1. health and fitness

2012
It’s your life
live it well
Kaiser Permanente Senior Advantage (HMO)
How our Medicare health plan
can do more for you
A comprehensive health plan that comes complete with peace of mind.
Your greatest asset is your health. For decades, our Medicare-eligible members have enjoyed
health plans that celebrate their independence and well-being.
You can count on us now and in the years to come. Our health plan gives you more benefits
and services than Original Medicare alone. With Senior Advantage, you’ll enjoy the continuity
of our seamless care—with most services in one location—and the reassurance that one single
plan covers your medical and hospital care. You may also get prescription drug coverage if your
group offers it. You’ll be connected and informed, and you can depend on us to be there for you
as your partner in health.
And did we mention it’s all at an affordable value that keeps you feeling great? Here are just
some of the benefits and services that you can expect with our health plan.
Choose the RIGHT DOCTOR for you.
We believe that the relationship you have with your doctor is a personal one. As a member, you’ll
be able to choose your own doctor from our network—and switch doctors within our network
whenever you want. And, our doctors will take the time to get to know you, so they can help
keep you healthy and detect problems before they become serious.
A single plan that covers even your PEACE OF MIND.
With our Medicare health plan, you’ll be covered for hospital and medical services. You may
also get prescription drug coverage, if your group offers it. So most everything you need is in a
single plan.
Access to a full range of SPECIALISTS.
When you need to see a specialist, we’ve got you covered. To make sure you’re getting the very
best care, your doctors and specialists work as a team with a single vision—keeping you healthy
and providing care when you need it.
Focus on PREVENTIVE HEALTH.
Your well-being depends on the steps you take to stay healthy. With our Medicare health plan,
you’ll have access to important preventive services like mammograms and flu shots. You’ll also
find a variety of online health programs and classes, some of which may require a fee. For a
complete list, visit kp.org/classes.
The products and services described above are neither offered nor guaranteed under our
contract with the Medicare program. In addition, they are not subject to the Medicare
appeals process. Any disputes regarding these products and services may be subject to the
Senior Advantage grievance process.
ELECTRONIC MEDICAL RECORDS link your medical team.
We all know that the hip bone is not just connected to the thigh bone—it’s connected to the
rest of you. That’s why we believe that all of your doctors, specialists, nurses, and pharmacists
should be connected, too, through our advanced electronic medical records system. When you
receive care at a Kaiser Permanente facility, your medical team will have immediate access to
your most up-to-date records, from what prescriptions you’re taking to which lab tests you’ve
had. And because they can share information and insights with each other, you’ll receive more
informed, seamless care.
More convenience means MORE FREEDOM.
When you visit our facilities, you’ll find that your doctor’s office, pharmacy, and lab are usually
all in one location. This means you can see your doctor, get lab work done, and pick up your
prescriptions all during the same visit.
And if you receive care at a Kaiser Permanente facility, you may take advantage of My Health
Manager, an innovative online resource that allows you to securely manage many aspects of your
health care anytime, anywhere.
• Email your doctor’s office with routine questions.
• Order most prescription refills, receive refill reminders, and read information about your
prescriptions.
• View most lab test results—many on the same day.
• Schedule, cancel, or change routine appointments.
• For a quick, useful introduction to My Health Manager, visit kp.org/experience.
To see how Kaiser Permanente Medicare health plans rate in comparison to other
Using Medicare plan
star ratings to help
make your decision
The Medicare plan star ratings rank
how well Medicare health and prescription drug plans perform across
numerous important categories.
And that information is readily
available to you. The overall ratings
compare:
• Quality of care
• Access to care
• Plan responsiveness
• Member satisfaction
• Customer service
• Prescription drug services
To learn what the star ratings mean
for you, visit kp.org/medicarestars.
Catastrophic protection—MORE WELLNESS, less worry.
Should catastrophic medical expenses come up
unexpectedly, you can rest easy because most of our plans
have a cap on medical expenses. And you’re always covered
for urgent and emergency care. Check your specific plan
information for all the details.
Join the CAN-DO MEDICARE HEALTH PLAN.
We know you value your health, independence, and all the
good things in your life. We value them, too. It’s our
goal to add to your well-being every day with our benefits
and services.
If you would like more information about Senior Advantage,
please contact your employer’s or trust fund’s benefits
administrator.
Our added benefits add to your WELL-BEING.
Your Kaiser Permanente Senior Advantage benefits don’t
stop with our standard Senior Advantage package. All of our
primary care physicians welcome Medicare members, and
now you’ll have even easier access than ever before to our
medical facilities.
We’ve added new locations and will continue to add more, so
you have even more options when choosing where to receive
care. You can also take advantage of extended hours—including
evening and Saturday appointments—at many locations.
And you’ll be able to see any of our specialists in our medical
centers with our easy referral process.
plans, please visit medicare.gov.
For more information
To learn more about Senior Advantage, please contact your employer’s or trust fund’s
benefits administrator.
Kaiser Permanente is a health plan with a Medicare contract. The benefit information provided herein
is a brief summary, not a comprehensive description of benefits. For more information contact the plan.
Benefits, formulary, pharmacy network, premiums, and copayments/coinsurance may change on January
1, 2013 and at other times in accord with your employer group’s contract with us. You must use network
pharmacies to access your prescription drug benefit, except under non-routine circumstances, and quantity
limitations and restrictions may apply. You must use plan providers except in emergency or urgent care
situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither
Medicare nor Kaiser Permanente will be responsible for the costs. You must continue to pay your Medicare
Part B premium. For information about Kaiser Permanente Senior Advantage benefits, call our Member
Service Call Center at 1-800-443-0815 (TTY 1-800-777-1370 for the deaf, hard of hearing, or speech
impaired), seven days a week, 8 a.m. to 8 p.m. Anyone who has Medicare Parts A and B (or Part B only),
including some people under the age of 65 with disabilities, may apply. You must reside in the Kaiser
Permanente Senior Advantage service area in which you enroll. You may be able to get Extra Help to pay
for your prescription drug premiums and costs. To see if you qualify for extra help, call:
•1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
•The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users
should call, 1-800-325-0778; or
•Your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you
qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly
prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not
be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings
and don’t even know it. For more information about this Extra Help, contact your local Social Security
office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should
call 1-877-486-2048.
Plan performance summary star ratings are assessed each year and may change from one year to the next.
For more information about Medicare benefits and services, visit medicare.gov or call 1-800-MEDICARE
(1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
Kaiser Foundation Health Plan, Inc.
393 E. Walnut St.
Pasadena, CA 91188-8514
MOM 60086785 (12/2011)