Kaiser Permanente Medicare Insurance Review & Complaints: Health Insurance (2024)

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One of the biggest names in HMO health plans, Kaiser Permanente is a California-based company serving eight states. They offer individual and group health insurance plans as well as Medicare Advantage.

In this Kaiser Permanente Medicare insurance review, we’ll look at the plans offered by Kaiser as well as how to get Kaiser Permanente Medicare quotes.

Before you decide to buy Kaiser Permanente Medicare insurance, make sure you have checked out all of your options. Compare rates from top companies right here. All you have to do is enter your ZIP code for free quotes.

About Kaiser Permanente

The roots of Kaiser Permanente are found in the creation of Industrial Indemnity in 1933, which was founded by Henry J. Kaiser to provide worker’s compensation insurance for his employees. The new insurance company partnered with a hospital also recently founded in Desert City, CA by Dr. Sidney Garfield. The partnership provided access to health care for workers on the California Aqueduct. By 1942 Permanente Health Plan was officially established, serving workers and their families.

Expansion came with the end of the Second World War, and the company added the name of one of its founders to become Kaiser Permanente. By 1977 the managed health care system was operating in six regions, but expansion slowed and eventually the company scaled back, withdrawing from Texas and North Carolina in the 90s.

Today the company operates in California, Oregon, Washington, Hawaii, Colorado, Georgia, Maryland, Virginia, and D.C. They have around 12 million members with the vast majority of those located in California.

Kaiser operates as a consortium made up of three separate companies, forming a blend of for-profit and not for profits. The company’s headquarters is located in Oakland, CA. They are very active in group health insurance plans, but also sell individual plans and Medicare Advantage; all of their plans are HMO.

What is Kaiser Permanente Medicare Advantage?

Kaiser Permanente Medicare coverage options vary depending on the state and even by county. For the purpose of this review, we used our usual sample area in Southern California to take a look at plans and rates.

In our sample area, Kaiser has only one Medicare Advantage plan available, which includes Part D prescription drug coverage.

The Senior Advantage plan is a $0 premium plan (you pay nothing but your usual Original Medicare premiums) with no deductible. Copays are $5 for primary care and $10 for specialists. Inpatient hospital stays with this plan have a copay of $100 a day for the first seven days.

The plan does not have a pharmacy deductible either, and Tier 1 drugs start at a $3 copay.

The plan includes basic dental and some hearing coverage, and there is the option to add on Advantage Plus, which increases those benefits for a monthly premium. It also adds on dental coverage and a fitness benefit.

As with all plans, the Senior Advantage is an HMO plan with no out of network coverage except in the event of an emergency; providers are limited to the Kaiser network.

Kaiser Permanente Medicare Supplement is not currently available.

What Are Kaiser Permanente Medicare Rates?

As already noted, the plan available by Kaiser does not have a premium beyond what you pay for Original Medicare Part A & B. If you wish to add on the Advantage Plus endorsement, the monthly cost is $16.

This is really affordable compared to the other options out there, and it includes low copays for office visits. Even the add-on for supplemental benefits is reasonably priced. As far as zero-premium plans go, it is quite basic, and we have seen some that include dental, hearing, and vision with no added premium. Overall, however, Kaiser is one of the least expensive options.

HMO plans usually have lower premiums than do PPO plans; keeping coverage within a limited network is what helps managed care companies keep the premiums lower.

Kaiser Permanente Medicare Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Kaiser Permanente Medicare plans offer a straightforward claims process for their members. Since Kaiser operates as an HMO (Health Maintenance Organization), all services are in-network, making it relatively easy to file claims.

Members can typically file claims directly with healthcare providers, and there is generally no need for insured individuals to be directly involved in claims filing or processing.

Average Claim Processing Time

Kaiser Permanente doesn’t provide specific information on their website regarding the average claim processing time. However, as an HMO, the company focuses on efficient and timely processing of claims for covered services. The exact processing time may vary depending on the specific circumstances and healthcare providers involved.

Customer Feedback on Claim Resolutions and Payouts

Based on available information, Kaiser Permanente generally receives positive feedback when it comes to claim resolutions and payouts. The company has low complaint volumes considering its size, and it consistently ranks well with consumer surveys.

Better Business Bureau (BBB) ratings for various Kaiser locations are generally positive, with an A+ rating for the headquarters location and a low volume of complaints. Additionally, Medicare has awarded Kaiser Permanente high ratings for their plans.

Digital and Technological Features of Kaiser Permanente Medicare

Mobile App Features and Functionality

Kaiser Permanente offers a mobile app that provides members with convenient access to various healthcare-related features and functionalities.

The app typically allows members to view their health plan information, find doctors and facilities, schedule appointments, refill prescriptions, and even access telehealth services. It serves as a valuable tool for managing healthcare needs on the go.

Online Account Management Capabilities

Kaiser Permanente provides robust online account management capabilities through their website. Members can log in to their accounts to review their coverage, access plan documents, view claims history, make payments, and communicate with customer support. The online portal offers a user-friendly interface for managing healthcare-related tasks and information.

Digital Tools and Resources

In addition to the mobile app and online account management, Kaiser Permanente offers various digital tools and resources to assist members in managing their health and wellness. These may include health assessment tools, educational resources, personalized health plans, and access to telehealth services.

These digital resources aim to empower members to make informed healthcare decisions and stay engaged in their well-being. Kaiser Permanente’s commitment to providing digital and technological features enhances the overall member experience, offering convenience, accessibility, and support in managing their healthcare journey.

What Are Kaiser Permanente Ratings and Consumer Reviews?

There are a number of Better Business Bureau (BBB) files for various Kaiser locations, but the file for the headquarters location has an A+ rating with a total of 49 complaints on file. Other complaints are scattered throughout the local BBB files, but we saw a very low volume of complaints overall considering the size of this company.

Each of Kaiser’s state branches has its own record with the National Committee for Quality Assistance. In most states, they have earned the highest rating – 5 out of 5, with 4.5 out of 5 in Georgia and part of Washington. These are impressive scores that are not often seen.

Kaiser also earned a 5 out of 5-star rating from Medicare for their 2020 plans, with the exception of the Northwest region where it earned 4.5 stars. 5 stars is the highest rating and not an accomplishment we see very often. They appear to consistently rank well with consumer surveys.

Consumer Affairs, a common site for insurance company complaints, has a total of 923 reviews of the company. Of the 161 reviews submitted in the past year, 122 were one-star ratings and 22 were five-star, with the rest in between. The complaints are mainly focused on poor customer service and denial of claims. Considering the number of members Kaiser has, this is not a high complaint volume.

Kaiser Permanente Medicare: What’s the Bottom Line?

Kaiser gets high marks for its Medicare Advantage plans from the top rating services, and their complaint volume is not high for a huge company. They do not have much to choose from in terms of plans, and some may find the limitations of an HMO network problematic, but if such things would work for you, Kaiser is a good bet. Kaiser Permanente Medicare enrollment is easy and information readily available online.

Affordable Kaiser Permanente Medicare insurance may be available to you, but that doesn’t mean you shouldn’t shop around. Make sure you have the best plan at the best price by entering your ZIP code below to compare rates now.