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Kaiser Permanente Medicare Advantage HMO 2027

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) | Last updated October 8, 2026

Kaiser Permanente’s Medicare Advantage plans are HMOs, Senior Advantage in most regions, and for 2027 they are Kaiser’s only Medicare Advantage option because Kaiser is dropping its last 3 PPOs.

Kaiser HMOs work inside Kaiser’s integrated system: Kaiser doctors, many Kaiser hospitals and pharmacies, coordinated through one record. Care outside Kaiser is generally covered only for emergencies, urgent care or with authorization.

Kaiser serves 9 states plus D.C. for 2027 and is leaving 2 Nevada and 3 Washington counties.

✔ Licensed across all 50 states
✔ Built on CMS 2027 data
✔ No-cost plan comparison

Key Highlights

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Kaiser MA plans are HMOs.

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Last 3 PPOs dropped.

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9 states + D.C.

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Nationally, the average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).

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The Annual Enrollment Period is October 15 to December 7, 2026.

Compare plans and enroll online

How Kaiser HMOs Work

Why People Choose Kaiser

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Doctors, hospitals and pharmacy in one system

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Shared records across your care team

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Simple copays on many plans

What to Weigh

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Generally must use Kaiser facilities

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Outside service areas, coverage is limited except for emergencies

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Only in certain counties

Benefits Kaiser Permanente Plans May Offer

Kaiser Permanente Plans May Include

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Hospital and medical coverage matching Original Medicare Part A and B

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Part D prescription drug coverage on most plans

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Routine dental, vision and hearing benefits

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Fitness programs and over-the-counter allowances

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Telehealth visits and care coordination programs

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A yearly out-of-pocket maximum on every plan

Benefits are not offered by every plan. They differ by plan and county and may change for 2027. Review the Evidence of Coverage for each plan before enrolling.

How Kaiser Permanente HMO coverage works with Medicare

What to Check for 2027

Keep an eye out: a non-renewal letter will arrive if your plan is ending. You stay covered through December 31, 2026. Taking no action sends you back to Original Medicare with no drug coverage.

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Kaiser 2027

9 States + D.C.

Service areas for Kaiser Permanente Medicare Advantage in 2027, Nevada included.

5 Counties

Kaiser is exiting 2 counties in Nevada and 3 in Washington.

Last 3 PPOs

Kaiser is dropping its remaining PPO plans.

How Medicare Advantage Works

Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.

In return, Kaiser Permanente plans generally rely on networks of doctors and hospitals and may require prior authorization or referrals for certain services. Unlike Original Medicare, every Medicare Advantage plan caps what you pay out of pocket each year for covered medical care. You continue to pay your Part B premium, along with the plan’s premium if there is one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Compare 2027 costs, prescriptions, and plan benefits

Pros and Cons of Medicare Advantage

Advantages

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Often a low or $0 premium

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A yearly out-of-pocket maximum

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Drug coverage usually included

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Dental, vision and hearing benefits may be included in many plans

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One card and one plan

Tradeoffs

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Networks; except for emergencies, HMOs require in-network care

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Prior authorization and referrals are common

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Copays add up if you use a lot of care

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Plans and networks can change every year

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Moving to Medigap later may involve health questions

Kaiser Permanente Drug Coverage for 2027

Part D drug coverage is included in most Kaiser Permanente Medicare Advantage plans. Every plan sets its own formulary, drug tiers and pharmacy network, and costs are often lower at preferred pharmacies and through mail order. In 2027, any plan’s Part D deductible can be as high as $700, and out-of-pocket costs for covered drugs are capped at $2,400.

Tier Typical Drugs Typical Cost
Tier 1 Preferred generics Lowest copay
Tier 2 Generics Low copay
Tier 3 Preferred brand-name drugs Moderate copay
Tier 4 Non-preferred drugs Higher copay or coinsurance
Tier 5 Specialty drugs Highest coinsurance

Each plan sets its own tiers. Review every plan’s formulary.

A drug you take may not be on a plan’s 2027 formulary, or it may come with a rule such as prior authorization. Even then, you have options:

If Your Drug Is Not Covered

1

Request a transition fill. During the first 90 days of a new plan or plan year, plans generally have to provide a temporary supply of a drug you already take, giving you time to change drugs or ask for an exception.

2

Talk to your doctor about other options. A covered drug from the same class could work just as well for less money.

3

Ask for a tiering or formulary exception. Your doctor sends a statement explaining why you need the drug or a lower copay. Plans have to decide within set time limits.

4

Challenge a denial. When the plan turns you down, you have the right to appeal through several levels of review.

See steps to appeal a Medicare Part D denial.

If Your Plan Is Ending

A non-renewal notice should have reached you in early October if your Kaiser Permanente plan won’t be available in your county for 2027. Coverage doesn’t end immediately; it runs through December 31, 2026, which gives you time to decide.

If Your Plan Is Ending

1

Review your non-renewal letter. It verifies that your plan is ending and lays out your choices.

2

Write down your doctors and drugs. Comparing replacement plans requires them.

3

Compare your 2027 plan choices. Look at networks, drug coverage and the out-of-pocket maximum, not only the premium.

4

Pick a plan by December 31 to avoid a gap. If you enroll during Annual Enrollment by December 7, your coverage starts January 1, 2027.

5

Rely on your Special Enrollment Period if necessary. If your plan is ending, you generally have until the end of February 2027 to make a choice.

If you take no action: on January 1, 2027, you go back to Original Medicare, and you will have no drug coverage unless you pick a Part D plan. Being without drug coverage may result in a late enrollment penalty.

Medigap rights: if your Medicare Advantage plan exits your area, you generally get a guaranteed issue right, lasting up to 63 days after your coverage ends, to purchase certain Medicare Supplement plans with no health questions.

How to Compare Kaiser Permanente Plans for 2027

How to Compare

1

Review your Annual Notice of Change. It spells out every 2027 change to the plan you have now.

2

Verify your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 network.

3

Review your prescriptions. Verify every drug, the tier it falls on and any step therapy or prior authorization rules.

4

Look at the full annual cost. Total up the premium, usual copays and drug costs, and review the out-of-pocket maximum.

5

Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.

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Sign up by December 7. Coverage under your new plan begins January 1, 2027.

2027 Enrollment Dates

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Join, change or drop a Medicare Advantage or Part D plan effective January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 In Medicare Advantage, you can change to another plan or go back to Original Medicare one time
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Switch plans after events such as a move, a loss of other coverage or your plan exiting your area

Annual Enrollment is when most people make changes. If you like your current plan, no action is needed; it renews on its own. Even so, review your Annual Notice of Change, since networks, premiums, copays and drug lists can all change on January 1.

Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around the members they serve, and many come with care coordinators. In 2027, SNPs are one of the few places large insurers are adding plans, even while cutting PPOs.

Type Who Qualifies What Is Different
Dual Special Needs Plan (D-SNP) People with both Medicare and Medicaid Coordinates both programs; costs are often very low, with extra benefits
Chronic Condition SNP (C-SNP) People who have qualifying conditions like diabetes, heart failure or chronic lung disease Doctors, drugs and programs designed around the condition
Institutional SNP (I-SNP) People who live in a nursing home or need that level of care at home Care delivered where the member lives

Turning 65 in 2027

When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.

Turning 65 Checklist

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Enroll in Part A and Part B, unless you have qualifying employer coverage and decide to postpone Part B

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Choose between Medicare Advantage and Original Medicare plus Medigap

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Enroll in a drug plan, or a Medicare Advantage plan that includes drugs, to avoid a late Part D penalty

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If you go with Medigap, purchase during your six-month Medigap Open Enrollment Period

Star Ratings

Each fall, Medicare gives every Medicare Advantage and Part D plan a rating of 1 to 5 stars, based on factors such as preventive care, how well chronic conditions are managed, member complaints, customer service and accuracy of drug pricing. You can see the ratings in Medicare Plan Finder.

Using Star Ratings

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Ratings of 4 stars or more are generally a good indicator of quality and service

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A special enrollment period lets you move into a five-star plan once during the year

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A new plan may not have a rating yet, and that alone isn’t a bad sign

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Ratings reflect the plan as a whole, not how well it covers your particular doctors and drugs

Medicare Advantage or Medigap?

Medicare Advantage Original Medicare + Medigap
Monthly premium Often low or $0 (2027 average $12, CMS) Higher; varies by plan letter, age and ZIP
Doctors Usually a network Any provider in the U.S. that accepts Medicare
Costs when you get care Copays and coinsurance up to a yearly maximum Low and predictable; on Plan G, little or nothing once the Part B deductible is met
Drug coverage Usually included Add a separate Part D plan
Dental, vision, hearing Many plans may include some coverage Not included
Changing later Every year during Annual Enrollment Health questions in most states once your Medigap Open Enrollment Period ends

Guaranteed issue: when your Medicare Advantage plan exits your area, you can generally purchase certain Medicare Supplement plans with no health questions asked, up until 63 days after that coverage ends.

Help Paying Medicare Costs

When your income and savings are limited, two programs can greatly lower your Medicare costs:

Medicare Savings Programs

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Run by your state Medicaid office

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May cover your Part B premium, and in some cases deductibles and coinsurance

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Income and asset limits vary by state

Extra Help (Part D)

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Run by Social Security

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Lowers Part D premiums, deductibles and copays

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Those enrolled in a Medicare Savings Program qualify automatically

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

Getting Help

You do not need to compare plans by yourself, and help should not cost you anything. Here are the free options:

Free Help Comparing Plans

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Available any time: Medicare Plan Finder on Medicare.gov

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1-800-MEDICARE (1-800-633-4227), reachable 24 hours a day on all seven days of the week

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Your State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling

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A licensed agent or insurance broker, who can compare plans across several insurers for free

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.

Bottom Line

The Bottom Line

Kaiser HMOs fit people who want integrated care within Kaiser. Confirm your area and compare during Annual Enrollment.

Compare plans and enroll online

Frequently Asked Questions

➤ Are Kaiser Medicare plans HMOs?

Yes. Kaiser Permanente is dropping its last three PPO plans for 2027, so its Medicare Advantage lineup is HMO-only. Kaiser Senior Advantage plans generally require you to use Kaiser doctors, hospitals and facilities, so make sure that fits how you get care.

➤ Can I see non-Kaiser doctors?

Generally, no. Kaiser HMOs cover care from non-Kaiser providers mainly for emergencies, urgently needed care, or when Kaiser authorizes it. If you want to keep a doctor outside Kaiser’s system, a different plan or plan type may suit you better.

➤ When can I enroll in a Kaiser Permanente Medicare Advantage plan for 2027?

Kaiser Permanente Senior Advantage plans for 2027 are available during Annual Enrollment, October 15 to December 7, 2026, with coverage starting January 1, 2027. If you are already in Medicare Advantage, you can make one change from January 1 to March 31, 2027.

➤ What happens if my Medicare Advantage plan is ending?

A non-renewal notice is sent, and your coverage continues through December 31, 2026. You can pick a new plan during Annual Enrollment or a Special Enrollment Period, and you generally have a guaranteed issue right to buy certain Medigap plans. Former Kaiser PPO members should watch for this notice.

➤ Where does Kaiser offer Medicare Advantage?

Kaiser Permanente offers Medicare Advantage in nine states plus Washington, DC, but only in specific counties. For 2027 it is leaving two Nevada counties and three Washington counties, so members there should check their Annual Notice of Change.

➤ How is Kaiser different from other HMOs?

Kaiser Permanente is an integrated system, meaning the same organization provides the coverage and much of the care through its own doctors and facilities. That can make care easier to coordinate, but your choices are largely limited to Kaiser’s network.

➤ What happens if I had a Kaiser PPO?

Kaiser is dropping its last three PPO plans for 2027, so PPO members will need new coverage. You can move to a Kaiser HMO or another plan during Annual Enrollment or a Special Enrollment Period, or use your guaranteed issue right to buy certain Medigap plans.

Have Questions?

Speak with a licensed insurance agent

1-833-641-4938

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-833-641-4938TTY 711

Mon-Fri: 8am-9pm ET

ZRN Health & Financial Services, LLC, a Texas limited liability company

( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.

CompareMedicareAdvantagePlans.org
215 RR 620 South Austin, TX 78734

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