senior Advantage Medicare Medi-Cal individual plan

Kaiser Permanente Senior Advantage Medicare Medi-Cal (HMO SNP) is a plan for individuals who are eligible for both Medicare and Medi-Cal. You can find details in the Summary of Benefits page and Annual Notice of Changes and Evidence of Coverage page.

To join our Senior Advantage Medicare Medi-Cal plan, you must be eligible for Medicare and full benefits under Medi-Cal. Call us to find out if you qualify.

Note: Our Medicare Medi-Cal plan is available to individual plan members only. If you’re covered through your employer or trust fund and are interested in our Senior Advantage Medicare Medi-Cal plan, call us to find out how to qualify.

Anyone who has full benefits under Medi-Cal and Medicare Parts A and B, including some people under the age of 65 with disabilities, may apply.

Kaiser Permanente is an HMO SNP plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

Advantage Plus

For a healthier, more vibrant you

Get more value from your plan by adding Advantage Plus to your Kaiser Permanente Senior Advantage (HMO)* plan. You’ll get extra benefits like dental, hearing aid, and eyewear coverage for an affordable monthly premium.

Visit our Advantage Plus website to learn about enrollment eligibilities and benefits, and you can enroll online.

*Advantage Plus is not available for Senior Advantage Medicare Medi-Cal plan members.

Group coverage

If you get health care coverage through your employer or trust fund, your benefits might be different from the benefits in our individual plans. For more information, contact your group benefits administrator. You also may call Member Services at 1-800-443-0815 (toll free) or TTY 711, from 8 a.m. to 8 p.m., 7 days a week.

Prescription drug coverage

If your Kaiser Permanente Senior Advantage (HMO) individual plan includes Medicare Part D prescription drug coverage, the cost is included in your monthly plan premium.

Find out more about your 2019 Medicare drug formulary and pharmacy coverage.

Provider and pharmacy directories

We make it easy to find a doctor or pharmacy to meet your needs. All of our available doctors welcome our Medicare health plan members, and you can change to another Kaiser Permanente doctor at any time, for any reason.

View or download our provider directory (PDF)
and Spanish (PDF)

We operate our own pharmacies and contract with affiliated pharmacies that meet or exceed Medicare requirements for pharmacy access.

View or download our pharmacy directory (PDF)
and Spanish (PDF)

You can also use our online directory to search for doctors and pharmacies in your area.

If you would like a directory sent to you by mail, call 1-800-443-0815 (TTY 711), 7 days a week,
8 a.m. to 8 p.m., or email us at mscc@kp.org. Be sure to include “directory request” in the subject line and your name, full address, and which directory you’re requesting in the body of the email.

Helpful resources

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

Medicare.govKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps.
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 formKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps..

Social SecurityKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps.
Search information about Medicare eligibility and enrollment, order a replacement Medicare card, and dig deeper into topics like retirement and disabilities.

Recognizing and reporting fraud

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 got. 

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 websiteKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps. for more information on preventing fraud. To report suspected fraud, call 1-877-7SAFERX (1-877-772-3379) (toll free).

Organization determinations, appeals, and grievances

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 (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.

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.

Contact us

For help understanding Kaiser Permanente Medicare health plan information, call Member Services at 1-800-443-0815 (toll free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

Kaiser Foundation Health Plan, Inc.
393 E. Walnut St.
Pasadena, CA 91188-8514

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

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This page was last updated: December 18, 2019 at 12:00 a.m. PT