This plan generally replaces your Medicare coverage. You agree to let Kaiser manage your Medicare benefits. It is an HMO (health maintenance organization) with a closed network of providers.
How the plan works
- You choose a primary care physician (PCP) from Kaiser’s network.
- The PCP coordinates your care and refers you to specialists.
- The plan covers the cost of services only when your primary care physician authorizes it.
- Kaiser provides coverage for services outside of the Kaiser network only in cases of emergency.
- Kaiser provides behavioral health services.
Best fit for you if:
- You want lower out-of-pocket costs
- You like having one doctor manager your care
- You are comfortable with out-of-network coverage only in emergencies
- Lifetime limit on transgender benefits will be removed
Typical out-of-pocket costs
Office visit/urgent care visit: $20 (preventive care has no charge)
Emergency room: $65
Hospital stay: $250
Prescription drugs: $5, generic; $25, brand name