Get answers to important questions about Medicare and Kaiser Permanente Medicare health plans
General coverage and enrollment
Q: How do I find out about changes in services covered by Medicare?
A: 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 (PDF).
Q: What’s the difference between Medicaid and Medicare?
A: Medicare is a federal program that provides health coverage to people age 65 and older, and to people with certain disabilities, such as end-stage renal disease.
Medicaid (Medi-Cal in California) is a public program that provides health coverage to people with low incomes.
Q: If I sign up for a Kaiser Permanente Medicare health plan, will I lose my Medicare coverage?
A: No. You won’t lose Part A and Part B coverage. When you become a member, Kaiser Permanente will provide your Medicare benefits to you. Keep in mind that to sign up for a Kaiser Permanente Medicare health plan, you’ll need to be enrolled in Medicare Part B.
Q: Can I be dropped from a Kaiser Permanente Medicare health plan?
A: You can't be disenrolled because of your health. Your membership can be ended for other reasons, which may include, but are not limited to:
- Failing to pay your Kaiser Permanente premium, if your plan has one
- Living outside a Kaiser Permanente service area for 90 days to 12 months (depending on your plan)
- Moving permanently out of a Kaiser Permanente service area
- Not staying enrolled in Medicare
See your Evidence of Coverage for causes for disenrollment.
Q: What do I need to do about the plan I was enrolled in before I signed up for a Kaiser Permanente Medicare health plan?
A. If you bought your previous non-Medicare plan yourself, be sure to cancel it as soon as your enrollment in a Kaiser Permanente Medicare health plan is approved. If you don't, you'll need to pay the premiums for both plans until you cancel your previous plan.
Coverage away from home or during a disaster
Q: Do I have medical coverage when I’m traveling?
A: Yes. In most cases, you're covered for emergency or urgent care from any medical provider while traveling outside a Kaiser Permanente service area, including while traveling outside the U.S. Read more about Travel Coverage (PDF) or visit kp.org/travel.
Q: What happens if I temporarily leave a Kaiser Permanente service area?
A: While you’re temporarily outside a Kaiser Permanente area, coverage is limited to medical emergencies and urgent care. For Kaiser Permanente Senior Advantage (HMO) and Medicare Advantage (HMO) members, renal dialysis services are also covered.
Q: What happens if I permanently move out of a Kaiser Permanente service area?
A: If you're outside a Kaiser Permanente area for more than 3 to 12 months (depending on your plan), or you permanently move outside the area, Medicare requires us to disenroll you from our plan. Call us and we can help you with coverage when you travel or move.
Q: How do I get care in the event of a disaster?
A: If a state of disaster or emergency in your geographic area is declared, Kaiser Permanente will make every effort to keep our facilities open to care for you.
If there’s a disaster, we'll post information about access to our facilities on kp.org. Read more about Kaiser Permanente’s Disaster Planning Policy.
Information about your rights and privacy
With a Kaiser Permanente Medicare health plan, you have a range of guaranteed rights and protections, including:
- Timely access to covered services and drugs
- Fair and respectful treatment at all times
- The right to file a complaint
- Security and privacy for your health information
- Clearly explained treatment options and participation in making decisions about your treatment options
- The right to get plan information and treatment explanations in a language or format that works for you (including languages other than English, Braille, large print, and audiotapes)
Find more details in your plan’s documents, such as the Evidence of Coverage, or in the Medicare & You handbook available at medicare.gov. You also can call Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 711), 24 hours a day, 7 days a week.
Q: How do I ask for coverage for a medical service or payment of a bill?
A: To request a coverage decision (also called an organization determination) about medical services you’d like but haven’t received, or about payment of a bill, contact Member Services.
A response for a standard request for care or services can take up to 14 calendar days. A response for a request for payment can take up to 30 days. If your health requires a quick response, you should ask us to make a "fast coverage decision." You, your doctor, or your representative can make the request for medical care. We'll respond to a fast coverage decision within 72 hours. If we say no to your request for coverage for medical care or payment, you can ask for an appeal.
Q: How do I make an appeal?
A: If we say no to your request for coverage for medical care or payment of a bill, you have the right to ask us to reconsider by making a Level 1 Appeal. You’ll need to make your appeal request within 60 calendar days from the date on the written notice we send you with our answer to your request for a coverage or payment decision.
- For a standard appeal, write to Member Services.
- If your health requires a quick response, ask for a "fast appeal" by writing or calling Member Services. You, your doctor, or your representative can do this. If your representative is appealing our decision for you, your appeal must include an Appointment of Representative form authorizing this person to represent you. We’ll consider your appeal and give you our answer:
- Within 72 hours for a fast appeal
- Within 30 calendar days for a standard appeal request for medical care
- Within 60 calendar days for a standard appeal request for payment of a bill
- Within 72 hours for a fast appeal
- If we say no to part or all of your appeal, your case will automatically be sent to Level 2 of the appeals process, which is done by an Independent Review Organization. That organization will review your appeal carefully and give you its decision and reasons for it in writing.
For additional details, see Chapter 9 in your Evidence of Coverage.
Q: How do I make a complaint about Kaiser Permanente care, services, or processes?
A: If you’re unhappy with the medical care or services you’re getting, or if you’re unhappy with our processes, you can make a complaint. This is also known as filing a grievance. Call or write to Member Services within 60 days of the incident.
We’ll look into your complaint and give you our answer within 30 calendar days. For additional details, see Chapter 9 in your Evidence of Coverage.
To get a summary of information about the appeals and grievances that plan members have filed with Kaiser Permanente, please contact Member Services.
You can also use the online Medicare Complaint Form to send a complaint directly to Medicare.
Q: How can I protect my privacy and personal information?
A: Protect your identity by knowing how to recognize and report fraud. Don't give your Medicare claim number, or other plan information, to anyone other than your health plan representatives and the medical professionals and facilities that give you care.
Look out for signs of fraud or suspicious offers. For example:
- Bills or statements for care you never got
- Bribes to get 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 the toll-free number 1-877-7SAFERX (1-877-772-3379).