How Does Medicare Work with Kaiser?

Doctor giving patient pills on Kaiser

Kaiser is a name in the healthcare world that many people find familiar. The organization has been around since 1945 and is now the largest managed care organization in the United States. It offers plans to all individuals but also has plans directed at Medicare beneficiaries.

Today, we’ll learn more about what Kaiser Permanente is and how they work with Medicare.

What Is Kaiser Permanente?

Kaiser Permanente offers health insurance in eight states, as well as the District of Columbia. It’s comprised of three entities: the Kaiser Foundation Health Plan, the regional Permanente Medical Groups, and the Kaiser Foundation Hospitals. There are approximately 11.7 million people insured by a Kaiser insurance plan. They offer business insurance, individual and family health insurance, and Medicare Advantage plans. We’ll focus on the Medicare aspect of Kaiser today.

Kaiser and Medicare Advantage

All Kaiser health plans are managed-care plans. That is no different when it comes to their Medicare options. Kaiser only offers one kind of Medicare plan: Medicare Advantage.

Medicare Advantage, otherwise known as Medicare Part C, is one way Medicare beneficiaries can choose to supplement their coverage from Original Medicare. Original Medicare, Parts A and B, offers coverage for inpatient and outpatient services but leaves beneficiaries with many out-of-pocket costs. A Medicare Advantage offers an alternative solution.

If you enroll in a Medicare Advantage plan – from Kaiser or any other private insurance company – it will essentially replace Original Medicare. You must still enroll in Parts A and B before you enroll in Medicare Advantage, but instead of getting your benefits from the federal program, you’ll be receiving them from the private carrier instead. (All except hospice benefits, which are still provided by Medicare Part A.)

You must still pay any premiums owed for Original Medicare. Most people enjoy premium-free Part A, but everyone pays a monthly premium for Part B. The benefit of enrolling in Medicare Advantage is that many of these plans include extra benefits you won’t find in Original Medicare.

Every Medicare Advantage plan is different. They have different premiums, cost-sharing amounts, coverage levels, and networks. In addition, there are several different types of Medicare Advantage plans. Kaiser only offers the HMO (Health Maintenance Organization) option.

Old couple during online consultation on Kaiser
This physician will oversee all your medical treatment and will coordinate the care you get from other providers.

What does HMO mean? HMO plans are a type of managed care health insurance plan that restricts coverage to a certain network of providers and hospitals. If you enroll in a Medicare Advantage plan from Kaiser, you’ll need to receive care from their providers at their facilities. Going outside the network will result in no coverage, and you’ll be responsible for the entire bill.

While an HMO plan certainly limits your ability to choose your own providers, there are some advantages as well. The reason these plans are referred to as “managed-care” is that you’ll have one dedicated primary care physician. This physician will oversee all your medical treatment and will coordinate the care you get from other providers. This offers an approach that ensures all your doctors are on the same page. They focus on preventive medicine, which keeps their costs down, and, ultimately, keeps you healthier.

Plus, because your choices are more limited, most HMO plans have lower cost-sharing amounts than other kinds of health insurance plans, like PPOs (Preferred Provider Organizations). As long as you stay within the plan’s network, you can expect minimal out-of-pocket costs for most services.

The benefit to Kaiser in all this is their payment from the Medicare program. Just like any other carrier offering Medicare Advantage plans, Kaiser is paid for every enrollee. Their profits are then directly impacted by how much they spend on healthcare for their members. This is why they focus heavily on preventive, less-expensive treatment.

If you’d like to learn more about Medicare Advantage plans, speak with one of the licensed agents at Carolina Senior Benefits. We offer plans from many carriers, so you can look at your options and select the plan that makes the most sense for you. That may be Kaiser, but it could also be a number of other carriers. It’s important that you compare plans to make sure you’re getting the most out of your Medicare benefits!