Your Medicare health plan coverage

Questions and answers about your Medicare health plan coverage changes

Why am I being automatically enrolled in the Kaiser Permanente Medicare health plan for individuals?
Your employer, union, or trust fund has made the difficult decision to cancel group sponsored Medicare health plan coverage for its Medicare retirees. We want to help you keep the Kaiser Permanente coverage and care you’ve come to rely on without any gap in coverage or care.

What's covered under the Medicare health plan for individuals?
Our Medicare health plans for individuals will be different from your current Medicare group coverage. You should have received Your Guide to Keeping Your Kaiser Permanente Medicare Health Plan in the mail, as well as benefit and cost information that explains your new benefits and coverage.But even as your plan changes, many things will stay the same. You’ll continue to enjoy the benefits of being a Kaiser Permanente member, with one plan giving you hospital care, medical services, and, with most plans, prescription drugs.

Do I get to stay with my health care team?
Absolutely! You can stay with your health care team and get the same quality service and convenience you’ve come to count on.

Does Kaiser Permanente offer any supplemental benefits such as dental, vision, or hearing?
You do have some options for supplemental benefits. Information about supplemental benefits will be included in the benefit and cost information that Kaiser Permanente will be sending you.You can also call one of our Kaiser Permanente Medicare specialists to talk about specific benefits and costs.If you have a reimbursement account, such as a health reimbursement arrangement (HRA), you may be eligible for reimbursement of these supplemental benefit premiums. Be sure and check with your benefits administrator about what expenses are eligible.

Do I need to enroll in prescription coverage?
Most Kaiser Permanente Medicare health plans for individuals include prescription drug coverage. Please be sure to review the information we send to you to understand your plan benefits. In some areas, you may have more than one option to choose from. Please be aware that you may only enroll in one Medicare health plan with Part D prescription drug coverage at a time. If you are enrolling in a Part D plan outside of Kaiser Permanente, your enrollment with Kaiser Permanente Medicare health plan for individuals may be discontinued.

Does the Medicare health plan for individuals cover specialists?
Yes. When you need specialized care, your personal doctor will help you find the right specialist.

How much does the Medicare health plan for individuals cost?
Please watch your mail for the Individual Kaiser Permanente Medicare health plan benefit and cost information. You can also call us to learn about specific costs. Be sure to ask how the new plan may save you money.

How can I pay for the Medicare health plan for individual’s premium?
You will receive information directly from Kaiser Permanente on how to pay your monthly plan premium. There are several options: you can pay by mail, or you can set up monthly payments from your bank account.You and your Medicare eligible dependents may be able to use funds from a Health Reimbursement Account (HRA), Retirement Reimbursement Account (RRA) or subsidy to help pay for premiums and approved medical costs with your new individual plan.  Information about your financial options should be available in the transition materials provided to you from your employer. Please contact the benefits administrator directly to discuss options that may be available, based on your eligibility.

How does the new plan affect my health reimbursement arrangement (HRA) and/or Retirement Reimbursement Account (RRA)?
The HRA/RRA benefits manager does not enroll Kaiser Permanente members. However, most of the time, retirees can remain a Kaiser Permanente member and still get a reimbursement, if available based on eligibility, from their HRA/RRA. For Kaiser Permanente members, the benefits administrator’s only role is administering the HRA/RRA.
Any questions regarding this HRA/RRA account and how it works with your Medicare health plan for individuals will be answered by the benefits administrator.
Some key questions you may want to ask the HRA/RRA benefits administrator are listed below:

  • Do I qualify for an HRA/RRA? If yes, how much?
  • Will I receive the same amount every year, or is there an end date?
  • What exactly can I use my reimbursement funds towards, for example, premiums such as Medical/ Hospitalization/ Dental/ Vision/ Medicare Part B? Copays such as Medical/ Hospitalization/ Dental/ Vision/ Medicare Part B?
  • If I don’t use all of my reimbursement funds in the current year, does the balance roll over to the next year, or do I lose it?
  • Does my spouse qualify? If yes, how much? Can my reimbursement funds be combined with my spouse to form a joint account or must they remain separate?
  • What type of documentation do I need to provide to the administrator to get reimbursements and how often?
  • Is there anything else I need to know about my reimbursement account?

Will there be a gap in my coverage or care?
No, you will be automatically enrolled in a Kaiser Permanente Medicare health plan for individuals the day your group Medicare health plan ends.

Will my Health/Medical Record number change?
No, your Health/Medical Record number will stay the same.

Can I use my current ID card for the Medicare health plan for individuals?
We’ll be sending you a new Kaiser Permanente ID card. If you need care after you’ve enrolled in the new plan but before your ID card arrives, use your old ID card. Your Health/Medical Record number and other medical record information will not change.

Can my spouse or other dependents join too?
Absolutely! As long as your spouse is eligible for Medicare and lives within the Kaiser Permanente Medicare health plan for individuals service area. Call us to learn more and enroll your spouse if he or she is eligible.If you have dependents that aren’t Medicare eligible, contact your benefits administrator to verify and understand options for continued coverage for your Non-Medicare eligible dependents.Kaiser Permanente also offers non-Medicare health plans for individuals. If you have any questions, please call one of our Kaiser Permanente Medicare specialists at 1-877-297-0584 (toll free) (TTY 711) 8 a.m. to 8 p.m., 7 days a week. They are ready to help.

I got an offer for Medicare plan coverage from another health plan. What should I do?
Call one of our Kaiser Permanente Medicare specialists at any time to learn all the reasons to stay with Kaiser Permanente.

I have more questions. Who do I call?
Call 1-877-297-0584 (toll free) (TTY 711), 8 a.m. to 8 p.m., 7 days a week. Our Kaiser Permanente Medicare specialists understand the details of your employer’s coverage termination and will help make the transition to a Kaiser Permanente Medicare health plan for individuals easy for you.

Helping you choose

Call 1-877-297-0584 (toll free) (TTY 711) to speak with a Kaiser Permanente Medicare specialist. If you have more questions, see our questions and answers page.

†When receiving care at a Kaiser Permanente facility.

‡Some online services are not available in all areas.

In California, Hawaii, and Washington, Kaiser Permanente is an HMO plan with a Medicare contract. In Colorado, Kaiser Permanente is an HMO, HMO-POS and PPO plan with Medicare contracts. In Oregon, Southwest Washington, Georgia, Maryland, Virginia and the District of Columbia, Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

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This page was last updated: October 15, 2023, at 12 a.m. PT