How do I Switch from Kaiser to Medicare or another Advantage Plan?

We get this question often. It usually revolves around some course of treatment.

For example, just the other day, a person called with her situation. Her husband had surgery scheduled and Kaiser was only going to let him recover for 1-2 days in the hospitals while the standard at UCSF or Stanford was for 5-7 days (she had checked).

It was a serious issue and Kaiser told her that if anything comes up, come back in. Per her explanation.

She was not comfortable with this as she was also 75 and not really skilled in knowing what to do with him.

So...she wanted to change her Advantage plan from Kaiser to a plan that worked with UCSF.

Then there are people who have Kaiser through an employer or as part of Covered California.

Now with Medicare, they want access to other networks and/or more PPO-like plans (Medicare supplements).

Okay...let's get into it. First our credentials:

We'll cover these topics:

• How to switch from Kaiser to another Advantage plan in California
• How to switch from Kaiser back to Medicare in California
• How to get Part D after switching from Kaiser
• Running your quote for Medicare supplements OR Advantage plans after Kaiser
• How to apply for the new plan after dropping Kaiser

Let's get started!

How to switch from Kaiser to another Advantage plan in California

We'll break down the key times you can change your Advantage plan throughout the year starting with the most common.

We have a whole guide on how and when to change your Advantage plan. The fact that it's Kaiser you're coming off doesn't change things.

The big three are:

• Initial Open Enrollment - newly eligible for Part B (usually turning 65 or losing employer coverage)
• Annual Open Enrollment Oct 15th - Dec 7th for Jan 1st eff date
• Open Enrollment - Jan 1st - March 31st - unhappy with current Advantage plan

Okay...that covers almost 6 months of the year! The effective date will usually be the 1st of the month following enrollment aside from the Initial window you get with a new Part B.

People who are eligible for Medi-cal or Extra Help can get quarterly options to change plans (Jan-March, April-June, July-Sept) one time in addition.  Learn more about changing medi medi plans.

There are less common triggers such as a move that affects your options or involuntarily losing your Advantage plan.

One key trigger is if the Advantage plan stops working with a provider but that's very uncommon with Kaiser since they are both the insurer AND care provider.

Reach out to us with your situation and we'll track down all the weird rules to see if there's something we can use at help@calhealth.net

The good news is that we do have some flexibility to change from a Kaiser Advantage plan during the year.

We're happy to help compare the available options and there's zero cost for our assistance. The networks are really the big deal when picking a plan but that's just the start.

Learn how to compare Advantage plans.

What about if we want to go from Kaiser back to traditional Medicare and/or a supplement?

How to switch from Kaiser back to Medicare in California

This is a little bit trickier depending on our situation.

If we're still in our Initial Open Enrollment (new Part B), we may still be able to get back to Medicare and/or a supplement.

At Annual Open Enrollment, we can revert back to Medicare (essentially, cancel our Kaiser advantage plan).

That part is not so difficult. It's more the supplement and Part D.

If we're in okay health, we can enroll in a Medicare supplement any time of the year!

To get "Guaranteed Issue", there are certain triggers.

Blue Shield has a pretty good walkthrough here but the big triggers:

• Still in the initial window following new Part B (3 months before part B eff month and 3 months after)
• Loss of employer insurance
• Significant move that affects options
• Enrolled in Kaiser advantage but didn't like it in the 1st year of enrollment

What if our health isn't great? Reach out to us!

For example, Blue Shield will occasionally have an "Underwriting Holiday" if you're coming from another carrier at the end of the year.

This is a fantastic time to move to a Medicare supplement regardless of health.

Lots of moving pieces so check in with us at help@calhealth.net  or via chat: https://calendly.com/dennis-jnw

Of course, you can just have Medicare without the supplement but that's very risky.

The 20% coinsurance has NO CAP!

Don't fight this trend:

You can quote the top Medicare supplement plans here. Focus on the G or N plan (two most popular by far). Big review of G versus N medigap plan.

Alright...one more wrinkle. Medication.

How to get Part D after switching from Kaiser

You likely won't need this with an Advantage plan since most of them cover RX already. We don't recommend the plans without Part D unless you've got RX covered somewhere else.

If you're moving to traditional Medicare and/or a Medicare supplement, Part D is a separate plan to quote and enroll in.

There's a penalty for not enrolling in Part D when you're eligible of 1%/month...ongoing!

There are some pretty inexpensive plans on the market as a placeholder since you can change end of each year if things change.

Wellcare's Part D plan is 40 cents and it covers a lot of people's medications!

Part D rules follow Advantage plan rules in terms of when you can enroll.

• Initial Enrollment Period (just requires Part A)
• Annual Enrollment Period (Oct 15 - Dec 7th)
• Open Enrollment Period (Jan 1st - March 31st)

There are lots of little triggers beyond the big 3 so check with us.

You can run your Part D quote here:

Make sure to enter your medications, dosages, and preferred pharmacy. Big review on how to Save on Part D in California.

If you're leaving Kaiser advantage, you'll need either another Advantage plan or a supplement with a Part D.

Even though we can apply for a Medicare Supplement any time during the year, that's not the case for Part D (Advantage rules) so we need to coordinate these two.

Let us help! Zero cost for our assistance.

Alright...so how do we check out the options available if we're switching from Kaiser?

Running your quote for Medicare supplements OR Advantage plans after Kaiser

We make this easy, fast, and free.

For Medicare Advantage plans OR Part D:

A few key notes.

Under the "Preference" box, add your:

• Doctors
• Medication/Dosages
• Preferred Pharmacy

Sort up top by "Total Estimated Cost" to take into account your medication out-of-pocket.

If you're eligible for medi-cal or have a chronic illness, select "Show Special Need Plans" up top.

Again, we're happy to help...there are lots of plans. Check how to Compare Advantage Plans in California or Top Tips to Save on Part D.

As for Medicare Supplements, you can quote those here:

We have all the big carriers and we can quote UnitedHealthcare® Health or Mutual of Omaha separately. Just email us with request (and date of birth with zip code).

We'll get to work!

What if you find the plan you want?

How to apply for the new plan after dropping Kaiser

For Advantage plans, this is super easy. Right through the Quote tool above, you'll see "Add to Cart".

That's it! It ties directly into the enrollment system of the major carriers and if approved, the old Kaiser plan will automatically cancel for the given effective date.

For Medicare supplements, each carrier has a different online system and we can send over the link to you. Just emails us at help@calhealth.net  with your request and we'll get started.

If we see better savings, we'll let you know!

That's a wrap on switching from Kaiser to Medicare. Reach out with any questions and Happy Switching!