northwest — kaiser permanente medicare health plan...380316611_sa_10-19 all plans offered and...

380316611_SA_10-19All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.

500 NE Multnomah St., Suite 100, Portland, OR 97232.

Your 2020 guide to choosing a Kaiser Permanente Medicare health plan

Northwest — Kaiser Permanente Medicare Health Plan

ENROLL in a Kaiser Permanente Senior Advantage 2 plan and get reimbursed up to $150 every month for your Medicare Part B premium.

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Kaiser Permanente

Get the most out of your FEHB coverage

High Option and Standard Option members have 2 great Medicare health plan choices:

Senior Advantage 1: $0 copays (High Option) and lower copays (Standard Option) for most covered services,

plus get membership in the Silver&Fit® Exercise and Healthy Aging Program.

Senior Advantage 2: We reimburse you for the Medicare Part B premium you pay — up to $1,800 a year — and you pay lower copays for most services, plus get membership in the Silver&Fit® Exercise and Healthy Aging Program at no extra cost.

This guide will help you understand your options so you can choose the coverage that’s right for you. You’ll also find tools and tips to make your transition easier.

What’s inside this guide The 4 parts of Medicare — and what they cover ..................................................................3

Plan options ..............................................................................................................................4

Medicare Part B ........................................................................................................................5

Compare your options for 2020 .........................................................................................6–9

Choosing the right FEHB option ..........................................................................................10

What’s next? ...........................................................................................................................11

Your care, your way ...........................................................................................................12–13

For more information on our Medicare health plans, visit kp.org/medicare.

If you have questions or are ready to enroll, our Kaiser Permanente representatives are here for you. Call one of our licensed sales specialists at 1-877-547-4909 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m.

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Medicare Health Plan

The 4 parts of Medicare — and what they cover

We want you to understand your choices and options. If you have questions, here are some helpful resources:

HELPFUL RESOURCES

PART A PART BHospital Insurance Medical Insurance

• Inpatient care• Skilled nursing facility care• Home health care

You pay no premium if you or your spouse paid Medicare taxes for at least 10 years while working.

• Services from doctors and other health care providers

• Outpatient care• Durable medical equipment

You pay a monthly premium.

PART C PART DMedicare Advantage Prescription Drug Coverage

Bundles Part A, Part B, and usually Part DPrescriptions not included in Part A and B coverage

• Senior Advantage for Federal Members is a Medicare Advantage plan with Part D prescription drug coverage.

• You do not pay a premium to enroll in Senior Advantage for Federal Members. • You must be a Kaiser Permanente FEHB member to enroll in Senior Advantage, so you

don’t suspend your FEHB coverage.

Medicare To learn more about Medicare coverage, enrollment periods, or Medicare in general, go to medicare.gov or call 1-800-633-4227 24 hours a day, 7 days a week. TTY users, call 1-877-486-2048.

Social Security To get more information about your Medicare eligibility, sign up for Part A and B, or find out your Part B premium, visit socialsecurity.gov or call Social Security at 1-800-772-1213 Monday through Friday, 7 a.m. to 7 p.m. TTY users, call 1-800-325-0778.

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Kaiser Permanente

We’ll enroll you in a Senior Advantage plan that matches the Kaiser Permanente FEHB option you have now. For example, if you’re a Kaiser Permanente High Option member, you must choose between High Option Senior Advantage 1 or High Option Senior Advantage 2. You must submit an enrollment change to switch to a Standard Option Medicare Advantage plan.

If you want to change plan options, see page 10 for more information.

Why should I enroll in Kaiser Permanente Senior Advantage for Federal Members? By enrolling in Senior Advantage, you will get better benefits without increasing your FEHB premium. FEHB members can choose between 2 Senior Advantage for Federal Members plans.

• If you choose Senior Advantage 1, you will pay lower cost sharing and get extra benefits.

• If you choose Senior Advantage 2, we will reimburse you up to $150 a month for the Medicare Part B premium you pay, plus you will pay lower cost sharing and get some extra benefits.

The richer benefits you get by enrolling in Senior Advantage depend on the option in which you are enrolled. In general, High Option has lower copays than Standard Option.

High and Standard Option members have 2 great choices:

Your FEHB premium will not increase when you enroll in Senior Advantage for Federal Members.

Plan options

Senior Advantage 1 Senior Advantage 2

• High Option: $0 copays for most services

• Standard Option: No deductible and lower copays for most services

• Lower out-of-pocket maximum

• Membership in Silver&Fit Exercise and Healthy Aging Program at no extra cost

• Up to $1,800 reimbursement a year ($150 per month) for your Medicare Part B premium

• Lower copays for primary and specialty care office visits, outpatient surgery, inpatient hospital care, emergency care, and urgent care

• No deductible (Standard Option)

• Lower out-of-pocket maximum

• Membership in Silver&Fit Exercise and Healthy Aging Program at no extra cost

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I know my FEHB premium won’t change, but what will I pay for Medicare Part B after Kaiser Permanente’s Part B premium reimbursement? We will reimburse you up to $150 a month of the Medicare Part B premium you pay.

The standard Part B premium amount in 2019 is $135.50* a month. Most people pay the standard Part B premium amount.

You may have an extra charge added to your Part B premium if:

• You have a higher income. If your income is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount, also known as Part B IRMAA. Note that you’ll also pay Part D IRMAA.

• You enroll in Part B late. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty (Part B LEP) for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could have had Part B but didn’t sign up for it.

You can find out what you pay for Part B by contacting Social Security. Go to ssa.gov or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 7 a.m. to 7 p.m.

Complete the chart below to find out what you will pay for Part B after our reimbursement.

Medicare Part B

Example based on what most people

pay in 2019*What you pay

Standard Medicare Part B premium + $135.50/month* +

Income Related Monthly Adjustment Amount (IRMAA)

+ $0 +

Late enrollment penalty (Part B LEP) + $0 +

Kaiser Permanente’s Part B premium reimbursement amount – Up to $150 a month –

Part B premium after reimbursement = $0 =

*The 2020 Part B premium amount wasn’t available at the time of printing, but is available starting in fall 2019. Contact Social Security to find out what you pay.

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Kaiser Permanente

High Option

Without Medicare With Medicare

2020 Benefits and ServicesHigh Option

You pay

High Option Senior Advantage 1

You pay


You payDeductible None None NoneOutpatient services (per visit or procedure)

Office visit — primary care1 $20; $0 for children through age 17 $0 $15; $0 for children through

age 17Office visit — specialty care1 $30 $0 $15Most X-rays $15 $0 $0Most lab tests $10 $0 $0

Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year) $20 ($25 massage) ($1,000 annual benefit maximum)

$20 ($25 massage) ($1,000 annual benefit maximum)


Eyeglasses and contact lenses (every calendar year for children through age 18 and every 2 calendar years ages 19 and over)

$0 for children; $150 allowance for adults



Hospital and facilityOutpatient surgery1 $100 $0 $50Inpatient hospital care (per admission) $250 ($0 for maternity) $0 $200 ($0 for maternity)Emergency and urgent care (per visit or trip)Emergency care $150 $60 $75Urgent care $35 $0 $30Ambulance $100 $75 $100Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)2

Generic $15 $15 $15Preferred brand $40 $30 $40Non-preferred brand $60 $50 $60Specialty $100 $100 $100Additional Senior Advantage benefitsSilver&Fit® program Not covered $0 0Part B reimbursement3 $0 $0 Up to $150Out-of-pocket maximum (2x per family maximum) $4,250 per person $600 per person $1,000 per person

Compare your optionsThe 2020 benefit summaries on pages 6 through 9 allow you to make a side-by-side comparison of your Kaiser Permanente Medicare health plan choices.

1Does not include costs of administered drugs.2Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to members for non-covered drugs.3We will reimburse you for any extra charges added to your standard Part B premium, such as the Part B Late Enrollment Penalty or Income Related Monthly Adjustment Amount, but not to exceed $150.

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High Option


2020 Benefits and ServicesHigh Option

You pay


You pay


You payDeductible None None NoneOutpatient services (per visit or procedure)

Office visit — primary care1 $20; $0 for children through age 17 $0 $15; $0 for children through

age 17Office visit — specialty care1 $30 $0 $15Most X-rays $15 $0 $0Most lab tests $10 $0 $0

Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year) $20 ($25 massage) ($1,000 annual benefit maximum)







Hospital and facilityOutpatient surgery1 $100 $0 $50Inpatient hospital care (per admission) $250 ($0 for maternity) $0 $200 ($0 for maternity)Emergency and urgent care (per visit or trip)Emergency care $150 $60 $75Urgent care $35 $0 $30Ambulance $100 $75 $100Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)2

Generic $15 $15 $15Preferred brand $40 $30 $40Non-preferred brand $60 $50 $60Specialty $100 $100 $100Additional Senior Advantage benefitsSilver&Fit® program Not covered $0 0Part B reimbursement3 $0 $0 Up to $150Out-of-pocket maximum (2x per family maximum) $4,250 per person $600 per person $1,000 per person

This is a summary of the features of the Kaiser Permanente health plan, including Kaiser Permanente Senior Advantage for Federal Members. Before making a final decision, please read the Federal Employees Health Benefits (FEHB) brochure 73-004. All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB brochure and the Kaiser Permanente Senior Advantage for Federal Members Evidence of Coverage (EOC).

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Kaiser Permanente

Standard Option


2020 Benefits and ServicesStandard Option

You pay

Standard Option Senior Advantage 1

You pay


You payDeductible (up to 2x per family maximum) $250 per person None NoneOutpatient services (per visit or procedure)1

Office visit — primary care2 $25; $0 for children through age 17

$5; $0 for children through age 17


Office visit — specialty care2 $35 $5 $20Most X-rays $30 $0 $15Most lab tests $25 $0 $15

Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year) $25 ($1,000 annual benefit maximum)

$25 ($1,000 annual benefit maximum)






Hospital and facilityOutpatient surgery2 $1501 $50 $100Inpatient hospital care (per admission) $3001 ($0 for maternity) $100 ($0 for maternity) $225 ($0 for maternity)Emergency and urgent care (per visit or trip)Emergency care $1251 $60 $120Urgent care $40 $10 $35Ambulance $1251 $75 $125Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)3

Generic $15 $15 $15Preferred brand $50 $40 $40Non-preferred brand $70 $60 $60Specialty $150 $150 $150Additional Senior Advantage benefitsSilver&Fit® program Not covered $0 $0Part B reimbursement4 $0 $0 Up to $150

Out-of-pocket maximum (2x per family maximum) $5,500 per person $750 per person $2,000 per person

1You pay the deductible, then cost sharing.2Does not include costs of administered drugs.3Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to members for non-covered drugs.4We will reimburse you for any extra charges added to your standard Part B premium, such as the Part B Late Enrollment Penalty or Income Related Monthly Adjustment Amount, but not to exceed $150.

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Standard Option


2020 Benefits and ServicesStandard Option

You pay


You pay


You payDeductible (up to 2x per family maximum) $250 per person None NoneOutpatient services (per visit or procedure)1

Office visit — primary care2 $25; $0 for children through age 17



Office visit — specialty care2 $35 $5 $20Most X-rays $30 $0 $15Most lab tests $25 $0 $15

Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year) $25 ($1,000 annual benefit maximum)







Hospital and facilityOutpatient surgery2 $1501 $50 $100Inpatient hospital care (per admission) $3001 ($0 for maternity) $100 ($0 for maternity) $225 ($0 for maternity)Emergency and urgent care (per visit or trip)Emergency care $1251 $60 $120Urgent care $40 $10 $35Ambulance $1251 $75 $125Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)3

Generic $15 $15 $15Preferred brand $50 $40 $40Non-preferred brand $70 $60 $60Specialty $150 $150 $150Additional Senior Advantage benefitsSilver&Fit® program Not covered $0 $0Part B reimbursement4 $0 $0 Up to $150

Out-of-pocket maximum (2x per family maximum) $5,500 per person $750 per person $2,000 per person

Kaiser Permanente

If you need to enroll or change options, here is information about your premium contribution and enrollment codes.

Your premium shareRemember: Your FEHB premium doesn’t change when you enroll in Senior Advantage for Federal Members.

Choose the right enrollment codeFind your enrollment code on the chart below. Then visit opm.gov to enroll online or contact your employing agency or retirement office for next steps and other information. Annuitants can contact the Retirement Information Center at 1-888-767-6738 (TTY 1-855-887-4957) or [email protected].

Choosing the right FEHB option

TierEnrollment Codes

High Option Standard OptionSelf Only Covers you 571 574Self Plus One Covers you and one eligible family member 573 576Self and Family Covers you and all eligible family members 572 575

Your Premium Share* High Option Standard Option

Self Only

Biweekly Non-Postal $101.12 $74.76

Biweekly Postal Category 1 $97.84 $71.77


Monthly Non-Postal $219.09 $161.99

Self Plus One





Self and Family





*The above FEHB rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer that maintains your health benefits enrollment. You must continue to pay the Medicare Part B premium to remain in the Kaiser Permanente Senior Advantage for Federal Members (HMO) plan.Enrollees covering themselves and one other eligible family member may choose either the “Self Plus One” or “Self and Family” enrollment type. If you choose the High Option, you’ll save money if you enroll in Self and Family. Current Self Plus One subscribers must make an active enrollment election to move to Self and Family and get a lower member contribution.

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To learn more about Medicare benefits and eligibility:

• Call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 7 a.m. to 7 p.m.

If you’re ready to enroll in a Kaiser Permanente Medicare health plan for Federal members, or have questions:

• Call our licensed sales specialists at 1-877-547-4909 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m. We’ll be happy to answer your questions and walk you through the enrollment process.

• After we have your enrollment form and confirm your status, you’ll receive a letter of confirmation and a new Kaiser Permanente ID card.

What’s next?

Kaiser Permanente

Personalized care that fits your life

Consistent costs for quality careWith Kaiser Permanente, you pay predictable copays for most services and no additional costs for preventive services like your yearly checkup, mammograms, prostate exams, flu shots, and cholesterol tests.

Come inMany services under one roof

When you visit a Kaiser Permanente facility, 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 and hospitals are also at the same location.

Worldwide care when it matters most

Traveling outside of our coverage area? Relax — as a Kaiser Permanente member, you’re covered for emergency and urgent care anywhere in the United States or in the world.*

CallCare by phone

If you have a condition that doesn’t require an in-person exam, you can save yourself a trip to the doctor’s office by scheduling a phone appointment. Plus, care guidance and advice are available by phone 24/7.

Better care with a connected teamYour doctor, nurses, and other specialists work together to help keep you healthy. They’re connected to each other, and to you, through your electronic health record. So they know important things about you and your health — like when you’re due for a screening and what medications you’re taking. A connected care team helps ensure nothing gets missed or forgotten, so you can stay on track.

Your care, your way

*Routine services like prevention, exams, checkups, and services for ongoing medical conditions aren’t covered, so make sure to get them before your trip if you’re traveling elsewhere. Please refer to your EOC or other coverage documents for details.

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ClickManage your health online

You can email your doctor’s office, view most test results, refill most prescriptions, and schedule or cancel appointments — all online.1 You can also download the Kaiser Permanente mobile app, at no cost, to manage your health on the go.2

Find the care you need

Visit kp.org/getcare to learn about all the care options in your region. Get advice, make an appointment, find a nearby Kaiser Permanente urgent care center, and more.

Choose your doctor — and change anytimeRead profiles online so you can select your personal doctor based on what’s important to you — education, languages spoken, specialties, and more. Plus, you have the freedom to switch to another Kaiser Permanente doctor at any time.

If you’re already a member and are joining our Medicare health plan, you can stay with the health care team you know and trust.

Quality care with you at the centerPreventive care can help keep you healthy, but we’re also here if you get sick or need specialty care. You have access to a full range of specialists, including cardiologists, orthopedists, audiologists, and more. Our doctors are some of the brightest minds in medicine and come from top medical schools. More importantly, they’re passionate about delivering excellent care. Equipped with the latest technology and proven treatments, they’ll help you recover quickly.

As a Kaiser Permanente member, you have many convenient options for getting care the way you want it.

You can feel confident about the care you get with Kaiser Permanente.

1These features are available when you get care at Kaiser Permanente facilities.2To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.

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Kaiser Permanente

In Oregon and Washington, Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. This information is not a complete description of benefits. Call 1-877-547-4909 (TTY 711) for more information. Enrolling in a Kaiser Permanente Medicare health plan for Federal members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply. FEHB Program coverage is described in FEHB brochure 73-004.

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