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Thank you for taking a moment to read my post. I've searched for answers and have found some info, but still have questions I'd appreciate some help with.
We are beginning our search to relocate to the Placer, Eldorado, Amador, Nevada County areas. Most likely the Auburn/Meadow Vista area. Rural home with space.
My wife is a Cancer Patient with Kaiser. She will qualify for Medicare in 2 years. Me in 4.
We called Kaiser to ask about location requirements to continue Kaiser Care. The person we talked to sounded like they had about an average level of knowledge of the rules and seemed to be looking up details while we talked, so I don't feel confident we got the actual real-world requirements.
They said you need to "live" 25 miles from a Kaiser emergency facility. I presume this is so that they won't be paying for ambulance rides to/from locations 100 miles from a facility...
My questions to anyone living in the area that has experience or knowledge of this are:
- Is that mileage requirement true, hard and fast or even accurate in anyone's actual experience?
- 25 miles to my HOUSE or can this be the zip code/City center?
- Can I use a mailing address for Kaiser correspondence to qualify? Or is this obviously faking it?
- Can we be covered outside of that range and assume and be willing to pay for any emergency transport OOP?
- I read a post that said you can have the coverage but your Coverage is limited to 10K / year.
I truly appreciate any insights.
Thank you!
My aunt and uncle lived in Ukiah and kept Kaiser via a Santa Rosa post office address. But if anything bad happened, they had to hop in the car and drive to Santa Rosa instead of calling an ambulance.
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?
You have to "live" within Kaiser's "service areas." You can find Kaiser's "service area" maps online. If you can't find them, call Kaiser and ask them where to find the maps.
FYI--Several of my family members, several of my friends, numerous acquaintances and I are all leaving Kaiser at the end of the year after being with Kaiser for many, many years. For the last several years, it's been a struggle to receive adequate medical care from Kaiser, for all of us. Covid simply gave Kaiser a "reason" to provide less and less medical care to its patients. One major medical provider in my area said they expect a "mass exodus" of people from Kaiser. Since mid year, they have received an endless stream of calls from Kaiser patients who will be joining them.
Thank you for taking a moment to read my post. I've searched for answers and have found some info, but still have questions I'd appreciate some help with.
We are beginning our search to relocate to the Placer, Eldorado, Amador, Nevada County areas. Most likely the Auburn/Meadow Vista area. Rural home with space.
My wife is a Cancer Patient with Kaiser. She will qualify for Medicare in 2 years. Me in 4.
We called Kaiser to ask about location requirements to continue Kaiser Care. The person we talked to sounded like they had about an average level of knowledge of the rules and seemed to be looking up details while we talked, so I don't feel confident we got the actual real-world requirements.
They said you need to "live" 25 miles from a Kaiser emergency facility. I presume this is so that they won't be paying for ambulance rides to/from locations 100 miles from a facility...
My questions to anyone living in the area that has experience or knowledge of this are:
- Is that mileage requirement true, hard and fast or even accurate in anyone's actual experience?
- 25 miles to my HOUSE or can this be the zip code/City center?
- Can I use a mailing address for Kaiser correspondence to qualify? Or is this obviously faking it?
- Can we be covered outside of that range and assume and be willing to pay for any emergency transport OOP?
- I read a post that said you can have the coverage but your Coverage is limited to 10K / year.
I truly appreciate any insights.
Thank you!
James
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. If you try to seek out a specialist with another hospital like Sutter, even if a relative or someone pays for the out of pocket cost, they may turn you away and you may jeopardize your Kaiser/Medicare coverage. We were dismayed to be told that and it didn't make much sense that there'd be such restrictions. So in that case, thesecondopinion.org is a resource a Kaiser oncologist suggested. You're also free to seek other opinions or another look at your case from another Kaiser oncologist if you identify one you'd like to give a second opinion or provide some additional info, but chances are they will tell you they have a standard protocol for treatment and not veer off of what another Kaiser oncologist tells you.
If seeking a specialist outside of Kaiser is desired (based on their specialization, expertise and experience that maybe a Kaiser doctor doesn't have with something specific), short of winning approval from Kaiser or winning in appeal, you may want to consider a PPO instead of HMO, so you have more freedom of choice in specialists.
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.
You have to "live" within Kaiser's "service areas." You can find Kaiser's "service area" maps online. If you can't find them, call Kaiser and ask them where to find the maps.
FYI--Several of my family members, several of my friends, numerous acquaintances and I are all leaving Kaiser at the end of the year after being with Kaiser for many, many years. For the last several years, it's been a struggle to receive adequate medical care from Kaiser, for all of us. Covid simply gave Kaiser a "reason" to provide less and less medical care to its patients. One major medical provider in my area said they expect a "mass exodus" of people from Kaiser. Since mid year, they have received an endless stream of calls from Kaiser patients who will be joining them.
I considered Kaiser at one time but then saw the majority of their doctors graduated in the bottom 10% of their schools of medicine. This was some years back.
I considered Kaiser at one time but then saw the majority of their doctors graduated in the bottom 10% of their schools of medicine. This was some years back.
Yes, most of their doctors, other than specialists, are not a bright group. Good luck getting to a specialist of recent years. I consider Kaiser one of the worst medical providers a person could choose. They won't allow members to get an "in office" annual physical now and cite "Covid." They only offer telephone or video "physicals." I know of only one person who was able to be seen in the office.
I hope the will the financial effects of what they've done to their members come January 2021. I loathe Kaiser at this point. They refused to see a relative of mine when he had Covid and was having difficult breathing. They threatened him that if he came to the emergency room they would "immediately intubate" yet they said he didn't need medical care or to be seen by a doctor. Kaiser is disgusting. I pity the person who is stuck with Kaiser.
Answering your Kaiser/Medicare Coverage Areas in Areas you mentioned
Quote:
Originally Posted by jamesly
Thank you for taking a moment to read my post. I've searched for answers and have found some info, but still have questions I'd appreciate some help with.
We are beginning our search to relocate to the Placer, Eldorado, Amador, Nevada County areas. Most likely the Auburn/Meadow Vista area. Rural home with space.
My wife is a Cancer Patient with Kaiser. She will qualify for Medicare in 2 years. Me in 4.
We called Kaiser to ask about location requirements to continue Kaiser Care. The person we talked to sounded like they had about an average level of knowledge of the rules and seemed to be looking up details while we talked, so I don't feel confident we got the actual real-world requirements.
They said you need to "live" 25 miles from a Kaiser emergency facility. I presume this is so that they won't be paying for ambulance rides to/from locations 100 miles from a facility...
My questions to anyone living in the area that has experience or knowledge of this are:
- Is that mileage requirement true, hard and fast or even accurate in anyone's actual experience?
- 25 miles to my HOUSE or can this be the zip code/City center?
- Can I use a mailing address for Kaiser correspondence to qualify? Or is this obviously faking it?
- Can we be covered outside of that range and assume and be willing to pay for any emergency transport OOP?
- I read a post that said you can have the coverage but your Coverage is limited to 10K / year.
I truly appreciate any insights.
Thank you!
James
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.
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:
(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.
Yes, most of their doctors, other than specialists, are not a bright group. Good luck getting to a specialist of recent years. I consider Kaiser one of the worst medical providers a person could choose. They won't allow members to get an "in office" annual physical now and cite "Covid." They only offer telephone or video "physicals." I know of only one person who was able to be seen in the office.
I hope the will the financial effects of what they've done to their members come January 2021. I loathe Kaiser at this point. They refused to see a relative of mine when he had Covid and was having difficult breathing. They threatened him that if he came to the emergency room they would "immediately intubate" yet they said he didn't need medical care or to be seen by a doctor. Kaiser is disgusting. I pity the person who is stuck with Kaiser.
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.
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Answering your Kaiser/Medicare Coverage Areas in Areas you mentioned
