Kaiser Permanente Medicare health planMedicare health plans tohelp you thriveYour Medicare overview from Kaiser PermanenteY0043 N00013018 M

Get care and coverage designedto help make your life easierWith Kaiser Permanente, you get quality care and coverage together.Your doctors and care team coordinate seamlessly to keep youhealthy. Innovative tools connect you to care whenever you need it.And your personalized treatment plan reflects what’s best foryou and your unique needs.2

The right choice for Medicare startswith understanding your optionsWhether you’re enrolling in Medicare for the first time or shopping for a new plan tobetter meet your needs, we can help you make a confident, informed decision.Here, you’ll find valuable information to help you choose the right Medicare coverage.In this booklet, we’ll explain the different parts of Medicare, how much they could cost,and how you can sign up. You’ll also see how Kaiser Permanente can help you enjoylife to the fullest with care and coverage in one easy-to-use package.Table of contentsMedicare: an overview. 2Part A.3Part B.5Part C.7Part D.9Get more with a Kaiser Permanente Medicare health plan. 13Your care, your way.14Get care the way you want — in person, by phone, or onlinePersonalized care that fits your life.14Enjoy predictable costs and the freedom to choose your Kaiser Permanente doctorPrescription drug coverage.16Manage your prescriptions to make sure you get the most effective and safeprescription medications availableAdditional coverage.17Choose an optional dental plan and moreConvenient locations nationwide.18Find Kaiser Permanente care services throughout the country1

Medicare: an overviewUnderstanding Parts A, B, C, and DMedicare is a federal health insurance program that provides health carecoverage to millions of Americans. It’s part of Social Security and designed toprotect the health and well-being of those who use it.There are 4 parts to Medicare: A, B, C, and D. Each part covers specific services,from medical care to prescription drugs. In the following section, you can readabout each part to better understand what coverage best fits your needs.Helpful resourcesWe want you to understand your choices and options. If you have questions, here are somehelpful resources:MedicareSocial SecurityCall 1-800-633-422724 hours a day, 7 days a weekTTY users, call 1-877-486-2048Visit Medicare.govCall 1-800-772-12137 a.m. to 7 p.m., Monday through FridayTTY users, call 1-800-325-0778Visit SocialSecurity.gov2

PART AWHAT TO KNOWPart A provides coverage for hospital services, including skilled nursing and hospice care.If you meet the qualifications, you can get Part A without paying a premium. You must haveParts A and B to get Part C.Part AHospital coverageMedicare Part A is offered by the federal government to help you pay for your inpatientcare (care you get when you stay in a medical facility).What it coversPart A covers inpatient care, if you meetcertain conditions and get the care inMedicare-certified hospitals and otherfacilities. It includes: I npatient care you get at hospitals andrehabilitation facilities I npatient hospital stays in skilled nursingfacilities (not custodial or long-term care) Hospice care services Home health care services I npatient care in religious, nonmedicalhealth care institutionsHow do I know if I’m eligiblefor Part A?If you’re 65 or olderYou can get Part A without paying apremium if: Y ou get retirement benefits fromSocial Security or the Railroad RetirementBoard (RRB) Y ou’re eligible to get Social Security or RRBbenefits but haven’t yet filed for them Y ou or your spouse worked for at least10 years and paid Medicare taxesHow much does it cost?You typically won’t have to pay a premium forPart A, but there are exceptions. If you do haveto pay a premium, you may be able to get helpfrom the state to pay for it.continues3

PART A continuedIf you’re younger than 65How do I enroll?You can get Part A without payinga premium if:To learn more and enroll, call Social Security at1-800-772-1213 (TTY 1-800-325-0778),7 a.m. to 7 p.m., Monday through Friday, orvisit Y ou’ve had Social Security or RRB disabilitybenefits for 24 months Y ou have end-stage renal disease and meetcertain requirementsI f you don’t meet any of those conditions,you may be able to buy Part A if: You meet citizenship andresidency requirements Y ou’re 65 or older, and you didn’t workor didn’t pay enough Medicare taxes whileyou worked You’re disabled and have returned to workIf you already get benefits from Social Securityor the RRB, your Medicare Part A coveragewill automatically start as soon as you qualify.If you aren’t getting Social Security benefits(for example, if you’re still working), you mayneed to sign up for Part A, even if you’reeligible to get Part A at no cost.How do I know if I have Part A?To see if you have Part A coverage, look for“HOSPITAL (PART A)” printed on your red,white, and blue Medicare card.4

WHAT TO KNOWPART BIf you want coverage for outpatient services, like doctor’s office visits, and you meet thequalifications, you can sign up for Part B. In most cases, if you sign up for Part A, you mustalso sign up for Part B when you’re first eligible. If you don’t, you may have to pay a lateenrollment penalty for as long as you have coverage.Part BMedical coverageMedicare Part B is coverage from the federal government to help you pay for some medicalservices that aren’t covered by Part A.What it coversHow much does it cost?Part B covers a range of outpatientservices, including:Most people pay a monthly premium forPart B, usually deducted from their SocialSecurity checks. Premiums are set each yearby the Centers for Medicare & MedicaidServices (CMS). Your yearly income, whetherhigh or low, affects how much you’llhave to pay. Doctor’s office visits Specialist visits P reventive care, such as flu shots andmammograms Lab costs, such as blood work and X-rays M edical equipment, such as wheelchairsand walkers Physical therapy Mental health care Ambulance services Annual wellness visits2019 Part B premium and deductible:Average monthly premium 135.50Average yearly deductible 185.00If your income is higher than 85,000( 170,000 per couple), you might have ahigher premium.Note: The above dollar amounts are for2019 and may change in 2020.continues5

PART BcontinuedHow do I know if I’m eligiblefor Part B?If you’re 65 or older, you can buy Part Bcoverage from the federal government. If youalready get benefits from Social Security orthe RRB, you may be automatically enrolled inPart B. You may also be eligible for Part B ifyou have certain disabilities, includingend-stage renal disease. In most cases, ifyou get Part A coverage, you must also signup for Part B coverage during your initialenrollment period or your special enrollmentperiod. If you don’t, you may have to paya late enrollment penalty for as long asyou have coverage. This could mean anincrease of your monthly premium.How do I know if I have Part B?To see if you have Part B coverage, look for“MEDICAL (PART B)” printed on your red,white, and blue Medicare card.6 do I enroll?To learn more and enroll, call Social Security at1-800-772-1213 (TTY 1-800-325-0778),7 a.m. to 7 p.m., Monday through Friday, orvisit

WHAT TO KNOWPART CIf you want coverage that includes more than what’s in Parts A and B, consider Part C.Part CMedicare AdvantageOriginal Medicare (Parts A and B) doesn’t cover all medical costs. You can buy more coveragethrough private health plans to help cover extra costs.These Medicare-approved private health plans — called Part C or Medicare Advantage plans— include both Part A and Part B coverage, plus additional benefits. Medicare pays an amountfor your coverage each month to these private health plans. There are many types of MedicareAdvantage plans, but we’ll explain 2 types that Kaiser Permanente offers — Medicare AdvantageHealth Maintenance Organization (HMO) plans and Medicare Cost plans.What it coversIn addition to services covered by Parts A and B,Medicare Advantage plans may also cover: Emergency and urgent care Vision services Hearing services Dental services Health and wellness programsMedicare Cost plans: In some areas of thecountry, you may be able to buy a MedicareCost plan. With a Cost plan, if you go to anon–network provider, the services arecovered under Original Medicare. You’d paythe Part B premium, a monthly health planpremium (if applicable), and any Part A andPart B coinsurance and deductibles. Medicare Part D prescription drug coverageMedicare Advantage HMO plans: Like OriginalMedicare, with Medicare Advantage HMOplans, you’ll usually use network providers foryour care. By getting care in a coordinatednetwork, you’ll likely have predictable copaysand out-of-pocket expenses. If you go to anon–network provider, you’ll probably haveto cover the cost.continues7

PART C continuedHow much does it cost?What you pay for coverage depends on: If the plan charges a monthly premium inaddition to your Part B premium If the plan pays any of your monthlyPart B premium If you have a Part D late enrollment penalty Your yearly deductible Your copays and coinsurance The types of services you need Whether the plan includes a limit onout-of-pocket costsHow do I know if I’m eligible forPart C (Medicare Advantage andMedicare Cost)?In most cases, you can join a MedicareAdvantage plan if: You have Original Medicare (Parts A and B) You live in the plan’s service area You don’t have end-stage renal disease(exceptions apply) You enroll when the plan is acceptingnew membersWith a Medicare Cost plan, you can: Join, even if you only have Part B Join a plan with Part D coverage anytimethe plan accepts new members Join a plan without Part D coverage atany time of the year Return to Original Medicare at any timeHow do I enroll?Sign up directly with the plan of your choice.For information on Kaiser PermanenteMedicare health plans, visit Supplement Insurance plansIf you choose Original Medicare, you can purchase Medicare SupplementInsurance plans — also called Medigap plans — to help you pay for care notcovered by Parts A and B. Unlike Medicare Advantage, these plans offer limited coverageand don’t include prescription drug coverage. You’d pay the Part B premium, a monthlyhealth plan premium, and any coinsurance and deductibles for out-of-network care.8

WHAT TO KNOWPART DIf you have Medicare Parts A and B through Original Medicare and want prescription drugcoverage, consider Part D or a Medicare Advantage or Medicare Cost plan with Part D coverage.Like Part B, Part D has a late enrollment penalty.Part DPrescription drug coveragePart D is an optional plan offered by Medicare-approved private companies and covers some ofthe costs for prescription drugs. You can sign up for a Part D plan if you have Part A, Part B, or both.What it coversHow much does it cost?Medications covered by your Part D planvary based on the plan’s formulary. Aformulary is a list of medications coveredby a plan and approved by CMS.Your Part D costs depend on which planyou choose.You may be able to request coveragefor a Part D drug that’s not covered onthe plan’s formulary.All Part D prescription drug plans, includingMedicare Advantage and Medicare Costplans that offer Part D, must provide coveragethat’s equal to or better than the standardPart D benefits.These plans can enhance coverage by: Lowering deductiblesStandard Part D costs include: Monthly premium — The amount you pay foryour Part D coverage. This varies by plan. Yearly deductible — The amount you pay foryour prescriptions before your plan starts topay its share. Once you reach your deductible,you’ll pay only your copay or coinsurance.Not all Part D plans have a deductible. Copays and coinsurance — The amountyou pay for covered drugs after your planpays its share. This varies depending onyour plan benefits. Offering a different but equal share of thecost as the standard benefit, or improvingyour share of the cost Covering certain drugs through thecoverage gapcontinues9

PART D continuedYour costs depend on the coveragestage you’re inWhen you meet certain dollar limits onPart D drug expenses, you’ll move throughthe Part D coverage stages and pay differentcopays and coinsurance. Initial coverage stage — You pay thecopays and coinsurance set by your planafter your plan pays its share. Once youreach a certain dollar limit, you move to thecoverage gap stage. Coverage gap stage — You pay more foryour drugs. Most Medicare health plans withPart D coverage have a coverage gap. Thismeans that after you and your plan havespent a certain amount in drug costs, thenyou have to pay more for your drugs whileyou are “in the gap.” The amount you mustpay varies by plan. Once you reach a certaindollar limit, you move to the catastrophiccoverage stage. Catastrophic coverage stage — You usuallypay a smaller share of the cost, which appliesfor the rest of the year. Most people neverreach this stage.10 drugs cansave you moneyAs you look at formularies, you’ll oftensee listings for generic and costlierbrand-name prescription drugs.Generic drugs are required by theFood and Drug Administration tomatch brand-name drugs in: Ingredients Strength Quality Performance SafetyYou can keep your costs down byasking your doctor to prescribe yougeneric medications.And keep an eye on your formulary —new generic drugs are regularly added.

PART DGetting financial helpHow do I enroll?If you’re on a limited income, you mayqualify for Extra Help, which could helpyou pay part or all of the costs of Part Dpremiums, deductibles, and your share ofprescription drug costs. If you think youmight qualify, contact Social Security at1-800-772-1213 (TTY 1-800-325-0778),7 a.m. to 7 p.m., Monday through Friday, orvisit are 2 ways to get Medicare Part Dprescription drug coverage: Join a Part C plan(a Medicare Advantage or Medicare Cost plan)with Part D prescription drug coverage or aMedicare prescription drug plan.How do I know if I’m eligiblefor Part D?Before you join, please note:You’re eligible for Part D if you have MedicarePart A or Part B. If you decide not to sign upduring your first enrollment period, you mayhave to pay a late enrollment penalty, which is1% of your monthly premium for every monthyou delayed your enrollment.You can sign up directly with a plan of yourchoice, or contact Medicare at 1-800-633-4227(TTY 1-877-486-2048), 24 hours a day,7 days a week, or visit You can only join, change, or drop Part Dplans during certain times of the year orunder certain special circumstances You can only have one Part D plan at a time If you have a Medicare Advantage planwith Part D coverage, joining a Medicareprescription drug plan could make you loseyour Medicare Advantage plan and go backto Original Medicare11


Get more with aKaiser PermanenteMedicare health planOur Medicare health plan is hereto help you thriveWhy choose Kaiser Permanente?The high-quality care you deserve. The predictable costs youneed. The doctor choice you want. With a Kaiser PermanenteMedicare health plan, you’ll get benefits that support yourgoals and help you thrive. Plus, many of our plans includeprescription drug coverage, so you can enjoy the convenienceof all-in-one coverage in a single plan.1Learn more about the additional benefits we offer to help youget care that best fits your life.For more information on our Medicare health plans,visit

Your care, your wayCome inCallMany services under one roofIn most Kaiser Permanente facilities, you can see your doctor,get lab work or X-rays done, and pick up your prescriptions— often in one trip. In many regions, specialists’ offices andhospitals are also at the same location.Care by phoneIf you have a condition thatdoesn’t require an in-personexam, you can save yourselfa trip to the doctor’s officeby scheduling a phoneappointment. Plus, careguidance and advice areavailable by phone 24/7.Worldwide care when it matters mostTraveling outside of our coverage area? Relax — as aKaiser Permanente member, you’re covered for emergencyand urgent care anywhere in the United States or in the world.2Personalized care that fits your lifeConsistent costs for quality careBetter care with a connected teamWith a Kaiser Permanente Medicare healthplan, you pay predictable copays andcoinsurance, and no additional costs forpreventive services like your yearly checkup,mammograms, prostate exams, flu shots,and cholesterol tests.Your doctor, nurses, and other specialistswork together to keep you healthy. They’reconnected to each other, and to you,through your electronic health record.3So they know important things about youand your health — like when you’re due for ascreening and what medications you’retaking. A connected care team helps ensurenothing gets missed or forgotten, so youcan stay on track.14

As a Kaiser Permanente member, you have many convenient options forgetting care the way you want it.ClickManage your health onlineYou can email your doctor’s office, view most test results, refill most prescriptions, andschedule or cancel appointments — all online.3 You can also download the Kaiser Permanentemobile app, at no cost, to manage your health on the go.Find the care you needVisit to learn about all the care options in your region. Get advice, make anappointment, find a nearby Kaiser Permanente urgent care center, and more.You can feel confident about the care you get with a Kaiser PermanenteMedicare health plan.Choose your Kaiser Permanentedoctor — and change to anotheravailable Kaiser Permanentedoctor anytimeAll our available doctors welcomeKaiser Permanente Medicare health planmembers. Read profiles online so you canselect your personal doctor based on what’simportant to you — education, languagesspoken, specialties, and more. Plus, youhave the freedom to switch to another availableKaiser Permanente doctor at any time.If you’re already a member and are joiningour Medicare health plan, you can stay withthe health care team you know and trust.Quality care with you at the centerPreventive care can help keep you healthy, butwe’re also here if you get sick or need specialtycare. Your primary doctor can refer you to a fullrange of specialists, including cardiologists,orthopedists, audiologists, and more. Ourdoctors are highly trained and experienced inmedicine and come from renowned medicalschools. More importantly, they’re passionateabout delivering high-quality care.15

Prescription drug coverageBenefitOrdering prescriptionsWith most of our plans, y