Medicare questions: Medicare FAQ
Q. How do I apply for Medicare?
A. If you plan to retire at 65, apply for Medicare through your local Social Security office up to 3 months before your 65th birthday, unless you're already receiving Social Security benefits. You may have to pay a late enrollment penalty if you delay signing up for Medicare more than 3 months after you turn 65.
If you're already receiving Social Security benefits, you do not need to apply for Medicare. You will automatically be enrolled. Social Security will send you a packet with your Medicare card approximately three months before you turn 65.
If you plan to continue working after age 65, if you or your spouse continue to work, and you or your spouse are covered under a group plan, take your Medicare questions to your local Social Security office or your group benefits administrator. It might not be in your best interest to sign up for Medicare Part B right now.
Q. How do I get a Medicare card?
A. You may contact Social Security as soon as 3 months before your 65th birthday to request your Medicare card, and there are 3 ways to do it:
- Go to Social Security online services†, OR
- Visit your local Social Security office, OR
- Call Social Security at 1-800-772-1213 (toll free) or 1-800-325-0778 (toll-free TTY for the hearing/speech impaired), Monday through Friday, 7 a.m. to 7 p.m.
Q. How do I get Medicare Part D?
A. Anyone receiving Medicare is eligible for Medicare Part D and can receive this optional coverage by enrolling in a Medicare Advantage plan with Part D coverage, a Medicare Cost plan with Part D, or a stand-alone Medicare prescription drug plan (PDP). Many Kaiser Permanente Medicare health plans offer prescription drug coverage.
Q. What does Original Medicare Cover?
A. Original Medicare covers inpatient hospital care (Part A) and outpatient medical expenses (Part B).
Q. How does Original Medicare work?
A. In most cases, you can go to any doctor, other health care provider, hospital, or other facility that's enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions aren't covered in Original Medicare.
Q. How much does Medicare cost?
A. Medicare charges a monthly premium for Medicare Part B (medical insurance). Most people will pay the standard premium amount, which may change from year to year. For most people, the Part B premium is deducted from their Social Security check. Medicare Part A (hospital insurance) is usually premium-free for most people.
Q. What do Medicare Advantage plans cover?
A. Medicare Advantage plans, also called Part C plans, are offered by private insurers and offer more benefits and services than Original Medicare. In addition to all services under Medicare Part A (hospital) and Medicare Part B (medical), many Medicare Advantage plans cover Medicare Part D prescription drug coverage, vision services, and health and wellness programs.
Q. Does Medicare cover dental, eye exams, and hearing aids?
A. In most cases, Original Medicare does not provide dental, vision, or hearing coverage. Most Kaiser Permanente Medicare health plans offer those services through Advantage Plus, an optional, supplemental benefit package*. For details, see the Advantage Plus tab in our plans and rates section.
Q. What’s the difference between Medicaid and Medicare?
A. Medicare is a federal program that provides health insurance to people age 65 and over, people with end-stage renal disease (ESRD), and people under 65 with certain disabilities.
Medicaid (Medi-Cal in California) is a public health care program for families and individuals with low income and resources.
Q. How do I find out about changes in Medicare covered services?
A. Throughout the year, the Centers for Medicare & Medicaid Services sends out updates about additional covered services or changes to existing covered services. These notifications are called National Coverage Determinations (NCDs). When NCDs become available, they will be posted here to view and download.
*Not currently available in Maryland, Virginia, Washington, D. C.
Q. Does Kaiser Permanente offer Medicare health plans?
A. Yes. We offer affordable Medicare Advantage health plans that have earned a reputation for service and quality*. See the plans and rates available in your area.
Q. What are the requirements to join a Kaiser Permanente Medicare health plan?
A. You must meet these 4 requirements:
- You are entitled to Medicare Part A (hospital insurance) and enrolled in Part B (medical insurance). (If you live in Maryland, Virginia, or Washington, D.C., you only have to be enrolled in Part B.)
- You reside in our Kaiser Permanente service area for the plan in which you are enrolling.
- You enroll during a valid enrollment period. See details on enrollment periods.
- You do not have end-stage renal disease (ESRD). There are limited exceptions to this, such as if you are already a member of our plan (in the same region in which you wish to enroll).
Q. Will I be turned down for membership in one of Kaiser Permanente’s Medicare health plans because of my age or medical condition?
A. No. Enrollment in a Kaiser Permanente Medicare health plan requires no health exam, and there is no age limit. However, if you have end-stage renal disease (ESRD) and require dialysis, you are not eligible for one of our Medicare health plans unless you are currently a member of the Kaiser Permanente region in which you wish to enroll, and were diagnosed with ESRD while a member. You may join our plan if you have had a kidney transplant and no longer require life-sustaining dialysis.
Q. If I join a Kaiser Permanente Medicare health plan, will I lose my Medicare coverage?
A. No. You do not lose Part A and Part B coverage. When you become a member of our plan, Kaiser Permanente will provide your Medicare benefits to you. You must maintain your Part B Medicare enrollment in order to keep your coverage in our Medicare health plan.
Q. What does a Kaiser Permanente Medicare health plan cost?
A. Kaiser Permanente offers Medicare health plans with a $0 premium option in some areas. In other areas, you might pay monthly premiums and copayments for the services you receive from Kaiser Permanente. You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s).
Learn more about our Medicare Advantage and Medicare Cost plans. Browse our Medicare health plans & rates section now.
Q. If I work past age 65, when should I sign up for a Medicare health plan, and how?
A. You can sign up for our Medicare health plan as soon as you’re ready to retire. Enroll online now or call us, and one of our licensed Kaiser Permanente Medicare health plan sales specialists will make sure you're all set.
Q. I am a current Kaiser Permanente member. Can I stay with Kaiser Permanente after I start getting Medicare?
A. Yes. You can continue your Kaiser Permanente membership and use the Medicare benefits you're qualified for by joining our Medicare health plan once you are eligible.
Q. Can my spouse join a Kaiser Permanente Medicare health plan, too?
A. Yes, as long as your spouse is eligible for Medicare.
Q. How do I enroll in a Kaiser Permanente Medicare health plan?
A. You can easily enroll online. You may also download the enrollment form, complete it, and mail it to us. Or call 1-866-973-4588 (toll free) or TTY 711, 8 a.m. to 8 p.m., 7 days a week and our licensed sales representatives will be happy to help you.
Q. How do I enroll in Advantage Plus?
A. You can enroll in Advantage Plus at the same time you enroll in Senior Advantage, using the Senior Advantage enrollment form.‡ If you've already enrolled in Senior Advantage and would like to add Advantage Plus, you may do so by completing the Advantage Plus enrollment form and mailing it to us. Get enrollment details and download the enrollment form in the Advantage Plus tab in our plans and rates section.
Q. Can I make changes to my application after I submit?
A. Yes. Contact Kaiser Permanente at 1-866-973-4588 (toll free) or TTY 711, 8 a.m. to 8 p.m., 7 days a week. We will be happy to help you.
Q. How can I check my enrollment status?
A. You can check your enrollment status by calling 1-866-973-4588 (toll free) or TTY 711, 8 a.m. to 8 p.m., 7 days a week.
*Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2016. Kaiser Permanente contract #H0524, #H0630, #H1170, #H1230, #H2150, #H9003.
‡ In Georgia, Advantage Plus is available for Senior Advantage (HMO) members and Senior Advantage Medicare Medicaid (SNP) members.
Benefits premiums and/or copayments/coinsurance may change on January 1 of each year.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party.
Q. How do I start using my Kaiser Permanente plan benefits?
A. You should receive your Kaiser Permanente ID card and other information about your plan benefits within 10 days of your enrollment confirmation. Then, visit our section for new members, which will take you through the steps you need in order to start taking advantage of your Kaiser Permanente membership.
Q. Can I choose my own doctor?
A: Yes, you can choose your own personal Kaiser Permanente physician from our extensive network of doctors, with the freedom to select a new doctor within the network at any time. All of our available physicians accept Medicare health plan members. Simply visit kp.org/chooseyourdoctor.
Q. How do I find a Kaiser Permanente facility to receive care?
A. Information on medical facility locations, departments and services, and directions and phone numbers are available online. You also can contact Member Services and our health plan representatives will be happy to help you find the information that you need.
Q. How do I transfer my prescriptions?
A. Call to speak with a pharmacy representative to assist you with transferring your prescriptions. When you call, please have your prescription number(s) and the pharmacy name and phone number ready — we’ll handle the rest.
Q. What are my rights under a Kaiser Permanente Medicare health plan?
A. Your guaranteed rights and protections include:
- timely access to covered services and drugs
- fair and respectful treatment at all times
- the right to file a complaint
- security and privacy for your health information
- clearly explained treatment options and participation in making decisions about your treatment options
- receiving plan information and treatment explanation in a language or format that works for you (languages other than English, Braille, large print, audio tapes)
Find further details in your plan’s documents, such as the Evidence of Coverage, or in the Medicare & You handbook available on www.medicare.gov.† You also can call Medicare at 1-800-MEDICARE (1-800-633-4227) (toll free) or TTY 711, 24 hours a day, 7 days a week.
Q: How do I ask for a coverage decision?
A: When a coverage decision involves your medical care or asking us to pay you back or pay a bill you have received, it is called an organization determination. To request for a coverage decision on medical care or service you want but have not received, or to pay a bill, you may call, write or fax Member Services.
If your health requires a quick response, you should ask us to make a "fast coverage decision." You, your doctor, or your representative can make the request for medical care. We will provide a response for a fast coverage decision within 72 hours. A response for a standard request for care or services can take up to 14 calendar days. A response for a request for payment can take up to 30 days. If we say no to your request for coverage for medical care or payment, you may seek an appeal. (See "How do I make an appeal?"). For additional details, refer to Chapter 9 in your Evidence of Coverage.
Q: How do I make an appeal?
A: If we say no to your request for coverage for medical care or payment of a bill you have the right to ask us to reconsider, and perhaps change the decision by making a Level 1 Appeal. You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for a coverage or payment decision.
- For a standard appeal, write to Member Services to make your appeal. If your health requires a quick response, you must ask for a "fast appeal" (also called an expedited reconsideration) by writing or calling Member Services. You, your doctor, or your representative can do this. If your representative is appealing our decision for you, your appeal must include an Appointment of Representative form authorizing this person to represent you.
- We consider your appeal and we give you our answer. A response for a fast appeal request will be within 72 hours. A response for a standard appeal request for medical care you have not received can take up to 30 calendar days. A response for a standard appeal request for payment of a bill can take up to 60 calendar days.
- If our plan says no to part or all of your appeal, your case will automatically be sent on to the next level of the appeals process. To make sure we were following all the rules when we said no to your appeal, we are required to send your appeal to the Independent Review Organization. This means your appeal has gone to Level 2. The Independent Review Organization reviews your appeal carefully and gives you its decision in writing and explains the reasons for it.
For additional details, refer to Chapter 9 in your Evidence of Coverage.
Q: How do I make a complaint about Kaiser Permanente’s process or services?
A: If you are unhappy with the medical care or services you are receiving, or if you are unhappy with our processes, you can make a complaint, also known as filing a grievance. Contact Member Services within 60 days of the event or incident, by phone or in writing. If there is anything else you need to do, Member Services will let you know. We look into your complaint and give you our answer within 30 calendar days. For additional details, refer to Chapter 9 in your Evidence of Coverage.
You may obtain a summary of information about the appeals and grievances that plan members have filed with Kaiser Permanente. To get this information, please contact Member Services.
You also may use the online Medicare Complaint Form† to transmit a complaint directly to Medicare.
Q: Where can I learn more about how Kaiser Permanente will use my personal health information?
A: For your service area, view or download the Notice of Privacy Practices.
- Northern California♦
- Southern California♦
- Maryland/Virginia/Washington, D.C.♦
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Q. I'm already a Kaiser Permanente member. How do I use the Kaiser Permanente online health record?
A. If you've already registered for an account on kp.org, you can sign on to My Health Manager to refill a prescription, schedule an appointment, check test results, and much more. If you don’t have an online account, it’s easy to register now.
Q. Where can I find information on Advantage Plus?
A. With the affordable Advantage Plus option, you can add additional benefits such as dental, vision, and hearing to your Senior Advantage plan for an additional premium.* To learn more and to apply, see the tab for “Advantage Plus” in our plans and rates section.
Q. Do I have medical coverage when I’m traveling?
A. You are covered worldwide for medically necessary emergencies or urgently needed care for a maximum of three to twelve consecutive months, depending on your plan. You will need to submit claim forms to be reimbursed for these services.
For more detailed information on coverage while traveling, please refer to your Evidence of Coverage or contact Member Services.
Note: Kaiser Permanente Medicare Plus Basic Option plan (MD, VA, and DC) does not include urgent or emergency care outside the United States except under limited circumstances.
Q. How do I get care in an event of a disaster?
A. Kaiser Permanente believes there is nothing more important than the health, safety and security of our organization and the communities we serve. This includes our employees, physicians, members, patients, and visitors, as well as our facilities, systems and business applications necessary for the provision of care during any disaster or emergency event.
Getting Care During a Disaster
If the State Governor, the U.S. Secretary of Health and Human Services, CMS (the Centers for Medicare & Medicaid Services), or the President of the United States declares a state of disaster or emergency in your geographic area, Kaiser Permanente will make every effort to keep our facilities, medical offices and pharmacies open to care for you.
In the event of a disaster, we will post information regarding access to our facilities, medical offices and pharmacies on our website.
During a declared state of disaster or emergency, if you need care and you can't make it to a Kaiser Permanente facility, medical office, or pharmacy-- or if we are closed:
- Kaiser Permanente will cover medically necessary plan benefits furnished to you by out of network providers.
- You do not need to get a referral or prior authorization to go outside the network.
- You will be responsible to pay only your in network cost share for these services.
When the Disaster Ends
Once the State Governor, the U.S. Secretary of Health and Human Services, CMS (the Centers for Medicare & Medicaid Services), or the President of the United States declares the disaster or emergency is over, or after 30 days have passed when there is no end date declared, you will need to use the plan provider network to receive services and the normal pre-authorization/referral requirements and cost sharing will resume and as described in your Evidence of Coverage.
If we cannot resume normal operations, we will keep you informed about how to receive covered care and prescription drugs and will also notify the Centers for Medicare and Medicaid Services.
Q. What happens if I leave the service area temporarily?
A. While temporarily outside the Kaiser Permanente service area, coverage is limited to medically necessary emergencies, urgent care, and, for Kaiser Permanente Senior Advantage (HMO) members, renal dialysis services.
Q. What happens if I move out of the service area permanently?
A. If you are outside of the service area for more than 3 to 12 months, depending on your plan, or move permanently outside of our service area, Medicare requires us to disenroll you from our plan. Call us, and we can help you with coverage when you travel or move.
Q. Can I be dropped from a Kaiser Permanente Medicare health plan?
A. You cannot be disenrolled because of your health status. Your membership can be terminated for other reasons, which may include, but are not limited to:
- failing to pay your Kaiser Permanente premium, if one is required under your plan
- living temporarily out of the service area for more than 90 consecutive days if you are in a Kaiser Permanente Medicare Plus (Cost) plan without Part D, 12 months if you are in a Kaiser Permanente Medicare Plus plan with Part D, or for more than 6 months if you are in a Kaiser Permanente Senior Advantage (HMO) plan
- moving permanently out of the service area
- not maintaining your enrollment in Medicare
There are a few other causes for disenrollment, which are explained in the Evidence of Coverage.
Q. Who do I contact to stop receiving mail about Kaiser Permanente Medicare health plans?
A. You can call the phone number listed on the piece of mail you received and ask to be removed from the mailing list. If you are already a Kaiser Permanente member, please call Member Services in your service area.
Q. What if I don’t want to receive any mail from Kaiser Permanente?
A. You can contact Member Services and our health plan representatives will be happy to help you.
*In Georgia, Advantage Plus is available for Senior Advantage (HMO) members and Senior Advantage Medicare Medicaid (SNP) members.
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