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1. Physical Therapy Copays
2. Is Therapy Covered By Kaiser

The Kaiser Permanente Medicare Advantage High MD (HMO) has a monthly premium of $142.00 and has an in-network Maximum Out-of-Pocket limit of $5,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,700 out of pocket. Kaiser Permanente medical office providers’ hours, search our facility directory; Affiliated providers’ office hours, call their office directly; Providers in your plan or accepting new patients, call 303-338-4545 or 1-800-218-1059 (TTY 711), Monday through Friday, 6 a.m. Comparing network costs versus non-network costs between Kaiser Permanente and United Healthcare in the Co-Pay plans; United Healthcare (UHC) Copay Choice Plus Plan Kaiser Permanente (KP) DHMO Plan. (Therapy) $30 Copay: Outpatient (Therapy) $30 Copay.

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Kaiser Permanente Senior Advantage Inland Empire (HMO) H0524-015 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Kaiser Permanente available to residents in California. This plan includes additional Medicare prescription drug (Part-D) coverage. The Kaiser Permanente Senior Advantage Inland Empire (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.

Kaiser Permanente Senior Advantage Inland Empire (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Kaiser Permanente works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Kaiser Permanente Senior Advantage Inland Empire (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Kaiser Permanente and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Kaiser Permanente except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

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2021 Kaiser Permanente Medicare Advantage Plan Costs

Kaiser Permanente Senior Advantage Inland Empire (HMO) Part-C Premium

Kaiser Permanente plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H0524-015 Part-D Deductible and Premium

Kaiser Permanente Senior Advantage Inland Empire (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Kaiser Permanente plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Kaiser Permanente above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Kaiser Permanente Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Kaiser Permanente plan does offer additional coverage through the gap.

H0524-015 Formulary or Drug Coverage

Kaiser Permanente Senior Advantage Inland Empire (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Kaiser Permanente Senior Advantage Inland Empire (HMO) Summary of Benefits

Additional Benefits

Comprehensive Dental

Deductible

Diagnostic Tests and Procedures

Doctor Visits

Emergency care/Urgent Care

Foot Care (podiatry services)

Ground Ambulance

Hearing

Inpatient Hospital Coverage

Medical Equipment/Supplies

Medicare Part B Drugs

Mental Health Services

MOOP

Option

Optional supplemental benefits

Outpatient Hospital Coverage

Package #1

Preventive Care

Preventive Dental

Rehabilitation Services

Skilled Nursing Facility

Transportation

Vision

Wellness Programs (e.g. fitness nursing hotline)

Reviews for Kaiser Permanente Senior Advantage Inland Empire (HMO) H0524

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Kaiser Permanente Senior Advantage Inland Empire (HMO) Plans Performance

Health Plan Customer Service Rating for Kaiser Permanente Senior Advantage Inland Empire (HMO)

Kaiser Permanente Senior Advantage Inland Empire (HMO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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1-855-778-4180
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Sun 9am-6pm EST

Coverage Area for Kaiser Permanente Senior Advantage Inland Empire (HMO)

Physical Therapy Copays

(Click county to compare all available Advantage plans)

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Many insurance companies are currently waiving copays and deductibles for telehealth; while some are waiving these fees for all telehealth services, others are limited to COVID-19 related treatment only, and many require that the provider use the insurer’s preferred telemedicine platform.

Below is a list of health insurance companies, indicating which companies are waiving copays, coinsurances, and deductibles, and if so, when they will return to regular coverage. Most health insurance companies have not released updates since they first made changes in March, but we're keeping a close eye on the situation and will share updates as we have them!

For the latest information, we encourage you to visit the linked sources, which will take you to the health insurance company's relevant press release.

Please note that specifics vary across plans, especially employer-issued plans.

Cost-Sharing Waivers By Health Insurance During COVID-19

Aetna

• Cost sharing waived for teletherapy? Yes
• Applicable providers: For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. For all Commercial plans, cost sharing will also be waived for real-time virtual visits offered by in-network providers.
• Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out.
• Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for real-time virtual visits offered by in-network providers (live video-conferencing and telephone-only telemedicine services) for all Commercial plan designs. Members may use telemedicine services for any reason, not just COVID-19 diagnosis. Self-insured plan sponsors will be able to opt-out of this program at their discretion.
• Notes: If clients have self-insured plans, it is important to check that the plan has not opted out of the program.
• Sources: Source one, Source two

Allways Health Partners

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists.
• Applicable plans: Not explicitly indicated.
• Description: AllWays Health Partners is removing cost-sharing (copayments, deductibles, or coinsurance) for testing and copayments for treatment at in-network facilities; ensuring access to out-of-network providers for the initial COVID-19 test or treatment when no in-network providers are available; and removing all cost-sharing for telemedicine services, including virtual visits with primary care providers and specialists, and through Partners HealthCare On Demand, to enable members to seek COVID-19-related care without the need to go to medical offices... There will be no cost to you for telemedicine (including telephone) visits for standard/routine outpatient behavioral health.
• Sources:Source

Anthem

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: Applies to all Anthem affiliated plans; self-insured plan sponsors can opt out.
• Description: For 90 days effective March 17, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits, including visits for mental health or substance use disorders, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.
• Sources:Source

Blue Cross Blue Shield Association

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: All 'fully-insured' members
• Description: 'All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services. We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, chat and/or e-visits. This builds on the commitment we previously announced to ensure swift and smooth access to care during the COVID-19 outbreak.'
• Sources:Source

Blue Cross Blue Shield of Massachusetts

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: All members
• Description: 'Blue Cross has waived member cost share (co-pays, co-insurance and deductibles) for all medically necessary medical and behavioral health covered services, via phone or video (telehealth) with in-network providers if such services are offered.'
• Sources: Source

Blue Cross and Blue Shield of Illinois

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: All BCBSIL members with telemedicine/telehealth benefits in their plan (excluding Part D plans for Medicare members)
• Description: 'Currently, if you are insured by BCBSIL, including Medicare (excluding Part D plans) and Medicare Supplement members, you can: Access provider visits for covered services through telemedicine or telehealth as outlined in your benefit plan. You won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.'
• Sources: Source

Blue Cross and Blue Shield of Rhode Island

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: All members
• Description: Expanded coverage for clinically appropriate telehealth services that are provided by any in-network provider through permitted means, including telephone and audiovisual technologies. Permitted audiovisual capabilities include nonpublic video conferencing such as Skype, Google Hangouts and FaceTime. Waived all member cost sharing (copays and deductibles) for telehealth whether provided by an in-network provider or through the Doctors Online telehealth platform.
• Sources: Source

Blue Shield of California

• Cost sharing waived for teletherapy? Yes, but only for Teladoc Services
• Applicable providers: Only waiving costs for Teladoc Health virtual care service.
• Applicable plans: Applies to Blue Shield’s Individual and Family Plans, Medicare Supplemental plans, Medicare Advantage plans, as well as employer- and union insured plans.
• Description: 'Blue Shield previously announced it is waiving prior approval and copayments for Teladoc Health virtual care service through May 31, 2020 for most of its members. Not all plans have access to these services.'
• Sources:Source

Cigna

• Cost sharing waived for teletherapy? No (only for categories of 'screening, diagnosis, or testing' for COVID-19)
• Applicable providers: N/A
• Applicable plans: N/A
• Description: 'Effective today, Cigna is waiving customer cost-sharing for all COVID-19 treatment through May 31, 2020. The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations. The company will reimburse health care providers at Cigna's in-network rates or Medicare rates, as applicable. Will Cigna cover Coronavirus virtual care visits? Yes. If your visit is related to screening, diagnosis, or testing for the Coronavirus, your out-of-pocket costs will be waived.'
• Sources: Source

ConnectiCare

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network
• Applicable plans: All members
• Description: 'Today, ConnectiCare, one of the region’s leading health plans, announced that members can temporarily use telehealth for covered medical and mental health services at no cost. To make it easier for our members to get the care they need, ConnectiCare is eliminating the financial burden associated with office visits by covering telehealth appointments for any reason.' The company is allowing no-cost member real time visits with medical and mental health professionals by phone, computer, and mobile app.'
• Sources:Source

EmblemHealth

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network
• Applicable plans: All except potentially not ASO plans
• Description: 'EmblemHealth members across all our product lines will have no cost sharing (including copayments, coinsurance, or deductibles) for in-network telehealth visits. These visits have no cost-sharing for COVID-19 and non-COVID-19 related services. Members with a benefit plan that includes the Teladoc™ program will also have no cost-sharing for Teladoc visits. The telehealth cost-sharing waiver may not apply to ASO plans.'
• Sources:Source

First Choice Health

• Cost sharing waived for teletherapy? No (only for virtual primary care service, not teletherapy)
• Applicable providers: N/A
• Applicable plans: N/A
• Description: 'To help ensure people will have access to a doctor during the current COVID-19 crisis, First Choice Health (FCH), a leading provider-owned healthcare administrator in the Northwest, has announced that it is covering the cost of telehealth services for its self-funded employer customers via on-demand primary care service 98point6.'
• Sources:Source

Harvard Pilgrim Health Care

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network
• Applicable plans: Members on individual and group fully insured plans
• Description: All telemedicine services: Covered in full (no copays, deductibles or coinsurance)
• Sources: Source

Healthfirst

• Cost sharing waived for teletherapy? No (only COVID-19 related testing and evaluation)
• Applicable providers: N/A
• Applicable plans: N/A
• Description: 'Healthfirst is waiving co-pays for all diagnostic testing and evaluations related to coronavirus.'
• Sources: Source

HealthPartners

• Cost sharing waived for teletherapy? No (only COVID-19 related testing and diagnosis)
• Applicable providers: N/A
• Applicable plans: N/A
• Description: 'If you’re a HealthPartners member, you have coverage with no member cost sharing for COVID-19 testing and diagnosis. This includes the cost of the care visit associated with testing.'
• Sources: Source

Kaiser Permanente

• Cost sharing waived for teletherapy? No (only COVID-19 related screening and testing fully covered)
• Applicable providers: N/A
• Applicable plans: N/A
• Description: 'We’re proactively extending the use of telehealth appointments via video and phone where appropriate. As a Kaiser Permanente member, you won’t have to pay for costs related to COVID-19 screening or testing if referred by a Kaiser Permanente doctor. If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details.'
• Sources: Source

Is Therapy Covered By Kaiser

Magellan Health

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: All members
• Description: 'As the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) guidance came out on Tuesday, Magellan was revising its operations to permit all credentialed and contracted behavioral health providers to conduct telehealth video sessions for all routine services and certain psychological testing, applied behavior analysis (ABA), intensive outpatient programs (IOP) and partial hospitalization program (PHP) services. Providers are able to use a number of HHS OCR-approved platforms to conduct their telehealth video sessions. Magellan is also allowing telephone-only sessions when a member has no access to a video platform. These alternative approaches will be covered to ensure members get the care they need, when they need it. Our experienced behavioral health network providers are available to serve the needs of our clients’ members through a variety of avenues. We are proud of our network providers and look forward to working with them to support those who may need mental health services as a result of the COVID-19 outbreak.'
• Sources: Source

Neighborhood Health Plan of Rhode Island

• Cost sharing waived for teletherapy? Yes, but only for Optum-based virtual visits
• Applicable providers: Optum virtual visits only for behavioral health
• Applicable plans: All members
• Description: 'Neighborhood’s behavioral health partner Optum, offers virtual visits so you can receive confidential care without leaving your home. For more information on accessing virtual visits, go to live and work well to locate providers and schedule an appointment with them online. Neighborhood has expanded telemedicine coverage for all members to include clinically appropriate and medically necessary services to support you not having to go into your doctor’s office, urgent cares or emergency rooms during the time of the Governor’s executive order. If your plan usually has co pays, deductibles or other cost-sharing, you will not need to pay for the services outlined below. Primary care physicians All Medical Specialists – defined as any MD, DO, NP and PA Optometrists Doctors of Podiatric Medicine (DPM’s) Lactation Consultants Physical, Occupational, and Speech Therapists Diabetes Educators Nutritionists Midwifes Urgent Care Centers Emergency Departments Retail Based Clinics'
• Sources: Source

Oscar

• Cost sharing waived for teletherapy? No; standard cost sharing rules apply for teletherapy
• Applicable providers: Offering Oscar's Doctor on Call for 'most members' free of charge
• Applicable plans: Varies depending on details of individual plans
• Description: 'In addition to offering Oscar's Doctor on Call services to most members for $0, Oscar will cover all COVID-19 care delivered via telemedicine at $0 for our members through May 10. We will re-evaluate this date as needed. Oscar will also cover telemedicine care, consistent with our plan terms, for our members when they see an in-network provider through May 10. Standard cost-sharing rules will apply in all states except New York and New Jersey. In these states, members will pay $0 for any medically-necessary telemedicine visit with an in-network provider.'
• Sources: Source

Premera Blue Cross

• Cost sharing waived for teletherapy? No; only through certain platforms
• Applicable providers: Specific services only (Talkspace for therapy)
• Applicable plans: Varies depending on 'participating groups'
• Description: 'To ease the burden for our members, we will waive copays, deductibles, and coinsurance for COVID-19 related treatment (both inpatient and outpatient). This waiver will continue through October 1, 2020 for participating groups. We've expanded options for you: Call your in-network primary care doctor's office. 24-Hour NurseLine is available at no charge. Just call the number on the back of your member ID card to reach medical professionals. Doctor On Demand is a video chat with a doctor. 98point6 is a text-based primary care app. Talkspace offers virtual access to licensed therapists.'
• Sources: Source

UnitedHealthcare

• Cost sharing waived for teletherapy? Yes
• Applicable providers: All in-network therapists
• Applicable plans: Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans
• Description: 'Starting March 31, 2020 until June 18, 2020, UnitedHealthcare will now also waive cost-sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans. Again, we will work with self-funded customers who want us to implement a similar approach. The company previously announced we would waive cost-sharing for telehealth visits related to COVID-19 testing, in addition to waiving cost-sharing for 24/7 Virtual Visits with preferred telehealth partners.'
• Sources: Source

Medicare coverage

For the duration of the Public Health Emergency (PHE) declared by the Secretary of Health and Human Services, CMS will be making these changes. The main note is that there will no longer be a limit on the originating site -- the place where a client or patient is receiving care. Clients can now temporarily receive telehealth visits in their home, regardless of whether they are located in a rural area.

Waived Cost End Dates

Insurance companies are planning to waive fees until the dates listed below. They will be re-evaluating and updating these dates as the situation progresses.

• Aetna: June 4, 2020 (source)
• Anthem: June 15, 2020 (source)
• Cigna: May 31, 2020 (source)
• Blue Cross Blue Shield: June 15, 2020 (source) ('All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services.' 90 days from the publication date of this press release of March 19th, 2020, takes us to about June 15th, 2020 (calculation), which is how we arrived at this end date.)
• Empire Blue Cross Blue Shield: June 15, 2020 (or “as long as the COVID-19 emergency is in effect.”) (source)
• UnitedHealthcare: June 18, 2020 (source)

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