Kaiser Permanente is the odd one out in Medicare Advantage, and the way it is odd is the whole decision. Every other big carrier rents a network of independent doctors and hospitals. Kaiser owns the hospitals, employs the doctors, runs the pharmacy, and does the lab work, then sells you a plan that only works inside that system.
That produces two results that pull in opposite directions. Kaiser’s plans score higher on CMS quality ratings than any other large carrier’s, and Kaiser’s plans are the least portable in the market. All figures below are 2026 plan year data, taken from CMS’s CY2026 landscape file (last updated March 2, 2026) and from Kaiser’s own published Summary of Benefits documents.
What Is Kaiser Permanente Medicare Advantage
Kaiser Permanente Medicare Advantage is Medicare Part C sold by Kaiser Foundation Health Plan. Like any Medicare Advantage plan, it replaces Original Medicare as your coverage, bundles in Part D drugs on most plans, and adds extras Original Medicare never covered. If the parts of Medicare are still unclear, start there.
The brand names are regional. In California, Hawaii, Georgia, Colorado, and Oregon the plans are called Kaiser Permanente Senior Advantage. In Washington, Maryland, Virginia, and DC they are called Kaiser Permanente Medicare Advantage. The dual-eligible plans are Kaiser Permanente Dual Complete or Dual Essential.
Kaiser is the fourth-largest Medicare Advantage insurer by enrollment. KFF puts it at 6% of the national market in 2026, behind UnitedHealth Group (26%), Humana (20%), and CVS Health (12%). It was also one of only two large insurers to grow in the year to March 2026, adding roughly 87,000 members while UnitedHealthcare shrank.
It does that on a tiny map. CMS’s 2026 file shows Kaiser Permanente Medicare Advantage plans in exactly 118 counties across nine states and the District of Columbia: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and DC. That is the smallest footprint of any major carrier by a wide margin.
How Kaiser’s Plans Work
Almost everything Kaiser sells is an HMO. Of 119 plan segments in the 2026 landscape file, 64 are HMO, 29 are HMO dual-eligible special needs plans, 23 are HMO-POS, and just 3 are PPO (the Senior Advantage Choice plans in Colorado). Compare that to Humana, which sells hundreds of PPOs.
Kaiser’s own 2026 Summary of Benefits spells out the network rule. You get covered services from plan providers listed in the Provider Directory, with five stated exceptions: care from plan providers in another Kaiser Permanente region, emergency care, out-of-area dialysis, out-of-area urgent care, and referrals to non-plan providers approved in advance in writing. The document then says that if you receive non-covered care or services, you must pay the full cost.
That is stricter than a typical HMO, because a typical HMO’s network is a list of independent practices you can shop within. Kaiser’s network is Kaiser. There is no second opinion from a competing health system unless Kaiser authorizes it first.
The upside is that everything is under one roof. Kaiser’s own document notes that at most plan facilities you can get specialty care, pharmacy, and lab work in the same place, and that you are not locked to a single facility within the region. Specialist visits carry a footnote saying your plan provider may need to provide a referral, and your personal doctor coordinates hospital stays, specialist referrals, and prior authorizations. Prior authorization is not unique to Kaiser: KFF found 99% of Medicare Advantage enrollees nationwide are in plans that require it for some services. Understanding how prior authorization works and the Medicare appeal process is worth doing early.
One genuine travel perk: both California Summary of Benefits documents state that Kaiser covers emergency care and urgently needed services anywhere in the world. Medicare.gov notes that Medicare Advantage plans generally do not cover care outside the U.S., so this is a real exception worth naming.
What It Costs
The named-plan figures below come from Kaiser’s own 2026 Summary of Benefits PDFs. Every premium and out-of-pocket maximum in those documents matches the CMS landscape file exactly, so each figure has two independent sources.
| 2026 cost item | Kaiser figure or range | Notes |
|---|---|---|
| Monthly plan premium, individual plans | $0 to $358 | Only 33 of 90 plans (37%) are $0; median $24 |
| Monthly plan premium, special needs plans | $0 | All 29 dual-eligible plans are $0 |
| Medicare Part B premium (you always pay this) | $202.90 | Standard 2026 rate, up from $185.00 in 2025 |
| Medicare Part B deductible | $283 | 2026 rate, up from $257 in 2025 |
| In-network out-of-pocket maximum | $699 to $8,900 | Median $5,500; no Kaiser plan sits at the $9,250 CMS ceiling |
| Part D drug deductible, individual plans | $0 to $160 | 82 of 86 drug plans have no deductible at all |
| Senior Advantage Los Angeles and Orange Counties Plan (HMO) H0524-003 | $0 premium, $699 cap | $0 primary care, $0 specialist, $0 inpatient, $150 ER, 4.5 stars |
| Senior Advantage Los Angeles and Orange Value Plan (HMO) H0524-078 | $0 premium, $1,999 cap | $0 primary care, $0 specialist, $150 per day inpatient days 1 to 5, $150 ER |
| Senior Advantage Greater Sacramento and Sonoma Basic (HMO) H0524-051 | $24 premium, $6,000 cap | $5 primary care, $30 specialist, $130 ER, $275 MRI/CT/PET, 4.5 stars |
| Senior Advantage Greater Sacramento and Sonoma Enhanced (HMO) H0524-013 | $95 premium, $3,900 cap | $0 primary care, $15 specialist, $150 ER, $275 MRI/CT/PET, 4.5 stars |
Several things worth pulling out.
Kaiser is the rare carrier where paying a premium is the norm rather than the exception. Sixty percent of its individual plans charge something. The Sacramento pair shows exactly what the money buys: $24 a month gets you a $6,000 cap, a $5 primary care copay, and a $30 specialist copay, while $95 a month gets you a $3,900 cap, a $0 primary care copay, and a $15 specialist copay. That is $71 a month for $2,100 less exposure and lower copays across the board.
Geography drives price more than anything. In California the median individual plan premium is $19 and 9 of 31 plans are $0. In Hawaii there is no $0 plan at all: premiums run $42 to $188 with a median of $170.50. In Washington the top plan, Kaiser Permanente Medicare Advantage Optimal (HMO), costs $358 a month, the highest individual Medicare Advantage premium Kaiser charges anywhere.
The out-of-pocket ceilings are the best in the market. Kaiser’s median in-network maximum is $5,500 against a national average of $5,421 that KFF calculated from CMS data, but the tail is what matters: not one Kaiser plan sits at the $9,250 legal ceiling, and the lowest is $699. Most large carriers park a fifth or more of their plans at the ceiling.
Drug deductibles are effectively zero. Of the 86 Kaiser individual plans with Part D coverage, 82 have no deductible and the highest is $160. Read our Medicare Part D cost page for how the 2026 $2,100 out-of-pocket drug cap interacts with that.
And the star ratings hold up. Across all 87 rated Kaiser individual plan segments in the 2026 CMS file, every single one is 4.0 stars or better, averaging 4.38. No other large carrier is close.
Who It’s Good For and Who Should Skip It
A good fit if you live in a Kaiser region and are happy to use Kaiser. The integrated model is why the ratings are high, and if your care is already inside the system the closed network costs you nothing.
A good fit if you want a low ceiling on catastrophic spending. Kaiser plans run from $699 to $8,900 in network, and none hit the $9,250 maximum CMS allows.
A good fit if your prescriptions are expensive. Almost every Kaiser drug plan has a $0 deductible in 2026.
Skip it if you have a specialist outside Kaiser you will not give up. There is no out-of-network benefit to fall back on outside the five stated exceptions.
Skip it if you move, travel domestically for long stretches, or split the year between states. Kaiser is in 118 counties. Everything outside them is emergency care only.
Skip it if you want a $0 premium above all else. Most Kaiser plans charge one, and in Hawaii none are free.
Kaiser Permanente Medicare Advantage vs Original Medicare Plus Medigap
| Kaiser Permanente Medicare Advantage | Original Medicare plus Medigap | |
|---|---|---|
| Monthly cost | $0 to $358 plan premium plus $202.90 Part B | $202.90 Part B plus a Medigap premium set by the insurer |
| Yearly out-of-pocket limit | Yes, $699 to $8,900 in network | No federal limit, but Medigap absorbs most cost sharing |
| Provider choice | Kaiser facilities only, 118 counties in 9 states and DC | Any provider that accepts Medicare, nationwide |
| Out-of-network coverage | None, except emergency, out-of-area urgent care, out-of-area dialysis, other Kaiser regions, and pre-approved referrals | Not applicable, no network |
| Referral to a specialist | May be required, but specialists are in-house | Not required in most cases |
| Drug coverage | Built in on 115 of 119 plans, usually with a $0 deductible | Separate Part D plan required |
| Care outside the U.S. | Emergency and urgent care covered worldwide | Original Medicare generally does not cover it; some Medigap policies do |
| Can you buy Medigap? | No. Medicare.gov states you cannot buy Medigap to cover Medicare Advantage out-of-pocket costs | Yes |
The trade is unusually clean here. Medigap buys you every doctor in America and no annual cap; Kaiser buys you a hard cap, high measured quality, and one health system. Our Medicare Advantage versus Medigap comparison walks it in detail, and Medigap cost shows what the alternative premium looks like.
One warning about direction of travel. You can join Medicare Advantage during any Medicare open enrollment period, but your guaranteed right to buy a Medigap policy without medical underwriting is a six-month window that opens the first month you are both 65 and enrolled in Part B. Choosing Kaiser at 65 can quietly close the Medigap door at 72.
The Bottom Line
Kaiser is the clearest value proposition in Medicare Advantage and also the least flexible. If you are inside a Kaiser region and willing to get all your care from Kaiser, the 2026 numbers are strong: the best out-of-pocket ceilings, essentially no drug deductibles, and the highest star ratings of any large carrier. If any part of that sentence does not describe you, another carrier will fit better.
Do two things before you enroll. Compare the premium tiers side by side in your own region, because Kaiser’s cheaper plan and its richer plan differ by thousands of dollars in worst-case exposure. And be honest about how much you travel, since outside emergencies the plan simply stops working at the region line.
One freshness note. Everything on this page is 2026 plan year data. CMS said in its 2027 Part D bid fact sheet that it will release the 2027 Medicare Advantage and Part D landscape in mid to late September 2026, and the annual enrollment period for 2027 runs October 15 to December 7, 2026. Compare against Humana, Aetna, Anthem, Cigna, Wellcare, and Devoted Health in your county, and check whether you qualify for Medicare Savings Programs or Extra Help first, since those reduce the Part B premium you owe no matter which plan you choose.