Kaiser Medicare Plans 2027

Kaiser Senior Advantage plans generally require you to get care from Kaiser providers, except emergencies, urgent care when you are away from home and approved referrals. Many services, such as primary care, specialists, lab and pharmacy, are often in the same building.

Kaiser’s Medicare service areas include parts of California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington, plus Washington, D.C., and Nevada. Senior Advantage is offered only in certain counties within each state, so confirm your ZIP code.

Emergency and urgent care are covered anywhere in the U.S. Routine care outside your Kaiser region is generally not covered, though Kaiser has programs for members who visit other Kaiser regions. If you spend part of the year away from home, ask how Kaiser handles care in your second location before enrolling.

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 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.

Most Kaiser 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 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:

See steps to appeal a Medicare Part D denial.

If your Kaiser 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.

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.

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.

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.

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

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

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

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.