Medicare Health Plans To Help You Thrive - Mykpagent

What to knowIf you have Medicare Parts A and B through Original Medicare and want prescriptiondrug coverage, consider Part D or a Medicare Advantage or Medicare Cost plan with Part Dcoverage.Like Part B, Part D has a late enrollment penalty.Part DPrescription drug coveragePart D is an optional plan offered by Medicare-approved private companies and covers some ofthe costs for prescription drugs. You can sign up for a Part D plan if you have Part A, Part B, or both.What it coversHow much does it cost?Medications covered by your Part D planvary based on the plan’s formulary. Aformulary is a list of medications coveredby a plan and approved by CMS.Your Part D costs depend on which planyou choose.You may be able to request coveragefor a Part D drug that’s not covered onthe plan’s formulary.All Part D prescription drug plans, includingMedicare Advantage and Medicare Costplans that offer Part D, must provide coveragethat’s equal to or better than the standardPart D benefits.These plans can enhance coverage by: Lowering deductibles Offering a different but equal share of thecost as the standard benefit, or improvingyour share of the cost Covering certain drugs through thecoverage gap12Standard Part D costs include: Monthly premium — The amount you pay foryour Part D coverage. This varies by plan. Yearly deductible — The amount you pay foryour prescriptions before your plan starts topay its share. Once you reach your deductible,you’ll pay only your copay or coinsurance.Not all Part D plans have a deductible. Copays and coinsurance — The amountyou pay for covered drugs after your planpays its share. This varies depending onyour plan benefits.

Part DYour costs depend on the coveragestage you’re inWhen you meet certain dollar limits onPart D drug expenses, you’ll move throughthe Part D coverage stages and pay differentcopays and coinsurance. Initial coverage stage — You pay thecopays and coinsurance set by your planafter your plan pays its share. Once youreach a certain dollar limit, you move tothe coverage gap stage. Coverage gap stage * — You pay more foryour drugs. Most Medicare health plans withPart D coverage have a coverage gap. Thismeans that after you and your plan havespent a certain amount in drug costs, thenyou have to pay more for your drugs whileyou are “in the gap.” The amount you mustpay varies by plan. Once you reach a certaindollar limit, you move to the catastrophiccoverage stage.Generic drugs can saveyou moneyAs you look at formularies, you’ll oftensee listings for generic and costlierbrand-name prescription drugs.Generic drugs are required by theFood and Drug Administration tomatch brand-name drugs in: Ingredients Strength Quality Performance SafetyYou can keep your costs down byasking your doctor to prescribe yougeneric medications.And keep an eye on your formulary —new generic drugs are regularly added. Catastrophic coverage stage — You usuallypay a smaller share of the cost, which appliesfor the rest of the year. Most people neverreach this stage.continues13

Part DcontinuedGetting financial helpHow do I enroll?If you’re on a limited income, you mayqualify for Extra Help, which could helpyou pay part or all of the costs of Part Dpremiums, deductibles, and your share ofprescription drug costs. If you think youmight qualify, contact Social Security at1-800-772-1213 (TTY 1-800-325-0778),7 a.m. to 7 p.m., Monday through Friday,or visit SocialSecurity.gov.There are 2 ways to get Medicare Part Dprescription drug coverage: Join a Part Cplan (a Medicare Advantage or MedicareCost plan) or a Medicare prescriptiondrug plan.How do I know if I’m eligiblefor Part D?You’re eligible for Part D if you have MedicarePart A or Part B. If you decide not to sign upduring your first enrollment period, you mayhave to pay a late enrollment penalty, whichis 1% of your monthly premium for everymonth you delayed your enrollment.14You can sign up directly with a planof your choice, or contact Medicare at1-800-633-4227 (TTY 1-877-486-2048),24 hours a day, 7 days a week, or visitMedicare.gov.Before you join, please note: You can only join, change, or drop Part Dplans during certain times of the year orunder certain special circumstances You can only have one Part D plan at a time If you have a Medicare Advantage planwith Part D coverage, joining a Medicareprescription drug plan could make youlose your Medicare Advantage plan andgo back to Original Medicare

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Get more with a Kaiser PermanenteMedicare health planOur Medicare health plan is here to help you thriveWhy choose Kaiser Permanente?The high-quality care you deserve. The predictable costs you need.The doctor choice you want. With a Kaiser Permanente Medicare healthplan, you’ll get benefits that support your goals and help you thrive.Plus, many of our plans include prescription drug coverage, so youcan enjoy the convenience of all-in-one coverage in a single plan.1Learn more about the better benefits we offer to help you get carethat best fits your life. For more information on our Kaiser Permanente Medicare health plans,visit kp.org/medicare.16

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Your care, your wayAs a Kaiser Permanente member, you have many convenient options forgetting care the way you want it.Come inMany services under one roofIn most Kaiser Permanente facilities, you can see your doctor, get lab workor X-rays done, and pick up your prescriptions — often in one trip. In manyregions, specialists’ offices and hospitals are also at the same location.Worldwide care when it matters mostTraveling outside of our coverage area?Relax — as a Kaiser Permanente member, you’re covered for emergencyand urgent care anywhere in the United States or in the world.2CallCare by phoneIf you have a condition that doesn’t require an in-person exam, youcan save yourself a trip to the doctor’s office by scheduling a phoneappointment. Plus, care guidance and advice are available by phone 24/7.ClickManage your health onlineYou can email your doctor’s office, view most test results, refill mostprescriptions, and schedule or cancel appointments — all online.3You can also download the Kaiser Permanente mobile app, at no cost,to manage your health on the go.Find the care you needVisit kp.org/getcare to learn about all the care options in your region.Get advice, make an appointment, find a nearby Kaiser Permanenteurgent care center, and more.18

Personalized care that fits your lifeYou can feel confident about the care you get with a Kaiser PermanenteMedicare health plan.Consistent costs forquality careWith a Kaiser Permanente Medicare healthplan, you pay predictable copays andcoinsurance, and no additional costs forpreventive services like your yearly checkup,mammograms, prostate exams, flu shots,and cholesterol tests.Better care with aconnected teamYour doctor, nurses, and other specialistswork together to keep you healthy. They’reconnected to each other, and to you,through your electronic health record.3So they know important things about youand your health — like when you’re due fora screening and what medications you’retaking. A connected care team helps ensurenothing gets missed or forgotten, so youcan stay on track.Choose yourKaiser Permanente doctor —and change to anotheravailable Kaiser Permanentedoctor anytimeAll our available doctors welcomeKaiser Permanente Medicare health planmembers. Read profiles online so you canselect your personal doctor based on what’simportant to you — education, languagesspoken, specialties, and more. Plus, youhave the freedom to switch to another availableKaiser Permanente doctor at any time.If you’re already a member and are joiningour Medicare health plan, you can stay withthe health care team you know and trust.Quality care with youat the centerPreventive care can help keep you healthy,but we’re also here if you get sick or needspecialty care. Your primary doctor can referyou to a full range of specialists, includingcardiologists, orthopedists, audiologists,and more. Our doctors are highly trainedand experienced in medicine and comefrom renowned medical schools. Moreimportantly, they’re passionate aboutdelivering high-quality care.19

Prescription drug coverageBenefitOrdering prescriptionsWith most of our plans, you’ll also get theKaiser Permanente Medicare prescriptiondrug benefit, which is our Medicare Part Dprescription drug coverage.As a member, you can review yourmedications and request most refills onlineor on our mobile app. Then choose whetheryou want to have it ready for pickup at an innetwork pharmacy or have your refill mailedto you at no extra charge. If you choose mailorder, you can track your order online.What’s coveredOur plans that include Part D prescriptiondrug coverage have an approved list of drugs(the formulary) to make sure you get the mosteffective and safe prescription medicationsavailable. The formulary is carefully chosenwith a team of our health care providers tohelp manage your prescription drug costs.It typically divides groups of medicationsinto tiers.Our plans with Part D have 6 tiers, rangingfrom preferred generic drugs to brand tospecialty medications and injectablePart D vaccines. The tier your medication isin determines your portion of the drug cost.The Kaiser Permanente Medicare prescriptiondrug benefit has more coverage “in the gap,”meaning you may pay a lower share of the costthan with the standard Part D benefitfor generic prescription drugs.Plans don’t cover: Nonprescription or over-the-counter medicines Drugs for cosmetic uses Drugs for weight loss or sexual dysfunction Drugs that Medicare won’t cover20Save time and moneywith mail orderGet your prescriptions delivered to your frontdoor. For most drugs, you can get a 3-monthsupply for just 2 copays when you use ourmail-order pharmacy.4Manage your prescriptions onlineOn our member website, you’ll also be ableto see your prescription and claim history, andyou’ll find a link to look up pricing informationand find pharmacies in your network.For drug costs, please check your summary ofbenefits or Evidence of Coverage (EOC).

Additional coverageOptional benefitsHearing benefitsIf your plan permits, you can choose to adddental, hearing, and extra vision benefits toyour Kaiser Permanente Medicare health plan.This way, it’s easy to take care of your healthcare needs with just one plan.In addition to hearing tests, the optionalbenefits added to your health plan feature anallowance for hearing aids.Dental planOral health is an important part of your overallhealth. In many regions, Kaiser Permanentehas teamed up with Delta Dental to offer youan optional plan.Delta Dental coverage: Lets you choose from a large networkof dentists (care received outside of ournetwork isn’t covered) Provides full coverage for your semiannualdental checkupsVision benefitsThe optional benefits added to your healthplan include an allowance for eyeglasses andcontact lenses.Fitness membershipSome plans include a fitness membership thatgives you access to a broad network of fitnessfacilities and other resources. Stay active witha membership at no additional cost at a fitnesscenter near you. Or you can enroll in the HomeFitness program and work out in the comfortof your own home. Helps make sure that dental health problemsare detected earlyYou can enroll for dental coverage when youfirst enroll in your Medicare Advantage planand during the annual enrollment period. Youcan drop your dental coverage at any time bycalling Member Services or contacting youremployer or union’s benefits administrator.Healthy extras for a healthier you Take advantage of wellness coaching, classes, and other programs — manyat no additional cost. Easy-to-access resources help you live smarter andhealthier, from writing an advance directive to managing chronic conditionssuch as diabetes, arthritis, and heart disease.21

Convenient locations nationwideYou can find Kaiser Permanente medical facilities, doctors’ offices, labs,pharmacies, and other health care services throughout the country: California Hawaii Virginia Colorado Maryland Washington Georgia Oregon Washington, D.C. We’re here to help To learn more about the advantages of enrolling in a Kaiser PermanenteMedicare health plan, call a Kaiser Permanente Medicare specialist at1-866-680-1523 (TTY 711), 8 a.m. to 8 p.m., 7 days a week. For our Groupmembers who are enrolled in an employer-sponsored plan, contact youremployer or union’s benefits administrator.22

We’re part of your communityOur members enjoy a coordinated approach to care and coverage, combinedwith the convenience of treatment close to home. Kaiser Permanente hasmedical facilities, doctors’ offices, labs, pharmacies, and other health careservices throughout the country.Kaiser FoundationHealth Plan, Inc.393 E. Walnut St.Pasadena, CA 91188-8514Kaiser FoundationHealth Plan of Colorado10350 E. Dakota Ave.Denver, CO 80247Kaiser FoundationHealth Plan of Georgia, Inc.Nine Piedmont Center3495 Piedmont Road NEAtlanta, GA 30305Kaiser FoundationHealth Plan, Inc.711 Kapiolani Blvd.Tower Suite 400Honolulu, HI 96813Kaiser FoundationHealth Plan of the Northwest500 NE Multnomah St.Suite 100Portland, OR 97232Kaiser FoundationHealth Plan of theMid-Atlantic States, Inc.2101 E. Jefferson St.Rockville, MD 20852Kaiser FoundationHealth Plan of Washington601 Union St.Suite 3100Seattle, WA 9810121

* In most Medicare Advantage Group Plans, offered by your employer or union, do not include a Coverage gapstage. Please review your EOC for your Part D copay structure. 1. All-in-one coverage includes Medicare PartsA, B, and D in a single plan. 2. If you need emergency or out-of-area urgent care, you can get care from anyprovider. Check your Evidence of Coverage (EOC) for details. 3. When receiving care at a Kaiser Permanentefacility. All online features may not be available in some areas. 4. For certain drugs, you can get prescriptionrefills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within10 business days. If not, please call: Northern California: 1-888-218-6245 (TTY 711), Monday through Friday,8 a.m. to 6 p.m.; Southern California: 1-866-206-2983 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m.;Colorado: 1-866-523-6059 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.; Georgia: 770-434-2008 ortoll-free 1-888-662-4579 (TTY 711), 7 days a week, 24 hours; Hawaii: 808-643-7979 (TTY 711), Mondaythrough Friday, 8:30 a.m. to 5 p.m.; Maryland, Virginia, and the District of Columbia: 703-466-4900 or toll-free1-800-733-6345 (TTY 711), Monday through Friday, 8 a.m. to 7 p.m.; Washington and Oregon: 1-800-548-9809(TTY 711), Monday through Friday, 8 a.m. to 4:30 p.m.In California, Hawaii, Oregon, Washington, Colorado, Georgia, and the District of Columbia, Kaiser Permanenteis an HMO plan with a Medicare contract. In Maryland and Virginia, Kaiser Permanente is an HMO plan and aCost 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.kp.org/medicarePlease recycle.514143718 July 2020

include both Part A and Part B coverage, plus additional benefits. Medicare pays an amount for your coverage each month to these private health plans. There are many types of Medicare Advantage plans, but we'll explain 2 types that Kaiser Permanente offers — Medicare Advantage Health Maintenance Organization (HMO) plans and Medicare Cost plans.