Medicare Advantage with Part D plans
If you are eligible for Medicare and have enrolled in Medicare Part A and Part B, you can enroll in our PEBB Medicare Advantage with Part D health plan.
The Kaiser Permanente PEBB Medicare Advantage with Part D health plan allows you to keep your Kaiser Permanente provider and gives you access to transportation to medical appointments for non-urgent needs. You'll also have access to the One Pass Select Affinity from Optum so you can choose a fitness plan and get unlimited access to all locations available within that plan, plus extensive digital resources.
Which plan is available to you
Different plans are available to you depending on where you live. You must reside in the Kaiser Permanente Medicare Advantage health plan service area in which you enroll.
To enroll in the Washington Medicare Advantage health plan, you must live in: Island, King, Kitsap, Lewis, Pierce, Skagit, Snohomish, Spokane, Thurston, Whatcom or parts of Grays Harbor (98541, 98557, 98559, 98568) or Mason (98524, 98528, 98546, 98548, 98555, 98584, 98588 and 98592) County.
To enroll in the Oregon/SW Washington Medicare Senior Advantage health plan, you must live in: Clark, Cowlitz, Skamania, parts of Wahkiakum (98612, 98647) County, or neighboring counties in Oregon.
View maps of our Medicare Advantage service areas:
| Annual Deductible | Primary Care Office Visit |
|---|---|
| None | $15 copay |
| Annual Deductible | Primary Care Office Visit | Specialist Office Visit |
|---|---|---|
| None | $25 | $35 |
| Annual Deductible | Primary Care Office Visit |
|---|---|
| None | $15 copay |
| Annual Deductible | Primary Care Office Visit | Specialist Office Visit |
|---|---|---|
| None | $25 | $35 |
Resources for Medicare Advantage
Review drugs listed in our prescription drug formulary:
To find Medicare Advantage providers, visit our Provider Directory ›
You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party. To qualify for the "Retiree & Spouse" premium, BOTH must be enrolled in Parts A and B. To see 2024 monthly premiums, visit the Public Employees Benefits Board (PEBB) Program website.
Kaiser Permanente is an health plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
You must reside in the Kaiser Permanente Medicare Advantage health plan service area in which you enroll.
New for Washington - 2025
- Medicare Advantage with Part D (MAPD) prescription drug plan
- Lower monthly premiums ($188.62/subscriber in 2024 to $177.41/subscriber in 2025)
- No deductible for prescription drugs
- Prescription drug copayments, most will have the same copayments, some will have lower copayments, some will have higher copayments
- $20 Tier 1 – Preferred generic drugs (this tier includes some brand-name drugs)
- $20 Tier 2 – Generic drugs (this tier includes some brand-name drugs)
- $40 Tier 3 – Preferred brand-name drugs
- $100 Tier 4 – Nonpreferred drugs (this tier includes both generic and brand-name drug)
- $250 Tier 5 – Specialty-tier drugs (this tier includes both generic and brand-name drugs)
- $0 Tier 6 – Injectable Part D vaccines (this tier includes brand-name drugs only)
- Mail order drug: two copays for a 90-day supply (exception specialty drugs may be mailed, but one copay for each 30-day supply)
- View our formulary to determine what copayment you will pay in 2025 (will need 2025 on 10/01/24)
- Some members may need to change where they purchase their prescriptions, click this link for MAPD pharmacies for 2025. All Kaiser Permanente pharmacies in the MAPD network.
- TrOOP (true out-of-pocket) – you will not pay more than $2,000 per calendar year for covered prescription drug cost shares
- Those with limited financial resources may qualify for the Low-Income Subsidy (LIS) - For more information on the LIS program and how it is administered, please contact Social Security
- Hearing aid maximum increased to $3,000 per ear every 36 months
New for SW Washington - 2025
- Senior Advantage with Part D (MAPD) prescription drug plan replaces KPNW’s Senior Advantage plan.
- Lower monthly premiums ($193.95/subscriber in 2024 to $171.19/subscriber in 2025).
- No deductible for prescription drugs.
- Retail prescription drug copayments
- $20 Tier 1 – Preferred generic drugs (includes some brand-name drugs)
- $20 Tier 2 – Generic drugs (includes some brand-name drugs)
- $40 Tier 3 – Preferred brand-name drugs
- 100 Tier 4 – Nonpreferred drugs (includes both generic and brand-name drugs)
- $200 Tier 5 – Specialty-tier drugs (includes both generic and brand-name drugs)
- $0 Tier 6 – Injectable Part D vaccines (includes brand-name drugs only)
- Mail-order drugs: two copays for a 90-day supply (Exception: Specialty drugs will have a single copay for a 30-day supply).
- Check the formulary to determine your copays in 2025. The 2025 Medicare Part D formulary will be posted after 10/1/2024 on kp.org/formulary
- TrOOP (true out-of-pocket) – you will not pay more than $2,000 per calendar year for covered prescription drug cost shares.
- Those with limited financial resources may qualify for the Low-Income Subsidy (LIS). For more information on the LIS program, please contact Social Security.