Speak with a licensed insurance agent

1-855-398-0716

TTY user 711 Mon-Fri : 8am-9pm EST

Kaiser Medicare Senior Advantage Benefits

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 8, 2026

Kaiser Senior Advantage plans cover all Part A and Part B services except hospice inside Kaiser’s system, usually include drug coverage, and may include extras such as dental, vision, hearing, fitness and virtual care.

Benefits vary by plan and region; not all plans offer all benefits. For 2027 Kaiser drops its last 3 PPOs and leaves 2 Nevada and 3 Washington counties.

✔ Licensed in all 50 states
✔ Based on CMS 2027 data
✔ Free plan comparison

Key Highlights

✔

Covers all Part A and B services.

✔

Drug coverage on most plans.

✔

Extras vary by plan.

✔

Kaiser drops last PPOs.

✔

The national average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).

✔

Annual Enrollment runs October 15 to December 7, 2026.

Compare plans and enroll online

Senior Advantage Benefits at a Glance

Benefit Area What Kaiser Senior Advantage Plans May Include Check
Medical and hospital All Part A and Part B services except hospice, in Kaiser facilities Copays per visit or stay
Drugs Part D coverage, often through Kaiser pharmacies and mail order 2027 formulary and tiers
Preventive care Screenings, wellness visits and vaccines Usually low or no cost
Dental Some plans may include dental or offer it as an option Annual limits and dental network
Vision and hearing Exams and allowances on some plans Allowance amounts
Fitness Fitness benefit on some plans Program and locations
Virtual care Video visits and secure messaging with your care team Copays

Not all plans offer all benefits. Benefits vary by plan and region.

Benefits Kaiser Senior Advantage Plans May Offer

Kaiser Senior Advantage Plans May Include

✔

Hospital and medical coverage, the same as Original Medicare Part A and B

✔

Part D prescription drug coverage on most plans

✔

Routine dental, vision and hearing benefits

✔

Fitness programs and over-the-counter allowances

✔

Telehealth visits and care coordination programs

✔

A yearly out-of-pocket maximum on every plan

Not all plans offer all benefits. Benefits vary by plan and county and can change for 2027. Check each plan’s Evidence of Coverage before you enroll.

Kaiser Medicare Senior Advantage Plans

What Changed at Kaiser for 2027

9 States + D.C.

Kaiser Permanente Medicare Advantage service areas for 2027, including Nevada.

5 Counties

Kaiser is leaving 2 counties in Nevada and 3 in Washington.

Last 3 PPOs

Kaiser is dropping its remaining PPO plans.

Watch for: if your plan is ending, you will get a non-renewal letter. Your coverage continues through December 31, 2026. If you do nothing, you return to Original Medicare without drug coverage.

Find & Compare Plans Online

Speak with a licensed insurance agent

1-855-398-0716TTY 711

Mon-Fri: 8am-9pm ET

Benefits Built on Integrated Care

How Kaiser Delivers Benefits

✔

One shared medical record across doctors, labs and pharmacy

✔

Care teams that may help manage chronic conditions

✔

Labs, imaging and pharmacy often in the same building

✔

Video visits and secure messaging with your doctor

Questions to Ask About Benefits

Benefit Checklist

1

What changed for 2027? Read the Annual Notice of Change.

2

Which extras does my plan include? Dental, vision, hearing and fitness differ by plan.

3

What are the copays? Check primary care, specialist and hospital copays.

4

What is the out-of-pocket maximum? Every plan has one.

Prescription drug coverage in Kaiser Senior Advantage

How Medicare Advantage Works

Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company approved by Medicare. The plan covers everything Original Medicare Part A and Part B cover, except hospice care, which Original Medicare still pays. Most plans also include Part D drug coverage, and many may add extras such as routine dental, vision and hearing benefits.

In exchange, Kaiser Senior Advantage plans generally use networks of doctors and hospitals, and may require referrals or prior authorization for some services. Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered medical care, which Original Medicare does not have. You keep paying your Part B premium, plus your plan’s premium if it has one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Pros and Cons of Medicare Advantage

Advantages

✔

Often a low or $0 premium

✔

A yearly out-of-pocket maximum

✔

Drug coverage usually included

✔

Many plans may include dental, vision and hearing benefits

✔

One card and one plan

Tradeoffs

✔

Networks; HMOs require in-network care except emergencies

✔

Prior authorization and referrals are common

✔

Copays add up if you use a lot of care

✔

Plans and networks can change every year

✔

Switching to Medigap later may require health questions

Kaiser Senior Advantage Drug Coverage for 2027

Most Kaiser Senior Advantage Medicare Advantage plans include Part D drug coverage. Each plan has its own formulary, drug tiers and pharmacy network, and plans commonly charge less at preferred pharmacies and through mail order. For 2027, any plan’s Part D deductible can be up to $700, and the out-of-pocket cap on covered drugs is $2,400.

Tier Typical Drugs Typical Cost
Tier 1 Preferred generics Lowest copay
Tier 2 Generics Low copay
Tier 3 Preferred brand-name drugs Moderate copay
Tier 4 Non-preferred drugs Higher copay or coinsurance
Tier 5 Specialty drugs Highest coinsurance

Tier structures vary by plan. Check each plan’s formulary.

Sometimes a drug you take is not on a plan’s 2027 formulary, or it carries a rule like prior authorization. You still have options:

If Your Drug Is Not Covered

1

Ask for a transition fill. In the first 90 days of a new plan year or a new plan, plans generally must give you a temporary supply of a drug you were already taking, so you have time to switch or request an exception.

2

Ask your doctor about alternatives. A covered drug in the same class may work as well and cost less.

3

Request a formulary or tiering exception. Your doctor submits a statement explaining why you need the drug or a lower copay. Plans must decide within set time limits.

4

Appeal a denial. If the plan says no, you can appeal, and there are several levels of review.

See steps to appeal a Medicare Part D denial.

If Your Plan Is Ending

If your Kaiser Senior Advantage plan will not be offered in your county for 2027, you should have received a non-renewal notice in early October. Your coverage does not stop right away: it continues through December 31, 2026, so you have time to choose.

If Your Plan Is Ending

1

Read the non-renewal letter. It confirms your plan is ending and explains your options.

2

List your doctors and drugs. You will need them to compare replacement plans.

3

Compare plans for 2027. Check networks, drug coverage and the out-of-pocket maximum, not just the premium.

4

Choose by December 31 for no gap. Enrolling during Annual Enrollment by December 7 gives you coverage on January 1, 2027.

5

Use your Special Enrollment Period if needed. People whose plans end generally can still make a choice through the end of February 2027.

If you do nothing: you return to Original Medicare on January 1, 2027, without drug coverage unless you choose a Part D plan. Going without drug coverage can lead to a late enrollment penalty.

Medigap rights: when your Medicare Advantage plan leaves your area, you generally have a guaranteed issue right to buy certain Medicare Supplement plans without health questions, up to 63 days after your coverage ends.

How to Compare Kaiser Senior Advantage Plans for 2027

How to Compare

1

Read your Annual Notice of Change. It lists every change to your current plan for 2027.

2

Check your doctors and hospitals. Confirm each provider is in the 2027 network, not just the 2026 one.

3

Check your prescriptions. Confirm each drug, its tier and any prior authorization or step therapy rules.

4

Compare total yearly cost. Add the premium, typical copays and drug costs, and look at the out-of-pocket maximum.

5

Check star ratings. Medicare rates plans from 1 to 5 stars on quality and service.

6

Enroll by December 7. Your new coverage starts January 1, 2027.

2027 Enrollment Dates

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Join, switch or drop a Medicare Advantage or Part D plan for January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 If you are in Medicare Advantage, switch to another plan or return to Original Medicare once
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Change plans after events like moving, losing other coverage or your plan leaving your area

Most people make changes during Annual Enrollment. If you are happy with your current plan, you do not have to do anything; it renews automatically. Still, read your Annual Notice of Change, because premiums, copays, networks and drug lists can all change on January 1.

Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plans built for specific groups. Benefits, networks and drug lists are designed around the members they serve, and many include care coordinators. For 2027, Special Needs Plans are one of the few areas where large insurers are adding plans, even as they cut PPOs.

Type Who Qualifies What Is Different
Dual Special Needs Plan (D-SNP) People with both Medicare and Medicaid Coordinates both programs; often very low costs and added benefits
Chronic Condition SNP (C-SNP) People with qualifying conditions such as diabetes, heart failure or chronic lung disease Doctors, drugs and programs built around the condition
Institutional SNP (I-SNP) People living in a nursing home or who need that level of care at home Care delivered where the member lives

Turning 65 in 2027

If you turn 65 in 2027, your Initial Enrollment Period lasts seven months: the three months before your birthday month, your birthday month and the three months after. Signing up during the first three months means your coverage starts on the first day of your birthday month.

Turning 65 Checklist

✔

Sign up for Part A and Part B, unless you have qualifying employer coverage and choose to delay Part B

✔

Decide between Medicare Advantage and Original Medicare with Medigap

✔

Join a drug plan, or a Medicare Advantage plan with drugs, to avoid a Part D late penalty

✔

If you choose Medigap, buy during your six-month Medigap Open Enrollment Period

Star Ratings

Medicare rates every Medicare Advantage and Part D plan from 1 to 5 stars each fall, based on things like preventive care, how well the plan manages chronic conditions, member complaints, customer service and drug pricing accuracy. The ratings are shown in Medicare Plan Finder.

Using Star Ratings

✔

A rating of 4 stars or higher is generally a good sign of quality and service

✔

Five-star plans have a special enrollment period, so you can switch into one once during the year

✔

New plans may not have a rating yet, which is not a bad sign by itself

✔

Ratings measure the plan overall, not how well it covers your specific doctors and drugs

Medicare Advantage or Medigap?

Medicare Advantage Original Medicare + Medigap
Monthly premium Often low or $0 (2027 average $12, CMS) Higher; varies by plan letter, age and ZIP
Doctors Usually a network Any provider in the U.S. that accepts Medicare
Costs when you get care Copays and coinsurance up to a yearly maximum Low and predictable; little or nothing on Plan G after the Part B deductible
Drug coverage Usually included Add a separate Part D plan
Dental, vision, hearing Many plans may include some coverage Not included
Changing later Every year during Annual Enrollment Health questions in most states after your Medigap Open Enrollment Period

Guaranteed issue: if your Medicare Advantage plan leaves your area, you generally can buy certain Medicare Supplement plans without health questions, until 63 days after your coverage ends.

Help Paying Medicare Costs

If your income and savings are limited, two programs can cut your Medicare costs sharply:

Medicare Savings Programs

✔

Run by your state Medicaid office

✔

Can pay your Part B premium, and sometimes deductibles and coinsurance

✔

Income and asset limits vary by state

Extra Help (Part D)

✔

Run by Social Security

✔

Lowers Part D premiums, deductibles and copays

✔

People in a Medicare Savings Program qualify automatically

Those who are eligible for Medicare along with full Medicaid might also have the option of enrolling in a Dual Special Needs Plan. Learn more about help for low-income Part D beneficiaries.

Reading Your Annual Notice of Change

Check Every Line

✔

Your 2027 premium and deductible

✔

Copays for doctors, specialists and hospital stays

✔

The out-of-pocket maximum

✔

Updates to your formulary, drug tiers and coverage requirements

✔

Whether your doctors, hospitals and pharmacy are still in network

✔

Changes to dental, vision, hearing and other extras

Plans must send the Annual Notice of Change by September 30. It is the single most useful document you get each fall, because it tells you exactly how your plan changes on January 1.

Special Enrollment Periods

Outside the fall and early-year windows, you generally need a Special Enrollment Period to change plans. Common reasons include:

You May Qualify If

✔

Your plan is leaving your area or ending

✔

You move outside your plan’s service area

✔

You lose employer or union coverage

✔

You qualify for Extra Help or a Medicare Savings Program, or your Medicaid status changes

✔

You want to join a 5-star plan, once a year

Each Special Enrollment Period has its own time limit, so act as soon as the event happens.

Prior Authorization and Referrals

Most Medicare Advantage plans require prior authorization for some services, such as certain surgeries, advanced imaging, skilled nursing stays and some drugs. Your doctor usually requests it, but ask whether a planned service needs approval so a denial does not surprise you.

If a request is denied, you or your doctor can appeal. Medicare rules set deadlines for plans to decide, with faster deadlines when waiting could seriously harm your health.

Getting Help

You do not have to compare plans alone, and you should not have to pay for help. These are the free options:

Free Help Comparing Plans

✔

Medicare Plan Finder on Medicare.gov, available any time

✔

1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week

✔

Your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling

✔

A licensed insurance agent or broker, who can compare plans from several insurers at no cost to you

Before any call, have your Medicare card, your list of drugs and doses, your doctors and your preferred pharmacies ready. It turns a long conversation into a short one.

Bottom Line

The Bottom Line

Kaiser Senior Advantage offers broad, coordinated benefits inside its system; confirm your plan’s 2027 extras and costs before you renew.

Compare plans and enroll online

Frequently Asked Questions

➤ What benefits do Kaiser Senior Advantage plans include?

Kaiser Senior Advantage plans cover all Part A and Part B services except hospice, and most include Part D drug coverage. Many plans may include extras such as dental, vision, hearing, fitness or virtual care, but not all plans offer all benefits.

➤ Does Kaiser Senior Advantage cover prescriptions?

Most Kaiser Senior Advantage plans include drug coverage, often through Kaiser pharmacies and mail order. For 2027 any plan’s Part D deductible can be up to $700, and covered drug costs are capped at $2,400.

➤ Does Kaiser Senior Advantage include dental?

Some Kaiser Senior Advantage plans may include dental coverage or offer it as an optional add-on. Coverage varies by plan and region, so check the 2027 Evidence of Coverage for annual limits and dentists. Original Medicare does not cover routine dental care.

➤ Are preventive services covered by Kaiser?

Yes, Kaiser Senior Advantage plans cover Medicare-approved preventive services such as screenings, annual wellness visits and many vaccines. These are usually low or no cost at Kaiser facilities. Your care team may also remind you when screenings are due.

➤ Can I use virtual care with Kaiser?

Many Kaiser plans may include video visits and secure messaging with your care team. Check your plan for copays and which services can be handled virtually. Virtual visits can save a trip for follow-ups and simple questions.

➤ What is changing for Kaiser Senior Advantage in 2027?

Kaiser is dropping its last 3 PPOs and leaving 2 Nevada and 3 Washington counties for 2027. Read your Annual Notice of Change for benefit and cost changes to your plan. Your coverage continues through December 31, 2026, if your plan is ending.

➤ Does Kaiser Senior Advantage have an out-of-pocket maximum?

Yes, every Kaiser Senior Advantage plan has a yearly out-of-pocket maximum for covered medical care. Check the 2027 Summary of Benefits for the exact amount. After you reach it, the plan pays 100% of covered medical care for the rest of the year.

➤ Do I still pay the Part B premium with Kaiser?

Yes, you keep paying your Part B premium, $202.90 in 2026 and projected at $209.50 for 2027. You also pay your Kaiser plan premium if your plan has one. Official 2027 Part B amounts are announced in November.

➤ Who is eligible for Kaiser Senior Advantage?

You must have Medicare Part A and Part B and live in a Kaiser Senior Advantage service area. Kaiser operates in 9 states plus Washington, D.C., in certain counties only. Special Needs Plans have extra requirements.

➤ When can I enroll in Kaiser Senior Advantage for 2027?

You can enroll during Annual Enrollment, October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll when you first become eligible for Medicare. Medicare Advantage members can also make one change from January 1 to March 31, 2027.

Have Questions?

Speak with a licensed insurance agent

1-855-398-0716

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-855-398-0716TTY 711

Mon-Fri: 8am-9pm ET

ZRN Health & Financial Services, LLC, a Texas limited liability company

MedicarePlansGuide.org
1200 Lakeway Drive, Suite 17A
Austin, TX 78734

TERMS & CONDITIONS | PRIVACY POLICY | EDITORIAL POLICY | DISCLOSURE

This website and MedicarePlansGuide.org are privately owned and operated and are not affiliated with, endorsed by, or connected to the Federal Medicare program or any other government agency. We do not offer every plan available in your area. Currently we represent multiple organizations which offer Medicare Advantage, Medicare Supplement Insurance plans, and Medicare Prescription Drug plans. Not all plans offer all benefits mentioned. Benefits, premiums, deductibles, copayments, coinsurance, exclusions, and limitations may vary by plan, carrier, and location and may change over time.

By submitting your information through this website, you agree to the site’s privacy policy and expressly consent to be contacted by a licensed insurance agent or insurance company regarding Medicare insurance plans by phone, email, or text message at the number provided, including a wireless number, using automated technology, prerecorded messages, or artificial voice. Consent is not a condition of purchase. Message and data rates may apply.

Enrollment in a Medicare plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period. Plan availability depends on contract renewal. We do not offer every plan available in your area. Any information provided is limited to the plans we offer in your area.

For complete and official information about Medicare benefits and coverage options, visit Medicare.gov or call 1-800-MEDICARE (TTY users: 1-877-486-2048), 24 hours a day, 7 days a week.

MedicarePlansGuide.org is owned and operated by ZRN Health & Financial Services, LLC, a Texas limited liability company.