Kaiser Permanente Medicare health plans, 2024

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

2024 Medicare Plan Rating Sheet (updated 11/03/23) (PDF)

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

Washington – Puget Sound counties:
King, Kitsap, Lewis, Pierce, Snohomish, and Thurston counties and parts of Grays Harbor County (ZIP codes 98541, 98557, 98559, 98568) and Mason County (ZIP codes 98524, 98528, 98546, 98548, 98555, 98584, 98588, 98592): Medicare Advantage Vital, Essential, and Optimal (HMO) Summary of Benefits (updated 10/01/23) (PDF)

Thurston, King, Kitsap, Pierce and Snohomish counties: Medicare Advantage Key (HMO) Summary of Benefits (updated 10/01/23) (PDF)

Washington – North counties:
Island County:
Medicare Advantage Harbor and Anchor (HMO) Summary of Benefits (updated 10/01/23) (PDF)
Medicare Advantage Key (HMO) Summary of Benefits (updated 10/01/23) (PDF)

Skagit and Whatcom counties:
Medicare Advantage Harbor and Anchor (HMO) Summary of Benefits (updated 10/01/23) (PDF)

Washington – Spokane County:
Medicare Advantage Centennial and Columbia (HMO) Summary of Benefits (updated 10/01/23) (PDF)

Washington – Available for all counties in WA region
Medicare Advantage Basic (HMO) Summary of Benefits (updated 10/01/23) (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 1-888-901-4600 (toll free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

Washington – Puget Sound counties:
King, Kitsap, Lewis, Pierce, Snohomish, and Thurston counties and parts of Grays Harbor County (ZIP codes 98541, 98557, 98559, 98568) and Mason County (ZIP codes 98524, 98528, 98546, 98548, 98555, 98584, 98588, 98592):
Medicare Advantage Vital (HMO) EOC (updated 10/01/23) (PDF)
Medicare Advantage Essential (HMO) EOC (updated 10/01/23) (PDF)
Medicare Advantage Optimal (HMO) EOC (updated 10/01/23) (PDF)

Thurston, King, Kitsap, Pierce, and Snohomish counties: Medicare Advantage Key (HMO) EOC (updated 10/01/23) (PDF)

Washington – North counties:
Island County:
Medicare Advantage Key (HMO) EOC (updated 10/01/23) (PDF)
Medicare Advantage Harbor (HMO) EOC (updated 10/01/23) (PDF)

Skagit and Whatcom counties:
Medicare Advantage Anchor (HMO) EOC (updated 10/01/23) (PDF)
Medicare Advantage Harbor (HMO) EOC (updated 10/01/23) (PDF)

Washington – Spokane County:
Medicare Advantage Centennial (HMO) EOC (updated 10/01/23) (PDF)
Medicare Advantage Columbia (HMO) EOC (updated 10/01/23) (PDF)

Washington – Available for all counties in WA region
Medicare Advantage Basic (HMO) EOC (updated 10/01/23) (PDF)

Employer Group Medicare Advantage plans
Enrolled in your Employer Group Medicare Advantage plan? Visit kpwa.memberdoc.com to view your Medicare Advantage Evidence of Coverage (EOC).

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.

Washington - Puget Sound counties:
King, Kitsap, Lewis, Pierce, Snohomish, and Thurston counties and parts of Grays Harbor County (ZIP codes 98541, 98557, 98559, 98568) and Mason County (ZIP codes 98524, 98528, 98546, 98548, 98555, 98584, 98588, 98592):
Medicare Advantage Vital (HMO) ANOC (updated 10/01/23) (PDF)
Medicare Advantage Essential (HMO) ANOC (updated 10/01/23) (PDF)
Medicare Advantage Optimal (HMO) ANOC (updated 10/01/23) (PDF)

Thurston, King, Kitsap, Pierce, and Snohomish counties: Medicare Advantage Key (HMO) ANOC (updated 10/01/23) (PDF)

Washington - North counties:
Island County:
Medicare Advantage Key (HMO) ANOC (updated 10/01/23) (PDF)
Medicare Advantage Harbor (HMO) ANOC (updated 10/01/23) (PDF)

Skagit and Whatcom counties:
Medicare Advantage Anchor (HMO) ANOC (updated 10/01/23) (PDF)
Medicare Advantage Harbor (HMO) ANOC (updated 10/01/23) (PDF)

Washington - Spokane County:
Medicare Advantage Centennial (HMO) ANOC (updated 10/01/23) (PDF)
Medicare Advantage Columbia (HMO) ANOC (updated 10/01/23) (PDF)

Washington - Available for all counties in WA region:
Medicare Advantage Basic (HMO) ANOC (updated 10/01/23) (PDF)

Pharmacy Directory
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. If you would like a directory sent to you by mail, call 1-888-901-4600 (TTY 711), 7 days a week, 8 a.m. to 8 p.m. 

Individual Medicare Advantage

Provider Directory

• Centennial, Columbia, Harbor, Key, Vital, Essential, and Optimal plans, see the provider directory (updated 04/26/24) (PDF) or search the online directory
• Anchor plan, see the provider directory (updated 04/26/24) (PDF) or search the online directory
• Basic (HMO) No Part D plan, see the provider directory (updated 04/26/24) (PDF) or search the online directory

Durable Medical Equipment (DME)

• Preferred brands and manufacturers directory (updated 10/01/23) (PDF)

Pharmacy Directory
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.

• Anchor, Centennial, Columbia, Harbor, Key, Vital, Essential, and Optimal plans see pharmacy directory (updated 03/27/24) (PDF)

Delta Dental Provider Search
To search dental providers for your preventive dental benefit included in your individual Kaiser Permanente Medicare health plan or the optional supplemental Delta Dental PPO Plus Premier plan, you can find in-network dentists in your area with the Delta Dental provider search tool. Before searching, select Delta Dental PPO, Delta Dental Premier, or Delta Dental PPO Plus Premier as your network.

Delta Dental provider search tool

Group Medicare Advantage
Provider Directory

• Group Medicare Advantage with Part D provider directory (updated 03/27/24) (PDF) or search the online directory 
• Group Medicare Advantage (with Commercial Non-Part D Rx coverage), FEHB, PEBB provider directory (updated 04/26/24) (PDF) or search the online directory

Durable Medical Equipment (DME)

• Preferred brands and manufacturers directory (updated 10/01/23) (PDF)

Pharmacy Directory
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.

• Group Medicare Advantage (HMO) with Part D pharmacy directory (updated 04/26/24) (PDF)
• Group Medicare Advantage (HMO) (with Commercial Non-Part D Rx coverage) online directory

Under Kaiser Permanente Medicare Advantage (HMO) health plans, some injectable Part B drugs administered by your provider may have special coverage requirements or limits.

What is step therapy?
One of these special coverage requirements or limits is known as step therapy. This means that Kaiser Permanente requires you to first try a preferred Part B drug to treat your medical condition before covering a non-preferred drug for that same condition. The preferred drug is equally effective but usually less costly for you.

Here's how it works
If preferred Drug A and non-preferred Drug B both treat your medical condition, Kaiser Permanente may require that you try Drug A first. If Drug A does not work, then Drug B will be covered by your plan. The preferred drugs are listed in the link below and should be tried first.

Note
Certain medical conditions may be excluded from the step therapy requirement.
The step therapy requirement does not apply if you have received treatment with the non-preferred drug within the past 365 days. For example, if you are a new or existing member and have been using a non-preferred drug within the past 365 days, you will not be required to switch to the preferred drug when you enroll in a Kaiser Permanente Medicare Advantage plan. Similarly, an existing member using a non-preferred drug will not be required to change drugs. Medicare Part B preferred and non-preferred drug list (updated 12/13/23) (PDF).

More Resources
Medicare Part B Step Therapy Policy (updated 10/01/23) (PDF)

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 1-888-901-4600 (toll-free) or TTY 711 from 8 a.m. to 8 p.m., 7 days a week.

Kaiser Foundation Health Plan of Washington
1300 SW 27th St.
Renton, WA 98057

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.