Learn more at kp.org/feds
Your 2024 Kaiser Permanente
FEHB Guide to Medicare
Northern California — Kaiser Permanente Medicare Health Plan
Get lower copays and extra benefits without increasing your FEHB monthly premium
2 3
If you have questions or are ready to enroll, our Kaiser Permanente Medicare
specialists are here for you. Call one of our Kaiser Permanente Medicare
specialists at 1-877-297-0569 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m.
WHAT’S INSIDE THIS GUIDE
The 4 parts of Medicare .................................................................................
4
The basics: Senior Advantage for Federal Members (HMO) ....................
5
The key 3: Benefits of Kaiser Permanente Senior Advantage ...................
6
Senior Advantage choices for FEHB members ...........................................
7
2024 FEHB plan options and premiums .......................................................
8
Find the right plan for you .............................................................................
10
3 steps to learn more and enroll ...................................................................
12
When to enroll ...........................................................................................................................
13
Get the most out of your
FEHB coverage
This guide is designed for Federal Employee Health Benefits (FEHB) program members
who are, or soon will be, eligible for Medicare. This guide will help you understand your
options so you can choose the coverage that’s right for you.
1
Add a Kaiser Permanente Medicare health plan to your FEHB plan to get lower
copayments and additional benefits without increasing your FEHB premium. Most
importantly, some plans offer reimbursement for your entire Medicare Part B premium.
This guide will also provide tools and tips to make enrollment simple.
2024 Senior Advantage Benefit Highlights
Part B premium
reimbursement of
up to $250 a month
Extras to keep you healthy,
like the Silver&Fit®
fitness program
2
Dental and
eyewear
coverage
4 5
•
Original Medicare includes Medicare Part A (hospital insurance) and Medicare
Part B (medical insurance) and is provided by the U.S. government as a federal
health insurance program.
•
With Original Medicare alone, you will pay deductibles and coinsurance for
most services.
•
Medicare Advantage plans (Part C) offer all the benefits of Original Medicare
PLUS extra benefits like vision, hearing, dental services, and fitness programs.
Some plans even pay for some or all of your Part B premium.
Part B reimbursement: All FEHB health plans are encouraged to offer attractive
and competitive benefits to enhance Medicare coverage for Federal retirees.
Our Medicare plans support this goal by offering lower cost-sharing, additional
benefits, and Part B premium reimbursement benefit so you get the most of your
FEHB and Medicare coverage.
PART B PREMIUM REIMBURSEMENT
•
With a qualifying plan,* Kaiser Permanente will reimburse you for your full Part B
premium, up to $250 per month. This covers what most people pay, including late
enrollment penalties (LEP) and income related monthly adjustment amount (IRMAA).
This benefit is not taxable as it is paid from a health reimbursement account (HRA).
•
Most people pay the standard Part B premium, which was $164.90 per month in
2023. There are 2 circumstances which will make this premium higher:
1. Late enrollment: If you didn’t sign up for Part B when you were first eligible, your
monthly premium for Part B would be 10% higher for each full 12 months in the
period that you could have had Part B but didn’t sign up for it.
2. Higher income: If your income in 2023 was greater than $97,000 if you file
individually or $194,000 if you’re married and file jointly, you may pay an Income
Related Monthly Adjustment Amount (also known as IRMAA) for Parts B and D.
NOTE: As your income adjusts in retirement, so does your IRMAA.
A Kaiser Permanente FEHB Medicare health plan combines all your coverage into one
simple plan and offers additional benefits like Part B premium reimbursement.
The basics: Kaiser Permanente Senior
Advantage for Federal Members (HMO)
*Senior Advantage 2 (HMO) for High or Standard Option.
*Kaiser Permanente offers Part B premium reimbursement with some plans.
PART D
Prescription Drug
Coverage
PART A
Hospital Insurance
PART B
Medical Insurance
•
Extra benefits, such as vision, hearing,
dental, and fitness programs
•
Lower out-of-pocket costs for many
services including office visits,
emergency care, prescription drugs,
and more
PART C
Kaiser Permanente
Medicare health plan
PART A PART B
Hospital 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.
Medical insurance
•
Services from doctors and other
health care providers
•
Outpatient care
•
Durable medical equipment
You pay a monthly premium.*
PART C PART D
Medicare Advantage
A Medicare-approved plan from
a private company that offers an
alternative to Original Medicare for
your health and drug coverage.
Bundles Part A, Part B, and usually
Part D.
Prescription drug coverage
Helps cover the cost of
prescription drugs, including many
recommended shots or vaccines.
ADDITIONAL MEDICARE NOTES
The 4 parts of Medicare
6 7
Senior Advantage choices for
FEHB members
•
As a Federal enrollee, you get to choose the Senior Advantage plan that best fits your health
and wellness goals.
•
If you are also covering dependent(s) that are not Medicare eligible, they will remain enrolled
in the commercial plan.
•
The chart on pages 10-11 has more details in a side-by-side summary for all options.
Prosper - Senior Advantage
• No deductible and lower out-of-pocket maximum
• No cost-sharing for lab tests and X-rays
• Eyewear allowance of $150 every 24 months
• Lower copays
• Silver&Fit® fitness program at no extra charge
2
High Option
Senior
Advantage 1
Senior
Advantage 2
• Lower copays
• Up to a 100-day supply
of prescription drugs for
1 copay
• Eyewear allowance of
$200 every 24 months
• Dental coverage
included (DeltaCare®
USA dental HMO)
• Meal delivery
• Silver&Fit® fitness
program at no extra
charge
2
• Nonemergency
transportation to
medical providers
• Over-the-counter health
and wellness allowance
• Up to $3,000
reimbursement
each year ($250
each month) for the
Medicare Part B
premium you pay
• Lower copays
• Silver&Fit® fitness
program at no extra
charge
2
• Over-the-counter
health and wellness
items allowance
• Hearing aid allowance
of $500 for each ear
for every 36 months
Standard Option
Senior
Advantage 1
Senior
Advantage 2
• Lower copays
• Eyewear allowance of
$150 every 24 months
• No deductible and
lower out-of-pocket
maximum
• Dental coverage
included (DeltaCare®
USA dental HMO)
• Silver&Fit® fitness
program at no extra
charge
2
• Up to $3,000
reimbursement
each year ($250
each month) for the
Medicare Part B
premium you pay
• Lower copays
• No deductible and
lower out-of-pocket
maximum
• Hearing aid allowance
of $500 for each ear
for every 36 months
• Silver&Fit fitness
program at no extra
charge
2
The key 3: Benefits of
Kaiser Permanente Senior Advantage
for Federal Members (HMO)
*Senior Advantage 2 (HMO) for High or Standard Option.
CARE WITHOUT COMPROMISE
•
You get all the benefits of your FEHB coverage and more, without increasing
your FEHB premium.
•
Your FEHB benefits are enhanced by enrolling in a Medicare Advantage plan
(which includes hospital, doctor, and prescription drug coverage)
•
Continue to receive the same great care from your Kaiser Permanente doctors
that you have on your current FEHB plan
ENHANCED BENEFITS
•
Extra benefits to help you thrive that are not included with Original Medicare.
•
Medicare Part B premium reimbursement* pays you back for the cost of
Medicare Part B, up to $250 per month. This covers what most people
pay, including Late Enrollment Penalties (LEP) and Income Related Monthly
Adjustment Amount (IRMAA).
•
Lower copayments for most covered services
•
Lower costs for some prescription drugs
•
No deductibles
PREVENTIVE CARE
•
Additional coverage for services like vision, hearing, and dental allows you to
take care of your health proactively
•
The Silver&Fit® Healthy Aging and Exercise Program is designed to support your
healthy aging journey. You can exercise at a fitness center, join classes and events
from home, and access personalized resources to enhance your well-being.
2
•
No additional costs for preventive services like your yearly checkup,
mammograms, prostate exams, flu shots, and cholesterol tests
8 9
When you become eligible for Medicare, you may be able to change your current plan option.
There are 2 ways to learn more about making enrollment changes outside of Open Season:
• Go to opm.gov.
• Contact your employing agency or retirement office.
Enrolling in Senior Advantage for Federal Members does not change your FEHB premium. Active
employees and retirees pay the same amount. The FEHB premium share you currently pay is
listed in the table below.
*
The above FEHB rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB Program website
or contact the agency or Tribal Employer which maintains your health benefits enrollment. You must continue to pay the Medicare Part B
premium to remain in the Kaiser Permanente Medicare health plan. Self Plus One enrollees covering themselves and one other eligible
family member may choose either the Self Plus One or Self and Family enrollment type, whichever has a lower premium. You should decide
which enrollment type is best for you.
**
To sign up or change options, find your enrollment code in the chart above. Then, visit opm.gov to enroll online or contact your employing
agency or retirement office for next steps and other information. These are highlights of the FEHB enrollment process. Please refer directly to
opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other
information.
You can enroll in Kaiser Permanente Senior Advantage for Federal Members if you have Medicare Parts A and B or Part B only and are an FEHB
Kaiser Permanente member.
2024 FEHB plan options and premiums
Your Premium Share* High Option Standard Option Prosper
Self Only
Biweekly $204.93 $119.45 $79.27
Monthly $444.01 $258.81 $171.75
Self Plus One
Biweekly $550.65 $328.17 $185.49
Monthly $1,193.08 $711.04 $401.89
Self and Family
Biweekly $490.97 $268.49 $185.49
Monthly $1,063.77 $581.73 $401.89
Enrollment Code** High Option Standard Option Prosper
Self Only 591 594 KC1
Self Plus One 593 596 KC3
Self and Family 592 595 KC2
10 11
*Deductible applies. **Copayments are for a 30-day supply, or 100-day supply for High Option Senior Advantage 1, at Kaiser Permanente pharmacies. You
pay only 2 copays for up to a 100-day supply for most drugs through Kaiser Permanente’s mail-order program.
†
Plan providers determine the drug that is
medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs. Some drugs may not be eligible for mail-order
delivery or mail-order discounts. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You
should receive them within 3–5 days. If not, please call 1-888-218-6245 (TTY 711).
Senior Advantage for Federal Members (HMO)
Enrolling in Senior Advantage for Federal Members does not change your FEHB premium.
See page 8 for your premium share.
Notes:
• Deductible and out-of-pocket maximum amounts are per person, but no more than 2 times per family.
• Coinsurance (%) is based on our allowance.
• Telehealth options include video, phone, email, and more.
• Silver&Fit® is a federally registered trademark of American Specialty Health, Inc.
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 RI 73-003. 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.
High Option
2024 Benefits and Services Without Medicare Senior Advantage 1
Senior Advantage 2
Deductible None None None
Outpatient services
Preventive care $0 $0 $0
Telehealth $0 $0 $0
Primary care office visit $15 $5 $10
Specialty care office visit $25 $5 $10
Most lab tests and X-rays $0 $0 $0
Chiropractic – 20 visits per year $15 $15 $15
Hospital services
Outpatient surgery $50 $5 $50
Inpatient hospital $250 $100 $250
Emergency and urgent care
Urgent care $15 $5 $10
Emergency care $100 $75 $75
Ambulance $50 $50 $50
Prescription drugs**
,
†
Generic $10 $10 $10
Brand $40 $30 $40
Specialty $100 $100 $100
Additional Senior Advantage benefits
Dental Not covered Included Not covered
Eyewear allowance (every 24 months) Not covered $200 Not covered
Fitness membership
Not covered Silver&Fit® Silver&Fit®
Hearing aid allowance for adults
(per ear, every 36 months)
Not covered Not covered $500
Nonemergency transportation and meal-delivery Not covered Included Not covered
Over-the-counter health and wellness items
allowance (every quarter)
Not covered $70 $70
Part B reimbursement None None Up to $250 per month
Out-of-Pocket Maximum $2,000 $2,000 $2,000
Standard Option Prosper
Without Medicare Senior Advantage 1
Senior Advantage 2
Without Medicare
Senior Advantage
$100 None None $500 None
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$30 $15 $25 $25 $25
$40 $15 $25 $35 $25
$10
*
$10 $10 20%* $0
$15 $15 $15 $15 $15
$200* $15 $25 20%* $25
$500* $250 $500 20%* $250 per day up to $1,000
$30 $15 $25 $25 $25
$150* $75 $75 20%* $75
$150* $125 $150 20%* $150
$15 $10 $10 $15 $10
$50 $40 $47 $60 $47
$150 $150 $150 $200 $200
Not covered Included Not covered Not covered Not covered
Not covered $150 Not covered Not covered $150
Not covered Silver&Fit® Silver&Fit® Not covered Silver&Fit®
Not covered Not covered $500 Not covered Not covered
Not covered Not covered Not covered Not covered Not covered
Not covered Not covered Not covered Not covered Not covered
None None Up to $250 per month None None
$3,000 $2,000 $2,000
$5,500 $2,000
12 13
If you already have Medicare Parts A and B, or Part B, only you can enroll in a
Senior Advantage plan for FEHB members today. There’s no need to wait for
Open Season.
3 steps to learn more and enroll
Attend a FREE
4
online seminar.
Register for a live webinar presented by Kaiser Permanente’s FEHB Medicare
team to hear about the exclusive Medicare health plan benefits available only
to FEHB members. You’ll also learn about the next steps you need to take, get
resources to help you enroll, and have the opportunity to ask questions that are
important to you.
Webinar meetings are available online to meet your busy schedule. You can
also watch an on-demand webinar anytime that works for you.
Scan the QR code with your smartphone’s camera or visit
kp.org/fedsmedicare to RSVP for an online webinar.
For a full list of benefit changes, refer to the FEHB plan brochure RI 73-003
and Kaiser Permanente Medicare Evidence of Coverage.
Determine when you can enroll (details on the following page).
Go to kp.org/feds and enroll online or call us at 1-877-297-0569
(TTY 711) to speak with a Medicare specialist. Monday through Friday,
8 a.m. to 8 p.m.
When to enroll
Initial Enrollment Period
You can first sign up for Part A and/or Part B during the 7-month
period that begins 3 months before the month you turn 65,
includes the month you turn 65, and ends 3 months after the
month you turn 65.
General Enrollment Period
If you do not sign up for Part A and Part B when you’re first eligible,
you can sign up between January 1 and March 31. When you
sign up during this period, your coverage starts the first day of the
month after you sign up.
Special Enrollment Period (SEP)
If you continue to work past age 65 and have delayed your
enrollment in Medicare Parts A and B, you have up to 8 months
from the date you retired to enroll in Medicare Parts A and B to
avoid a late enrollment penalty.
Medicare
To learn more about Medicare
coverage or enrollment periods
or to ask a general question about
Medicare, go to medicare.gov or
call 1- 800 - 6 33 - 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/or B, or determine your Part B
premium, visit ssa.gov or call Social
Security at 1-800-772-1213, Monday
through Friday, 8 a.m. to 7 p.m.
TTY users, call 1-800-325-0778.
To help better understand your
choices and options, here are some
helpful resources:
Helpful resources
14 15
Notes
1144047141_NCAL October 2023
Learn more at kp.org/feds
Kaiser Foundation Health Plan, Inc.
393 E. Walnut St.
Pasadena, CA 91188-8514
If you have questions or are ready to enroll, call one of our
Kaiser Permanente Medicare specialists at 1-877-297-0569
(TTY 711), Monday through Friday, 8 a.m. to 8 p.m.
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 RI 73-003. 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.
1. If you are not on a Kaiser Permanente FEHB plan, go to kp.org/feds to learn more. 2. The Silver&Fit
program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health
Incorporated (ASH). Silver&Fit is a trademark of ASH and used with permission herein. 3. Kaiser Permanente
offers Part B premium reimbursement with some plans. 4. Free with no obligation to enroll.
Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends
on contract renewal. To join a Kaiser Permanente Medicare health plan, you must reside in the Kaiser
Permanente Medicare health plan service area in which you enroll. 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 RI 73-003.
