Q. How do I apply for Medicare?
A. If you plan to retire at 65, and aren't receiving Social Security benefits, apply through your local Social Security office up to 3 months before your 65th birthday. You may have to pay a late enrollment penalty if you sign up more than 3 months after you turn 65.
- If you're already receiving Social Security benefits, you don't need to apply for Medicare.You'll be automatically enrolled.
- If you or your spouse plan to continue working after age 65 and are covered under a group plan, it might not be in your best interest to sign up for Medicare Part B right now. Contact your local Social Security office or your group benefits administrator for information.
Q. How do I get a Medicare card?
A. As soon as 3 months before your 65th birthday contact Social Security through one of the following:
- Go to Social Security online services†
- Visit your local Social Security office
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday.
Q. How do I get Medicare Part D?
A. Anyone receiving Medicare is eligible for Medicare Part D prescription drug coverage and can receive this optional coverage by enrolling in one of these plans:
- Medicare Advantage plan with Part D coverage
- Medicare Cost plan with Part D
- Stand-alone Medicare prescription drug plan (PDP)
Most Kaiser Permanente Medicare health plans offer prescription drug coverage.
Q. What does Original Medicare Cover?
A. Original Medicare covers inpatient hospital care (Part A) and outpatient medical services (Part B).
Q. How does Original Medicare work?
A. In most cases, you can go to any doctor, health care provider, hospital, or other facility that's enrolled in Medicare and is accepting new Medicare patients. Most prescriptions aren't covered by Original Medicare.
Q. How much does Medicare cost?
A. For most people, there is no premium for Medicare Part A (hospital insurance).
There is a monthly premium for each of the following:
- Medicare Part B (medical insurance)
- Medicare supplement plan
- Medicare prescription drug plan
- Some Medicare Advantage plans
Q. What does Medicare Part C cover?
A. Medicare Advantage plans, also called Part C plans, offer more benefits and services than Original Medicare. Many Medicare Advantage plans cover Medicare Part D prescription drug benefits, vision services, and health and wellness programs.
Q. Does Medicare cover dental, eye exams, and hearing aids?
A. Original Medicare doesn't provide that coverage. Most Kaiser Permanente Medicare health plans offer those services through Advantage Plus, an optional benefit package you can add to your plan.* For details, see the Advantage Plus tab in our plans and rates section.
Q. What’s the difference between Medicaid and Medicare?
A. Medicare is a federal program that provides health insurance to people age 65 and over, and to people with certain disabilites, such as end-stage renal disease (ESRD).
Medicaid (Medi-Cal in California) is a public health care program for people with low incomes.
Q. How do I find out about changes in Medicare covered services?
A. Throughout the year, the Centers for Medicare & Medicaid Services CMS sends out updates about additional covered services or changes to existing covered services. These notifications called National Coverage Determinations (NCDs), will be posted here to view and download when they become available.
Advantage Plus is available for all Kaiser Permanente Senior Advantage (HMO) and Medicare Advantage (HMO) individual plan members. Advantage Plus is available for all Medicare Plus (Cost) individual plan members, except for Basic plans. In California, Advantage Plus is not available under the Medicare Medi-Cal (HMO SNP) plan. In Colorado, Advantage Plus is not available under the Medicare Medicaid (HMO SNP) plan.
Q. Does Kaiser Permanente offer Medicare health plans?
A. Yes. We offer affordable Medicare health plans for both individuals and groups. Learn about plans and rates for individuals, or talk to your benefits administrator about group plans.
Q. Has Kaiser Permanente recently expanded?
A. Yes. In 2017, Kaiser Permanente acquired Seattle-based Group Health Cooperative. The move brings Kaiser Permanente to several counties in Washington state.
Q. What are the requirements to join a Kaiser Permanente Medicare health plan?
A. To join a Kaiser Permanente Medicare health plan, you must:
- Be entitled to Medicare Part A and in most cases be enrolled in Medicare Part B
- Reside in the plan's service area
- Enroll during a valid enrollment period
- Not have end-stage renal disease (ESRD). See the next question for exceptions to this rule
Q. Will I be turned down for membership in a Kaiser Permanente Medicare health plan because of my age or medical condition?
A. No. You don’t need a health exam to enroll in a Kaiser Permanente Medicare health plan, and there's no Medicare age limit.
If you have end-stage renal disease (ESRD) and need dialysis, you typically aren’t eligible for one of our Medicare health plans unless you meet these 2 requirements:
- You're currently a Kaiser Permanente member in the region where you wish to enroll
- You were diagnosed with ESRD while a member
You may join our Medicare health plan if you have had a kidney transplant and no longer need life-sustaining dialysis.
Q. If I join a Kaiser Permanente Medicare health plan, will I lose my Medicare coverage?
A. No. You don't lose Part A and Part B coverage. When you become a member, Kaiser Permanente will provide your Medicare benefits to you. You must maintain your Part B Medicare enrollment to keep your coverage in our Medicare health plan.
Q.What do I need to do about the individual plan that I was enrolled in before enrolling in the Kaiser Permanente Medicare health plan?
A. As soon as your enrollment in a Kaiser Permanente Medicare health plan is approved, cancel your previous non-Medicare plan. If you don't, you'll have to pay the premiums for both plans.
Q. What does a Kaiser Permanente Medicare health plan cost?
A. For individuals, the costs depend on the regions where you live. For people enrolling through group coverage, costs vary by the organization.
Learn more about our Medicare Advantage and Medicare Cost plans.
Q. If I work past age 65, when should I sign up for a Medicare health plan, and how?
A. You can sign up for our Medicare health plan as soon as you’re ready to retire. Enroll online or by phone.
Q. I'm a current Kaiser Permanente member. Can I stay with Kaiser Permanente after I start getting Medicare?
A. Yes, you can continue your Kaiser Permanente membership and use your Medicare benefits by joining our Medicare health plan.
Q. Can my spouse join a Kaiser Permanente Medicare health plan, too?
A. Yes, as long as your spouse meets all Medicare health plan enrollment requirements.
Q. How do I enroll in a Kaiser Permanente Medicare health plan?
A. You can enroll: online, by mail, and other options.
Q. How do I enroll in Advantage Plus?
A. You can enroll in Advantage Plus at the same time you enroll in a Kaiser Permanente Medicare health plan.‡
If you've already enrolled in a Kaiser Permanente Medicare health plan and would like to add Advantage Plus, fill out the Advantage Plus enrollment form and mail it to us.
Get enrollment details, including when you can enroll, and download the enrollment form in the Advantage Plus tab in our plans and rates section.
Q. Can I make changes to my health plan enrollment application after I submit?
A. Yes. Call 1-866-973-4588 (toll free) (TTY 711) 8 a.m. to 8 p.m., 7 days a week.
Q. How can I check my enrollment status?
A. Call 1-866-973-4588 (toll free) (TTY 711) 8 a.m. to 8 p.m., 7 days a week.
‡Advantage Plus is available for all Kaiser Permanente Senior Advantage (HMO) and Medicare Advantage (HMO) individual plan members. Advantage Plus is available for all Medicare Plus (Cost) individual plan members, except for Basic plans. In California, Advantage Plus is not available under the Medicare Medi-Cal (HMO SNP) plan. In Colorado, Advantage Plus is not available under the Medicare Medicaid (HMO SNP) plan.
Q. How do I start using my Kaiser Permanente plan benefits? Q. Can I choose my own doctor? A:
A. Visit our website for new members to find facilities near you, choose your doctor, try our online health services, explore our wellness programs, and more.
Yes, you can choose your personal Kaiser Permanente physician and change at any time. Go to kp.org/chooseyourdoctor
Q. How do I find a Kaiser Permanente facility to receive care?
A. Locate our facilities, departments, and services here. You also can contact Member Services to speak to a health plan representative.
Q. How do I transfer my prescriptions?
A. Call to speak with a pharmacy representative. Please have your prescription number(s) and the pharmacy name and phone number ready — we’ll handle the rest.
Q. What are my rights under a Kaiser Permanente Medicare health plan?
A. Your guaranteed rights and protections include:
- 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
- Getting plan information and treatment explanation in a language or format that works for you (languages other than English, Braille, large print, audio tapes)
Find more details in your plan’s documents, such as the Evidence of Coverage, or in the Medicare & You handbook available on www.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 a coverage decision?
A: To request a coverage decision, also called an organization determination, on medical care or service you want but have not received, or to pay 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 provide a response for a fast coverage decision within 72 hours. If we say no to your request for coverage for medical care or payment, you may seek 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 must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for a coverage or payment decision.
If our plan says no to part or all of your appeal, your case will automatically be sent on to Level 2 of the appeals process, which is an Independent Review Organization. That organization will review your appeal carefully and will give you its decision and reasons for it in writing.
- 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 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
For additional details, refer to Chapter 9 in your Evidence of Coverage.
Q: How do I make a complaint about Kaiser Permanente’s process or services?
A: If you’re unhappy with the medical care or services you are receiving, 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, refer to 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 may obtain a summary of information about the appeals and grievances that plan members have filed with Kaiser Permanente. To get this information, please contact Member Services.
You also may use the online Medicare Complaint Form† to transmit a complaint directly to Medicare.
Q: Where can I learn more about how Kaiser Permanente will use my personal health information?
A: View or download the Notice of Privacy Practices for your service area.
Q. How do I recognize and report fraud?
A. Protect your identity. Don't give your Medicare claim number, or other plan information, to anyone other than your plan and care providers.
Look out for signs of fraud or suspicious offers. Some examples:
- Bills or statements for care you never received
- 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).
Q. What can I do on kp.org?
A. If you're a member, register at kp.org to refill a prescription, schedule an appointment, check test results, email your doctor, and much more.
Q. Where can I find information on Advantage Plus?
A. With the Advantage Plus option, you can add coverage such as dental, vision, and extra hearing to your Kaiser Permanente Medicare health plan for a small monthly amount.* To learn more and to apply, see the tab for “Advantage Plus” in our plans and rates section.
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 traveling outside the U.S. Read more about Travel Coverage♦
For more detailed information, please refer to your Evidence of Coverage or contact Member Services.
Note: Kaiser Permanente Medicare Plus (Cost) Basic Option plan does not include urgent or emergency care outside the U.S.—except under limited circumstances.
Q. How do I get care in an 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, medical offices, and pharmacies open to care for you.
In the event of a disaster, we'll post information about access to our facilities, medical offices, and pharmacies on our website.
During a declared state of disaster or emergency, if you need care and you can't make it to a Kaiser Permanente facility, medical office, or pharmacy, or if we're closed:
- Kaiser Permanente will cover medically necessary plan benefits delivered by out-of-network providers.
- You don't need a referral or prior authorization to go outside the network.
- You'll only pay your in-network cost share for these services.
When the Disaster Ends
Once the disaster or emergency is officially declared over, or after 30 days have passed when there is no end date declared, you'll need to use the plan provider network and the normal pre-authorization/referral requirements and cost sharing will resume as described in your Evidence of Coverage.
If we can't resume normal operations, we'll keep you informed about how to receive covered care and prescription drugs and will also notify CMS.
Q. What happens if I leave the service area temporarily?
A. While you’re temporarily outside the Kaiser Permanente service 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 move out of the service area permanently?
A. If you're outside of the service area for more than 3 to 12 months (depending on your plan), or move permanently outside of our service 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. 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 terminated for other reasons, which may include, but are not limited to:
- Failing to pay your Kaiser Permanente premium, if your plan has one
- Living temporarily out of the service area for 90 days to 12 months (depending on your plan)
- Moving permanently out of the service area
- Not staying enrolled in Medicare
See your Evidence of Coverage for causes for disenrollment.
Q. How do I stop receiving mail about Kaiser Permanente Medicare health plans?
A. Call the phone number listed on the piece of mail you received and ask to be removed from the mailing list. If you're already a Kaiser Permanente member, please call Member Services.
Q. What if I don’t want to receive any mail from Kaiser Permanente?
A. Contact Member Services.
*Advantage Plus is available for all Senior Advantage (HMO) and Medicare Advantage (HMO) individual plan members. Advantage Plus is available for all Medicare Plus (Cost) individual plan members, except for Basic plans. In California, Advantage Plus is not available under the Medicare Medi-Cal (HMO SNP) plan. In Colorado, Advantage Plus is not available under the Medicare Medicaid (HMO SNP) plan.