BROKER TOOL KIT

If you enroll in our plan you will not lose your Original Medicare. You’re just choosing to allow a private company to administer your benefits instead of the federal government. You do not lose your Medicare benefits and you must continue to pay your Part B premiums.

KP offers only HMO products. With an HMO, you will be assigned a Primary Care Provider (PCP) at a center closest to you. You can change this PCP as often as you like. Your PCP will coordinate all of your care at Kaiser and can direct you to Specialists or hospitals if you require additional care. You must get your care from providers that are in the Kaiser Permanente locations unless authorized by your PCP. If you go to a provider outside of our network without authorization, you will be responsible for the entire cost.

With the HMO, you have the freedom to choose physicians and specialists from within our network or seek care out of network. If you choose to see a provider that is not in the KP Medicare Advantage network, you may be responsible for the entire cost of that service/visit.

Kaiser Permanente members are covered both nationally and internationally for Urgent and Emergent situations.

A: Your premium will stay the same every month during the calendar year. The only way your premium will change is if you receive a Part D Late Enrollment Penalty (LEP) from the Social Security Administration or if you add or remove the Advantage Plus rider.

A: The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

1. A Medicare Prescription Drug Plan (Part D)
2. A Medicare Advantage Plan (Part C) (like an HMO or PPO)
3. Another Medicare health plan that offers Medicare prescription drug coverage
4. Creditable prescription drug coverage

A: It will take a minimum of 90 days to start or stop automatic withdrawal from Social Security checks.

A: No. Your KP Senior Advantage ID card and Member ID number will be accepted and recognized by the supplemental vendors, but you are also welcome to go online to Delta Dental to create an account and print a card. Hearing aid services happen at Kaiser Permanente facilities with Kaiser Permanente doctors.

A: Yes, all of our Physicians in the Kaiser Permanente facilities are in network. We do have many Community Providers outside of our facilities in network, but you should check with Member Services if you need authorization and a referral from your KP Primary Care Doctor to see them.

You will be responsible for 100% of the bill unless you received prior authorization from Kaiser Permanente. There is no out of network coverage on this plan except for Emergency, Urgent Care and Out of Area Renal Dialysis nationwide. Emergency and Urgent Care is also covered outside of the U.S.

Our HMO plan requires referrals for some specialist visits. Your Primary Care Provider will help to coordinate your care with any Specialists you may require.

Our rider has a $9 monthly premium in addition to any plan premiums and there is no waiting period for the benefits to begin.

A: Yes. Kaiser Permanente does offer Member Financial Assistance. It is needs based and the member must meet certain income requirements to qualify. Have your member call the Medical Financial Assistance Program phone number: 404-949-5112 (TTY 800-255-0056) or go online at kp.org/mfa/ga.