Is Kaiser A Good Medicare Advantage Plan

Kaiser Permanente Medicare Advantage Plans For 2021

If you are looking for a substitute to original Medicare, consider Medicare Advantage. Youll get the coverage that is way better than original Medicare. Kaiser Permanente Medicare Advantage plans for 2021 is one such plan.

Well help you gather information regarding the same. So, you can make an informed decision. Although these plans are not for everyone, eligible people can save a lot of money. The coverage is quite extensive. You might not use all the coverage and if you use the coverage, bear in mind to compare the plans.

A comparison is necessary to fetch you a great deal.

New Market Entrants And Exits

Medicare Advantage continues to be an attractive market for insurers, with 20 firms entering the market for the first time in 2022, collectively accounting for about 19 percent of the growth in the number of plans available for general enrollment and about 6 percent of the growth in SNPs . Thirteen new entrants are offering HMOs available for individual enrollment. Nine of the new entrants are offering SNPs seven firms are offering D-SNPs for people dually eligible for Medicaid, one firm is offering a C-SNP for people with select chronic conditions, and one firm is offering an I-SNP.

Three of the new firm entrants are offering plans in Massachusetts, two are offering plans in California, Florida, North Carolina, South Carolina, and Utah, and the remainder are offering plans in at least one of thirteen other states .

Seven firms that previously participated in the Medicare Advantage market are not offering plans in 2022. Six of the firms had very low enrollment in 2021, while one firm had no enrollment in 2021. Two of the seven exiting firms offered plans in California.

What Are Kaiser Foundation Medicare Advantage Plan Options

Kaiser Foundation offers three HMO Medicare Advantage Plans. With an HMO plan, you have a network of providers you need to use. This includes your primary doctor, and if you need specialist treatment, you must go to in-network providers and hospitals. In return, your medical expenses are generally lower than with other Medicare plans.

The Kaiser Foundation Advantage Plans differ in what you pay for services , additional benefits, and maximum annual out-of-pocket expenses. Depending on the plan, youll pay $10 per visit to your doctor and up to $50 for a specialist.

Kaiser Foundation Medicare Advantage Plans are available in eight states and Washington DC. The following table demonstrates differences between the three Kaiser Permanente HMO plans in Baltimore, MD.

Kaiser Foundation Medicare Advantage Plans

*Based on pricing in Baltimore City, MD.

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Medicare Advantage Plans Send Pals To Seniors Homes For Companionship And Profits

By Phil GalewitzMarch 15, 2022

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Tips For Comparing Plans

No two Medicare beneficiaries have the same needs. You might hate the plan your neighbor loves. So don’t rely on customer reviews or reputation alone. Some questions to ask as you compare plans include:

• Does the Kaiser plan in my area have a good reputation?
• Which doctors does this plan cover? Do these doctors have good reviews?
• How much will I pay for care? What are the copays and what is the deductible?
• Does the plan offer supplemental services?
• Would another plan better serve my needs while offering me more providers to choose from?
• Am I comfortable choosing from a limited pool of providers?

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Kaiser Permanente Medicare Advantage Review

Even though Kaiser Permanentes Medicare Advantage plans are only available in eight states and DC, its enrollment numbers are high. With 8% of all Medicare Advantage recipients enrolled in a Kaiser Permanente plan, this not-for-profit firm is the fourth-largest in the country .1

And despite their limited availability across the country, its easy to see why so many choose an MA plan from Kaiser Permanente. Consistently above-average Medicare Star Ratings and relatively low prices create a high demand for its policies.

Get Extra Coverage With These Best Medicare Advantage Plans

Theres more to Medicare than Original Medicare: An estimated 39% of Medicare beneficiaries are opting for Medicare Advantage. This is when you choose a private health insurance company to provide your Medicare benefits, and the health plans are often area-specific. They provide cost savings to you by creating a regional network of providers the company negotiates with to lower healthcare costs. To stay competitive, Medicare Advantage companies often offer benefits beyond traditional Medicare, such as vision, dental, or hearing coverage.

You can enroll in Medicare Advantage during several key times throughout the year . Because there are many Medicare Advantage options to choose from, we reviewed more than 40 top Medicare Advantage companies. Keep reading to find out who made the cut.

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Is It Better To Have Medicare Advantage Or Medigap

Were often asked which is best, Medicare Advantage or Medigap? The issue really comes down to peace of mind. You dont need supplemental insurance with Medicare Advantage. However, with Original Medicare, you can get supplemental insurance to fill the gaps. This is the main reason people feel that Original Medicare, with a Medigap policy for supplemental coverage, is better than Medicare Advantage.

If you have access to additional benefits that will take care of some or all of your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary’s health insurance plan. These costs can come from the beneficiary’s monthly premiums, deductibles, coinsurance, and copayments…., use those benefits. If not, ask yourself if you are prepared to pay up to the maximum out-of-pocket limit on a Medicare Advantage plan.

When it comes to which is better, Medigap or Medicare Advantage, consider this. If the prospect of pulling an average of $4,925 out of your pocket, which does not include your prescriptions or monthly premiums, makes you nervous, then its time to compare the top Medigap plans in your area. When you do, you will find a wide range of coverage options.

Why Kaiser Medicare Advantage Plans Outrank Others In Customer Satisfaction

J.D. Power’s 1,000-point Medicare Advantage plan survey has ranked Kaiser plans number one for 5 years. In most states where Kaiser Medicare Advantage plans are available, customer satisfaction with Kaiser Medicare Advantage plans is high. Kaiser only offers health maintenance organization plans. With this plan structure, premiums are lower but you must choose a provider within Kaiser’s health network. This approach works well for many seniors, so Kaiser produces consistently high customer reviews.

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Pros And Cons Of Medicare Advantage Plans Vs Original Medicare

In addition to the fact that Medicare Advantage plan insurance carriers are generally obligated to sell you a plan, they also bundle additional benefits, such as vision, dental, hearing, and a prescription drug plan . These are valuable benefits that Original Medicare does not cover. For healthy people, these extras make a Medicare Advantage plan a very good deal.

Many of the extra benefits that some insurance plans offer look very enticing, but they often come with limits or high out-of-pocket costs. For example, a plan may have excellent healthcare benefits and a poor Part D plan .

Also, it is important to understand that the extra benefits, including Part D prescriptions, are not included in the plans maximum out-of-pocket limit. So, lets say you use the plans dental coverage and pay $1,500 in copays for restoration work, that $1,500 is not included in your MOOP, nor are your Part D medications. This is why so many people feel that traditional Medicare, plus a supplement plan, dental plan, and a stand-alone Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each… plan are the best way to go.

Pros And Cons Of Kaiser Foundation Medicare Advantage Plans

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Get Flexible Care With A Kaiser Medicare Cost Plan

Since all Kaiser Medicare Advantage plans are HMOs, plan members have to stay within the Kaiser network of providers in order to have their care covered.

Kaiser does offer a unique type of Medicare Advantage plan known as Medicare Cost plan. Think of this plan as a hybrid of Original Medicare and Medicare Advantage. Heres how it works:

• You must retain your Medicare part B coverage. This is different from a typical Medicare Advantage plan, which replaces your Original Medicare coverage.
• Your Kaiser plan covers you when you visit in-network Kaiser providers.
• Your Medicare Part B covers you if you go out-of-network.
• If you are enrolled in Original Medicare, you can join a Kaiser Medicare Cost plan at any time you dont need to wait for an enrollment period.

A Medicare Cost plan is a good option for you if you want Medicare Advantage benefits but also want the flexibility to see an out-of-network provider. This would be particularly beneficial if you travel frequently or if you simply want to keep seeing a provider who is not part of the Kaiser organization.

Health Insurance Plan Options

Kaiser Permanente offers health insurance for all categories of consumers. That includes individual/family, Medicare, Medicaid and group health insurance.

Most Kaiser insurance plans are health maintenance organization plans, and this type of health insurance only covers in-network care and generally has cheaper monthly costs. This means your medical benefits are limited to Kaiser’s 700 medical offices and 39 hospitals. You’re also required to select a primary care physician who can refer you to specialists as needed.

A key concern for those with ongoing health conditions is that this integration between insurance and health care limits your access to specialists who are not affiliated with Kaiser. Keep in mind that Kaiser may have similar providers who are also well-rated.

The limited network can also be a problem for frequent travelers. When you’re away from home, only urgent care and emergency room services are covered at facilities that are not affiliated with Kaiser. The company also has a dedicated travel line to help you navigate circumstances, coverage or preapproval when youâre traveling to another Kaiser service area or outside of the service area.

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Reason : Free Plans Are Not Really Free

This is true.

The real issue here is peoples misunderstanding of how Medicare Advantage plans work. Specifically, many people dont understand copayments and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. …. So, if you are wondering, how can Medicare Advantage plans be free?, they arent. Far from it.

Just like Original Medicare , Medicare Advantage is a cost-sharing system. With Original Medicare beneficiaries pay about 20 percent of the cost for all Medicare-approved services and Medicare pays 80 percent. With a Medicare Advantage plan, you also pay about 20 percent of your costs, but there is an annual cap that limits your out-of-pocket costs, which solves one of the biggest problems with Medicare Parts A and B.

NOTE: The annual maximum out-of-pocket limit thats built into all Medicare Advantage plans is a major advantage. For those beneficiaries with chronic health conditions, who cannot get a Medicare supplement, the annual MOOP keeps them out of bankruptcy from excessive medical bills.

Most Popular Medicare Advantage Company

AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits.

For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.

The plans may not be as highly rated as those from Kaiser Permanente, but they are still rated above-average while also being priced affordably at about $21 per month.

AARP Medicare Advantage plans are administered by UnitedHealthcare , which offers good benefits and a wide network of providers. There’s also the option to get a PPO plan for better access to out-of-network care.

The company stands out for its broad range of add-on programs and discounts including vision, dental, free gym memberships, mental fitness and a credit toward over-the-counter products. These programs can be especially useful for those who want to stay healthy on a budget.

For most people, AARP’s prescription drug benefits are middle-of-the-road with a typical drug deductible being about $139. However, for those who need expensive medications, many plans provide benefits during the coverage gap . This is an important benefit that can protect those with high prescription drug costs from paying more for medications at some point in the policy year.

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What Are The Advantages And Disadvantages Of Medicare Advantage Plans

In our experience, the question about Medicare Advantage plans comes up because people ask their friends, neighbors, and healthcare providers about them. That brings up the Medicare Advantage nightmares and a litany of reasons why people dislike their current or former plan.

But, is it true?

Over the years, weve heard from many people, healthcare providers in particular, that they dislike Medicare Advantage plans, but that does not mean they are bad.

These are the 7 most common reasons weve documented that make people feel Medicare Advantage plans are terrible:

Medicare Advantage Company With The Largest Network

When comparing provider networks, keep in mind that it’s not always an apples-to-apples comparison because each company publicizes its figures slightly differently. However, the overall trends can give you a snapshot of how broad the health care access could be in your area.

• Blue Cross Blue Shield/Anthem: 90% of doctors and hospitals
• Cigna Healthspring: 1.5 million health care providers, clinics and facilities
• UnitedHealthcare/AARP: 1.3 million health care providers
• Aetna/CVS: 1.2 million health care providers
• Humana: 560,000 providers in the ChoiceCare and Behavioral Health networks
• Centene: 238,000 physicians
• Kaiser Permanente: 80,000 physicians and nurses

Blue Cross Blue Shield has one of the largest provider networks, making it a good choice for those who are seeking flexibility about which doctors and medical facilities they use.

Whether Blue Cross Blue Shield is operating in your area as Anthem, Highmark or another subsidiary, the company’s massive footprint can give you access to one of the industry’s largest provider networks.

This makes BCBS Medicare Advantage plans an especially good choice for those who want the flexibility to get care from a wide range of doctors and medical providers. Not only can this help you see doctors you like, but the wide network is especially useful for those who need specialized health care.

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Medicare Annual Election Period

The Medicare Advantage Annual Election Period , also called Medicare Open EnrollmentIn health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions…., is the period when beneficiaries can enroll in a Medicare Advantage plan, switch plans, add prescription drug coverage, or disenroll from a Medicare Advantage plan and return to Original Medicare. It occurs every Fall from October 15 to December 7. Youll know its coming up when you start seeing Medicare commercials on TV.

Plan Offerings In 2022

Number of Plans

Number of Plans Available to Beneficiaries. For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, more than double the number of plans per person in 2017, and the largest number of options available in more than a decade . These numbers exclude employer or union-sponsored group plans, Special Needs Plans and PACE plans, which are only available to select populations.

Among the 39 Medicare Advantage plans generally available for individual enrollment to the average Medicare beneficiary, 31 of the plans include prescription drug coverage .

Total Number of Plans. In total, 3,834 Medicare Advantage plans are available nationwide for individual enrollment in 2022 an 8 percent increase from 2021 and the largest number of plans available in more than a decade . The vast majority of all Medicare Advantage plans offered include prescription drug coverage in 2022.

HMOs account for about six in ten of all plans offered in 2022, a slight decline from prior years where they accounted for about two-thirds of all plans offered. The availability of local PPOs has increased rapidly over recent years. In 2022, more than one-third of plans offered are local PPOs, compared to a quarter in 2018. Between 2021 and 2022, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.

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Regional Providers With Top Medicare Advantage Plans

In addition to the major insurance companies, there are also regional insurance providers with very highly rated Medicare Advantage plans.

On Medicare.gov, the average star rating for these regional providers is above 4.5, an achievement that Kaiser Permanente is the only national insurer to achieve. For those who want a highly rated plan but who don’t have access to Kaiser Permanente, these smaller insurers are a great option. For example, those living in some areas of New York can choose a Medicare Advantage plan from CDPHP, a 5-star insurer with an average rate of just $44 per month.

Average monthly cost and star rating for 2022 plans sourced from Medicare.gov

Keep in mind that there are a few additional factors to weigh when considering a smaller insurance company. One of the advantages is that a smaller company could be better tied into the local community and have more investment in the health needs of the Medicare enrollees who live in the region.

On the other hand, a smaller company may not have the same financial strength as the major insurers. Among the list of Medicare Advantage plans above, only two have a rating with AM Best: Capital Health Plan has an A+ , and Highmark has an A . These high financial ratings mean that the companies are well-positioned to pay out large claims. The rest of the companies are unrated, which means we don’t have any information about their financial strength.