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Kaiser Permanente Medicare Advantage 2024 Review
Kaiser Permanente’s Medicare Advantage plans get slightly below-average ratings and are available in only a handful of states.
Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 20 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
Alex Rosenberg Lead Writer | Medicare, health care, legislation
Alex Rosenberg is a NerdWallet writer focusing on Medicare and information technology. He has more than 10 years of experience researching and writing about health care, insurance, technology, data privacy and public policy. His research has supported lawmakers in the Wisconsin State Legislature as well as health systems and national health authorities in the U.S. and more than 10 other countries. He is based in Eau Claire, Wisconsin.
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Kaiser Permanente
3.93
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Kaiser Permanente plans get slightly below-average ratings, and the provider sells plans in only eight states and Washington, D.C.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Medium (50% to 89%)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.30 (Below average)
Pros
Earns above-average customer satisfaction scores in California, one of the major Medicare markets studied by J.D. Power.
Eight in 10 members are in a highly-rated plan.
Most plans include drug coverage.
Cons
Available in only eight states and Washington, D.C.
Offers mostly HMO plans, so most members must work within Kaiser’s network of medical providers.
Member experience ratings overall are below average.
States available
8 states and Washington, D.C.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Medium (50% to 89%)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.30 (Below average)
Pros
Earns above-average customer satisfaction scores in California, one of the major Medicare markets studied by J.D. Power.
Eight in 10 members are in a highly-rated plan.
Most plans include drug coverage.
Cons
Available in only eight states and Washington, D.C.
Offers mostly HMO plans, so most members must work within Kaiser’s network of medical providers.
Member experience ratings overall are below average.
Kaiser Permanente is the fifth-largest provider of Medicare Advantage plans
, and the insurer's 2024 plans score just below the industry average in terms of Medicare star ratings — a drop from 2023 plans.
It’s also the largest not-for-profit health care organization in the United States. Kaiser uses an integrated care model, which means that members can get all their care in one place and all the providers are connected
Kaiser Permanente. Our Model. Accessed Apr 26, 2024.
Kaiser's plans are available in only eight states and Washington, D.C., and the company offers mostly HMO plans — which are less flexible than other options. Here’s what you should know about Kaiser Permanente Medicare Advantage.
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NerdWallet’s Medicare content, including articles, reviews and recommendations, is produced by a team of writers and editors who specialize in Medicare. Their work has appeared in The Associated Press, Washington Post, Nasdaq, MSN, MarketWatch, Yahoo! Finance and other national and regional media outlets. They have been cited in publications including Healthline, and appeared on NerdWallet's "Smart Money" podcast.
Kaiser Permanente Medicare Advantage pros and cons
Kaiser Permanente’s offerings have advantages and disadvantages.
Pros
Californians are happy: Kaiser plans score above the industry average in terms of customer satisfaction in California, one of the major Medicare markets measured by J.D. Power in this year's study.
Members are in strong plans: Eight out of 10 Kaiser Medicare Advantage members (80%) are in a plan rated 4 stars or higher.
Prescription benefits: Most of Kaiser’s Medicare Advantage plans include drug coverage.
Cons
Limited availability: Kaiser Permanente plans are available in just eight states and Washington, D.C.
Limited plan types: Kaiser offers mostly HMO plans, so most members must work within Kaiser’s network of medical providers.
Low member experience ratings: Kaiser’s member experience ratings, including customer service and getting needed care, are lower than other major providers.
If you want Medicare’s take on Kaiser Permanente’s plans, look no further than the Centers for Medicare & Medicaid Services' own star ratings, which rank each plan from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.
Based on the most recent year of data and weighted by enrollment, Kaiser Permanente’s 2024 Medicare Advantage plans scored 3.93 stars
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024. However, some plans cover part or all of this cost
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:
Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and any other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.
Whether you require extra benefits, and if the plan charges for them.
Here are examples of Kaiser Permanente Medicare Advantage costs for the most popular plans in a mid-range city:
Kaiser Permanente Medicare Advantage plan
Pricing
Kaiser Permanente Medicare Advantage Centennial (HMO)
Monthly premium: $0.
Out-of-pocket max: $4,950.
Copays:
Primary care: $0.
Specialist: $25.
Tier 1 prescription drugs: $2.
Kaiser Permanente Medicare Advantage Basic (HMO)
Monthly premium: $76.
Out-of-pocket max: $4,200.
Copays:
Primary care: $0.
Specialist: $30.
Tier 1 prescription drugs: N/A.
Kaiser Permanente Medicare Advantage Columbia (HMO)
To get a sense of costs, use Medicare’s website to compare information among available plans in your area. You can select by insurance carrier to see only Kaiser Permanente plans or compare across carriers.
Kaiser Permanente Medicare Advantage plan types
Kaiser Permanente offers mostly HMO Medicare Advantage plans, but also offers some PPO plans.
Plan availability may vary by county. Plan offerings may include the following types:
HMO plans
A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.
HMO-POS plans
HMO point-of-service plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.
PPO plans
Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.
SNPs
Special needs plans (SNPs) restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Kaiser Permanente offers one type of SNP:
Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.
Kaiser Permanente
3.93
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Fitch Ratings is a credit rating agency that assigns ratings based on its opinion of a company’s ability to meet financial commitments. In June 2023, Fitch Ratings affirmed an Insurer Financial Strength rating of AA- (very strong) for Kaiser Foundation Health Plan, or KFHP, and its insurance company subsidiaries. Among other factors, Fitch Ratings called out KFHP’s favorable competitive positioning, unique operating model, and strong financial performance and earnings
In its 2023 Medicare Advantage Study — the ninth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the five biggest Medicare markets: California, Florida, New York, Pennsylvania and Texas. On these measures, Kaiser Foundation Health Plan placed third of all major providers in California (the only state of the five in which Kaiser has plans)
The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on quality of care, patient satisfaction and health plans’ efforts to keep improving.
In its September 2023 ratings of Kaiser Permanente plans, the NCQA awarded ratings of 4.5 to all Kaiser plans listed
Kaiser Permanente offers Medicare Advantage plans in eight states and Washington, D.C. (Kaiser sells plans in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state.)
More than 1.8 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Advantage plans.
About Kaiser Permanente
Kaiser Permanente, headquartered in Oakland, California, was founded in 1945 and serves 12.7 million people across eight states and Washington, D.C. The company is made up of Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and its subsidiaries, and the Permanente Medical Groups.
Kaiser Permanente offers insurance for individuals and families, employer group plans, Medicaid/Medi-Cal and Medicare Advantage.
Customer service
Kaiser Permanente Medicare Advantage members can contact their plan’s customer service in a few ways:
Call a customer service representative, available daily from 8 a.m. to 8 p.m. The phone number varies by location. Find yours by clicking on “Support Center” under “Member Support” at the bottom of your plan’s website.
Chat with a member services representative after signing into your account.
Compare Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
Medicare Advantage review methodology
The Medicare Advantage marketplace is concentrated among just a handful of companies; in many places, one insurer serves more than half of the market. NerdWallet reviewed 26 Medicare Advantage brands, with some insurers having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.) At the national level, these reviews include nine of the 10 largest brands by enrollment. At the state level, our research includes at least one major insurer in 47 of the 49 states that offer Medicare Advantage plans, and includes the top two insurers in 35 of those states. (Alaska doesn't offer Medicare Advantage plans.) We also look at online search volume to identify regional and other notable players in the space.
NerdWallet’s Medicare Advantage reviews are based on ratings data from the Centers for Medicare & Medicaid Services, as well as pricing, plan availability by state, plan types available, consumer experience, extra benefits offered and more. These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.
