Experience or knowledge of Kaiser availability

[shelato]

Originally Posted by SFBayBoomer

I don't live in your area; however, I am familiar with locating service areas, etc. with Kaiser. I had a family member lose Kaiser when moving to an area not in the zip code coverage list. I have not before heard of any 25-mile criteria. From my knowledge and experience, Kaiser uses zip codes. And while they will use P.O. boxes for mailing purposes, they also need and will check for proof of physical location, whether someone tells you otherwise or not. But you're in luck, because the areas you mentioned are all in the zip code coverage area (I bolded in green, below) are all OK. (This list is for Senior Advantage, but I think it holds true for pre-Medicare coverage, also.)

Here's what Kaiser says about the coverage area in which you are interested for Senior Advantage (Medicare):

"Senior Advantage Greater Sacramento Area and Sonoma County Basic or Enhanced plans (for persons who live in this plan's service area and have Medicare Parts A and B)

Our service area for this plan includes Sacramento County in California.

Also, our service area includes these parts of counties in California, in the following ZIP codes only:

• Amador County: 95640 and 95669.

• El Dorado County: 95613–14, 95619, 95623, 95633–35, 95651, 95664, 95667, 95672,
95682, and 95762.

• Placer County: 95602–04 [Auburn], 95610, 95626, 95648, 95650, 95658, 95661, 95663, 95668, 95677–78, 95681, 95703, 95722 [Meadow Vista], 95736, 95746–47, and 95765.

• Sonoma County: 94515, 94922–23, 94926–28, 94931, 94951–55, 94972, 94975, 94999, 95401–07, 95409, 95416, 95419, 95421, 95425, 95430–31, 95433, 95436, 95439, 95441–42, 95444, 95446, 95448, 95450, 95452, 95462, 95465, 95471–73, 95476, 95486–87, and 95492.

• Sutter County: 95626, 95645, 95659, 95668, 95674, 95676, 95692, and 95836–37.

• Yolo County: 95605, 95607, 95612, 95615–18, 95645, 95691, 95694–95, 95697–98, 95776,
and 95798–99.

• Yuba County: 95692, 95903, and 95961.

Regarding Kaiser Senior Advantage, (2 and 4 years from now for your wife and you), the following page is entitled "2021 Evidence of Coverage for Senior Advantage" and lists the areas of coverage permitted and includes even more locations, such as the SF Bay Area:

https://healthy.kaiserpermanente.org...-area-ncal.pdf

(I didn't include any SF Bay Area coverage areas in the post, just the possible areas up north.)

At the bottom of the above, there is a warning (probably does not apply to you, but Kaiser is much stricter with coverage offered once a member is of Medicare age):

"Section 2.4 – U.S. citizen or lawful presence:

A member of a Medicare health plan must be a U.S. citizen or lawfully present in the United States. Medicare (the Centers for Medicare & Medicaid Services) will notify us if you are not eligible to remain a member on this basis. We must disenroll you if you do not meet this requirement." I think it is safe to say that if Medicare has your residence address, and I cannot imagine that they do not, that they will also notify Kaiser of that address.

That was a really complete answer.

Originally Posted by adistea17

I love Kaiser. My whole family has had them for decades now. When I had surgery I was treated so well. I've had Kaiser since I was 22. My parents has had them forever and haven't had any problems. A bump here and there of course, but nothing bad at all. In fact, my dad refuses to use the hospital at Travis because he loves Kaiser. My doctor is available via email and responds to any concerns I have quickly. He's from Germany and he's very nice and thorough. I've been in for x-rays during Covid with no problem and I have my specialist appt next week. Hasn't been an issue at all.

What I like about Kaiser is that if you have a problem, you will be seen. My neighbor broke her arm on a Friday night, her doctor was out of town, we had a hell of a time finding anyone to see her/treat her. That gave me a new found appreciation for Kaiser. That said there seems to be some variance in doctor quality. you might have to switch doctors a couple of times to find one that you like.

[2sleepy]

I had Kaiser for a few years and didn't like it at all. They lost my x-rays twice, the optical department gave me a prescription for glasses that made me see double and when I complained they were adamant that I was wrong and that the prescription was perfect. I ended up having another eye exam done out of network. The first PCP I saw at Kaiser had to have been playing Candy Crush on his tablet while he was asking me questions, he kept asking me the same questions and when I told him he had already asked me those questions he got quite upset. I changed to UC Davis, it's fantastic, I just hope that my health plan (PERS choice) continues to offer them as a provider.

[jamesly]

Originally Posted by SFBayBoomer

I don't live in your area; however, I am familiar with locating service areas, etc. with Kaiser. I had a family member lose Kaiser when moving to an area not in the zip code coverage list. I have not before heard of any 25-mile criteria. From my knowledge and experience, Kaiser uses zip codes. And while they will use P.O. boxes for mailing purposes, they also need and will check for proof of physical location, whether someone tells you otherwise or not. But you're in luck, because the areas you mentioned are all in the zip code coverage area (I bolded in green, below) are all OK. (This list is for Senior Advantage, but I think it holds true for pre-Medicare coverage, also.)

Here's what Kaiser says about the coverage area in which you are interested for Senior Advantage (Medicare):

"Senior Advantage Greater Sacramento Area and Sonoma County Basic or Enhanced plans (for persons who live in this plan's service area and have Medicare Parts A and B)

Our service area for this plan includes Sacramento County in California.

Also, our service area includes these parts of counties in California, in the following ZIP codes only:

• Amador County: 95640 and 95669.

• El Dorado County: 95613–14, 95619, 95623, 95633–35, 95651, 95664, 95667, 95672,
95682, and 95762.

• Placer County: 95602–04 [Auburn], 95610, 95626, 95648, 95650, 95658, 95661, 95663, 95668, 95677–78, 95681, 95703, 95722 [Meadow Vista], 95736, 95746–47, and 95765.

• Sonoma County: 94515, 94922–23, 94926–28, 94931, 94951–55, 94972, 94975, 94999, 95401–07, 95409, 95416, 95419, 95421, 95425, 95430–31, 95433, 95436, 95439, 95441–42, 95444, 95446, 95448, 95450, 95452, 95462, 95465, 95471–73, 95476, 95486–87, and 95492.

• Sutter County: 95626, 95645, 95659, 95668, 95674, 95676, 95692, and 95836–37.

• Yolo County: 95605, 95607, 95612, 95615–18, 95645, 95691, 95694–95, 95697–98, 95776,
and 95798–99.

• Yuba County: 95692, 95903, and 95961.

Regarding Kaiser Senior Advantage, (2 and 4 years from now for your wife and you), the following page is entitled "2021 Evidence of Coverage for Senior Advantage" and lists the areas of coverage permitted and includes even more locations, such as the SF Bay Area:

https://healthy.kaiserpermanente.org...-area-ncal.pdf

(I didn't include any SF Bay Area coverage areas in the post, just the possible areas up north.)

At the bottom of the above, there is a warning (probably does not apply to you, but Kaiser is much stricter with coverage offered once a member is of Medicare age):

"Section 2.4 – U.S. citizen or lawful presence:

A member of a Medicare health plan must be a U.S. citizen or lawfully present in the United States. Medicare (the Centers for Medicare & Medicaid Services) will notify us if you are not eligible to remain a member on this basis. We must disenroll you if you do not meet this requirement." I think it is safe to say that if Medicare has your residence address, and I cannot imagine that they do not, that they will also notify Kaiser of that address.

WOW...
Thank you for that very helpful reply and for the time you took to do that. I was away and just returned to see the thread. Lost of helpful experiences.

Again thanks TO ALL that took the time..
I may have further questions.
Take Care people.

[jamesly]

Originally Posted by brysonpeebo

I would suggest either calling or going to a Kaiser hospital nearest you and speaking to Member Services. One of the reps in the Member Services office should be familiar with eligibility requirements and can provide you with answers.

When the time comes and you are eligible for Medicare, you may want to look into and ask about the Kaiser Senior Advantage program, and what it offers or how it differs from the Medicare default. I forget what the differences are but they are slight, if I recall correctly. But you may wish to look into it when the time comes and they can provide you with a comparison chart of the differences.

If you ever wish to get a 2nd opinion or seek out a specialist not within Kaiser, you'd have to submit an appeal and it may be kind of difficult to get approval if Kaiser says that they have plenty of specialists you can see within Kaiser. But if you'd still like an outside opinion, you could try thesecondopinion.org. .....

Kaiser is great as a mostly under one roof solution for general medical needs, delivering babies, and routine operations. It's convenient and they generally do a good job. If you want to see a specific practicing expert that doesn't work at Kaiser, though, that will be very, very difficult.

Thank you very much for that perspective and explanation of your experience...

[jamesly]

Originally Posted by 2sleepy

I had Kaiser for a few years and didn't like it at all. They lost my x-rays twice, the optical department gave me a prescription for glasses that made me see double and when I complained they were adamant that I was wrong and that the prescription was perfect. I ended up having another eye exam done out of network. The first PCP I saw at Kaiser had to have been playing Candy Crush on his tablet while he was asking me questions, he kept asking me the same questions and when I told him he had already asked me those questions he got quite upset. I changed to UC Davis, it's fantastic, I just hope that my health plan (PERS choice) continues to offer them as a provider.

Where or what exactly is UC Davis Health Insurance? I have looked online and it seems that they have facilities that accept various other plans. I can't find where to get info on an actual UC Davis Health Insurance Plan except as a Student?

[2sleepy]

Originally Posted by jamesly

Where or what exactly is UC Davis Health Insurance? I have looked online and it seems that they have facilities that accept various other plans. I can't find where to get info on an actual UC Davis Health Insurance Plan except as a Student?

There is no "UC Davis insurance" other than for their employees or students, but other plans might have them in their network. UC Davis on my plan which is for retired public employees, Blue Cross Anthem administers the plan. My husband has a Medicare supplement and UC Davis is not part of their network. I guess you would have to check which plans you can get and look at their provider list. It's a PPO so you can still see providers outside of UC Davis Kaiser is an HMO so you can't see any providers other than Kaiser unless they refer you to one

[SFBayBoomer]

Originally Posted by jamesly

Thank you. That is very helpful.
So it's not a "REQUIREMENT"? But if something comes up like that.. you can't call them. Is it the kind of thing that they would terminate your membership if they found out? I mean, is it tolerated but it has to be understood that certain services are not included?

I don't want to play dirty if I don't have to.

You don't have to do that, nor should you. Your wife, being a cancer patient, is already under a lot of stress. Lying is stressful.

Kaiser is located in many, many communities in California, but, of course, it's not everywhere. A family member of mine used to live in a qualifying zip code (Kaiser uses the zip code of your residence to determine eligibility, unless they have changed their method recently.)

Unfortunately, when house shopping, he didn't pay attention to the zip code requirement and he lost his Kaiser insurance and had to change to something that was both more costly and less desirable.

I use a P.O. Box for all my mail, including Kaiser, but I live in the same zip code as my P.O. Box and Kaiser knows that. All data about you is going to be online on more websites than you can even imagine, so you would be risking more than you will win, if the house is outside the Kaiser zip code, unless you are willing to change your insurance and leave Kaiser.

I found a list of all Kaiser Northern California zip codes, actually ALL Kaiser zip codes, and have linked to it here:

https://mytabenefits.com/-/media/Mer...B97343E50D5C48

The above is for Transamerica employees and dated 2018, but it's probably the same list used elsewhere in Northern California. Two hours from Livermore and you'll still be in Northern California.

If I find a more recent list, I'll link to it in a subsequent post.

Are you flexible about where you are willing to move? (I know you made an offer already.)

[Aquaboy]

Ive had Kaiser for 40+ years and I like it. The people you hear complaining usually dont know how to use phones, email etc to get the treatment you want. You have a to push a little, sometimes.
Kaiser is very proactive about tests and screening, too. Thumbs up.