How Your Plan Works – Medical

Kaiser Permanente Senior Advantage Choice (PPO) offers you the flexibility to choose any licensed provider who accepts Original Medicare for care. However, you’ll pay less when you choose from in-network hospitals, clinics, and providers nationwide.

Urgent care: Just like with your doctors, you can go to the location of your choice any time you need urgent care. Proximity is especially important when you need immediate attention. Need care quickly? Licensed care providers are available by phone 24 hours a day, 7 days a week to offer guidance. Call 303-338-4545.

In-network: You have access to Kaiser Permanente and other designated urgent care locations.
Out-of-network: You can get care from any other urgent care location you choose. You may have to pay the full cost for each visit upfront and file a claim for reimbursement.

Hospital care: When you need inpatient hospital care, you can select from in-network and out-of-network options. In an emergency – a medical or psychotic condition that requires immediate medical attention to prevent serious jeopardy to your health – your coverage will be the same for any hospital emergency department.

In-network: You have access to designated hospitals.
Out-of-network: You can get care from any other hospital you choose. If you choose this option, your out-of-pocket expenses are typically higher than if you get care from an in-network hospital.

In-Network	Out-of-Network
$0 Primary Care office visit and for most preventive care services. Copays for predictable costs for specialty care and inpatient stays. No deductible. A maximum out-of-pocket maximum that limits how much you’ll spend for care each year. You don’t have to choose a personal doctor, and you can see specialists without a referral. Before you get some types of care, you need prior authorization. That means your provider has to check with us first to make sure we’ll cover it. Providers file claims on your behalf. Search the Senior Advantage PPO provider directory to find providers in the network or call Member Services at 1-800-476-2167 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.	Choose to see any licensed provider outside the network who accepts original Medicare. No deductible. Simple copays for primary and specialist office visits. A combined in-network and out-of-network maximum out-of-pocket maximum that limits how much you’ll spend for care each year. We only pay for services if they’re medically necessary and your plan covers them. To avoid any surprises, we recommend that you check with us first. You may need to pay charges upfront and submit a claim to Kaiser Permanente for reimbursement. For more information, please call Member Services toll-free at 1-800-476-2167 (TTY 711), 8 a.m. to 8 p.m., 7 days a week.

In-Network

Out-of-Network

$0 Primary Care office visit and for most preventive care services.
Copays for predictable costs for specialty care and inpatient stays.
No deductible.
A maximum out-of-pocket maximum that limits how much you’ll spend for care each year.
You don’t have to choose a personal doctor, and you can see specialists without a referral.
Before you get some types of care, you need prior authorization. That means your provider has to check with us first to make sure we’ll cover it.
Providers file claims on your behalf.
Search the Senior Advantage PPO provider directory to find providers in the network or call Member Services at 1-800-476-2167 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.

Choose to see any licensed provider outside the network who accepts original Medicare.
No deductible.
Simple copays for primary and specialist office visits.
A combined in-network and out-of-network maximum out-of-pocket maximum that limits how much you’ll spend for care each year.
We only pay for services if they’re medically necessary and your plan covers them. To avoid any surprises, we recommend that you check with us first.
You may need to pay charges upfront and submit a claim to Kaiser Permanente for reimbursement. For more information, please call Member Services toll-free at 1-800-476-2167 (TTY 711), 8 a.m. to 8 p.m., 7 days a week.

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