Kaiser Permanente Medicare health plans, 2024

Kaiser Permanente Senior Advantage (HMO) and Senior Advantage Medicare Medi-Cal (HMO D-SNP)

Make the most of your coverage by learning more about your plan.

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

2024 Medicare Plan Rating Sheet (updated 11/03/2023) (PDF). Also available in Chinese [中文本] (PDF)

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

Summary of Benefits for Senior Advantage Inland Empire Plan and Senior Advantage Inland Empire Value Plan (updated 10/01/23) (PDF)

Summary of Benefits for Senior Advantage Kern County Plan – Basic and Enhanced (updated 10/01/23) (PDF)

Summary of Benefits for Senior Advantage Los Angeles and Orange Counties Plan and Senior Advantage Los Angeles and Orange Counties Value Plan (updated 10/01/23) (PDF)

Summary of Benefits for Senior Advantage San Diego County Plan and Senior Advantage San Diego County Value Plan (updated 04/19/23) (PDF)

Summary of Benefits for Senior Advantage Ventura County Plan and Senior Advantage Ventura County Value Plan (updated 10/01/23) (PDF)

The following Summary of Benefits applies to Senior Advantage Medicare Medi-Cal plan for the following counties: Fresno, Kings, Los Angeles, Madera, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Mateo, and Santa Clara.

The following Summary of Benefits applies to Senior Advantage Medicare Medi-Cal plan for the following counties: Alameda, Amador, Contra Costa, El Dorado, Kern, Marin, Mariposa, Napa, Placer, San Francisco, San Joaquin, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, Yolo, and Yuba.

Summary of Benefits for Senior Advantage Medicare Medi-Cal Plan (updated 10/01/23)
English (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 Members Services at 1-800-443-0815 (toll free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

The following EOC applies to Senior Advantage Plan

EOC for Senior Advantage – Southern California (updated 10/01/23) (PDF)

The following EOC/Member Handbook applies to Senior Advantage Medicare Medi-Cal plan for the following counties: Los Angeles, Orange, Riverside, San Bernardino, and San Diego

The following EOC applies to Senior Advantage Medicare Medi-Cal Plan for the following counties: Alameda, Amador, Contra Costa, El Dorado, Kern, Marin, Mariposa, Napa, Placer, San Francisco, San Joaquin, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, Yolo, and Yuba.

EOC for Senior Advantage Medicare Medi-Cal Plan (updated 10/01/23) (PDF)
English (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.

ANOC for Senior Advantage Inland Empire Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Inland Empire - Value Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Kern County - Basic Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Kern County - Enhanced Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Los Angeles and Orange Counties Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Los Angeles and Orange Counties - Value Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage San Diego County Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage San Diego County - Value Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Ventura County Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Ventura County - Value Plan (updated 10/01/23) (PDF)

ANOC for Senior Advantage Medicare Medi-Cal Riverside and San Bernardino counties (updated 10/01/23)
English (PDF) | Chinese [中文本] (PDF) | Tiếng Việt (Vietnamese) (PDF)

ANOC for Senior Advantage Medicare Medi-Cal Kern and Ventura counties (updated 10/01/23) (PDF)

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

The following Provider directory applies to Senior Advantage plan in Southern California and Senior Advantage Medicare Medi-Cal Plan for Kern and Ventura counties

Provider directory (updated 04/26/24) (PDF)

We operate our own pharmacies and contract with affiliated pharmacies that meet or exceed Medicare requirements for pharmacy access. You can download a pharmacy directory below.

The following Provider and Pharmacy directory applies to Senior Advantage Medicare Medi-Cal Plan for the following counties: Los Angeles, Orange, Riverside, San Bernardino, and San Diego

The following Pharmacy directory applies to Senior Advantage plan and Senior Advantage Medicare Medi-Cal Plan for the following counties: Alameda, Amador, Contra Costa, El Dorado, Kern, Marin, Mariposa, Napa, Placer, San Francisco, San Joaquin, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, Yolo, and Yuba

Pharmacy directory (updated 03/27/24)
English (PDF) | Chinese [中文本] (PDF)

We work with Delta Dental of California who offers you a wide range of dental care. You can download a dental directory below.

Dental provider directory (updated 04/26/2024)

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.

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 12/19/23) (PDF)

If you would like help understanding these documents, 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

The Centers for Medicare & Medicaid Services (CMS) requires healthcare organizations to publish Durable Medical Equipment (DME) criteria when CMS does not have criteria published or when that criteria is not specifically defined.

View Southern California DME Criteria (PDF)

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 10/01/23) (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 10/01/23) (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.

Medicare nondiscrimination notice

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This page was last updated: April 26, 2024 at 12 a.m. PT