If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from a Medicare Advantage plan. These are private healthcare choices (like HMOs and regional PPOs) in some areas of the country. To learn more about Medicare Advantage plans, contact Medicare at 800-MEDICARE (800-633-4227) (TTY: 877-486-2048) or at www.medicare.gov.
If you enroll in a Medicare Advantage plan, the following options are available to you:
This Plan and our Medicare Advantage plan:
We offer a Medicare Advantage plan known as Kaiser Permanente Senior Advantage for Postal Service Members. Senior Advantage for Postal Service Members enhances your PSHB coverage by lowering cost-sharing for some services and/or adding benefits. High and Standard Option members can choose between 2 Medicare Advantage plans: "Senior Advantage 1" (best benefits) and "Senior Advantage 2" (some better benefits and Part B premium reimbursement). Prosper members have one choice, called “Senior Advantage". If you live in our Medicare Advantage service area and you have Medicare Parts A and B, or Medicare Part B only, you can enroll in Senior Advantage for Postal Service Members. Enrolling in Senior Advantage for Postal Service Members does not change your PSHB premium. Your enrollment is in addition to your PSHB High Option, Standard Option, or Prosper enrollment; however, your benefits will be provided under the Kaiser Permanente Senior Advantage for Postal Service Members plan and are subject to Medicare rules. If you are already a member of Senior Advantage for Postal Service Members and would like to understand your additional benefits in more detail, please refer to your Senior Advantage for Postal Workers Evidence of Coverage. If you are considering enrolling in Senior Advantage for Postal Service Members, please call us at (800-476-2167) (TTY 711), 8 a.m. to 8 p.m., 7 days a week, or visit our website at www.kp.org/postal.
With Kaiser Permanente Senior Advantage for Postal Service Members, you will get more coverage, such as lower cost-sharing and additional benefits. This 2025 benefit summary allows you to make a comparison of your choices:
2025 Benefits and Services: Deductible High Option without Medicare You pay: None
High Option Senior Advantage 1 You pay: None
High Option Senior Advantage 2 You pay: None
Standard Option without Medicare You pay: $150
Standard Option Senior Advantage 1 You pay: None
Standard Option Senior Advantage 2 You pay: None
Prosper without Medicare You pay: $300
Prosper Senior Advantage You pay: None
2025 Benefits and Services: Primary care High Option without Medicare You pay: $20
High Option Senior Advantage 1 You pay: $5
High Option Senior Advantage 2 You pay: $15
Standard Option without Medicare You pay: $30
Standard Option Senior Advantage 1 You pay: $20
Standard Option Senior Advantage 2 You pay: $30
Prosper without Medicare You pay: $10
Prosper Senior Advantage You pay: $10
2025 Benefits and Services: Specialty care High Option without Medicare You pay: $30
High Option Senior Advantage 1 You pay: $15
High Option Senior Advantage 2 You pay: $25
Standard Option without Medicare You pay: $40
Standard Option Senior Advantage 1 You pay: $35
Standard Option Senior Advantage 2 You pay: $40
Prosper without Medicare You pay: $35
Prosper Senior Advantage You pay: $35
2025 Benefits and Services: Outpatient surgery High Option without Medicare You pay: $150/$250
High Option Senior Advantage 1 You pay: $50
High Option Senior Advantage 2 You pay: $150
Standard Option without Medicare You pay: $200/$300 (You pay the deductible, then cost-sharing.)
Standard Option Senior Advantage 1 You pay: $200
Standard Option Senior Advantage 2 You pay: $200
Prosper without Medicare You pay: $275/$375 (You pay the deductible, then cost-sharing.)
Prosper Senior Advantage You pay: $275
2025 Benefits and Services: Inpatient hospital care High Option without Medicare You pay: $500 per day up to $1,000
High Option Senior Advantage 1 You pay: $100/admit
High Option Senior Advantage 2 You pay: $300/admit
Standard Option without Medicare You pay: $750 (You pay the deductible, then cost-sharing.)
Standard Option Senior Advantage 1 You pay: $250 per day up to $750
Standard Option Senior Advantage 2 You pay: $250 per day up to $750
Prosper without Medicare You pay: 20% (You pay the deductible, then cost-sharing.)
Prosper Senior Advantage You pay: $275 per day up to $1,100
2025 Benefits and Services: Additional benefits offered High Option without Medicare: Not applicable
High Option Senior Advantage 1: Eyeglasses and contact lenses allowance, hearing aid allowance, acupuncture, preventive dental with a comprehensive allowance, nonemergency transportation, over-the-counter drugs and wellness supplies allowance, in-home support, and One Pass
High Option Senior Advantage 2: Nonemergency transportation, over-the-counter drugs and wellness supplies allowance, in-home support, and One Pass
Standard Option without Medicare: Not applicable
Standard Option Senior Advantage 1: Nonemergency transportation, over-the-counter drugs and wellness supplies allowance, in-home support, and One Pass
Standard Option Senior Advantage 2: Nonemergency transportation, over-the-counter drugs and wellness supplies allowance, in-home support, and One Pass
Prosper without Medicare: Not applicable
Prosper Senior Advantage: Nonemergency transportation, over-the-counter drugs and wellness supplies allowance, in-home support, and One Pass
2025 Benefits and Services: Part B Reimbursement High Option without Medicare: None
High Option Senior Advantage 1: None
High Option Senior Advantage 2: up to $200monthly
Standard Option without Medicare: None
Standard Option Senior Advantage 1: None
Standard Option Senior Advantage 2: up to $200 monthly
Prosper without Medicare: None
Prosper Senior Advantage: None
2025 Benefits and Services: Out-of-pocket maximum (2x per family)
High Option without Medicare You pay: $4,000 per person
High Option Senior Advantage 1 You pay: $2,200 per person
High Option Senior Advantage 2 You pay: $2,950 per person
Standard Option without Medicare You pay: $5,500 per person
Standard Option Senior Advantage 1 You pay: $2,950 per person
Standard Option Senior Advantage 2 You pay: $3,300 per person
Prosper without Medicare You pay: $7,000 per person
Prosper Senior Advantage You pay: $3,600 per person
This is a summary of the features of the Kaiser Permanente Senior Advantage for Postal Workers. As a Senior Advantage member, you are still entitled to coverage under the PSHB Program. All benefits are subject to the definitions, limitations, and exclusions set forth in this PSHB brochure and the Kaiser Permanente Senior Advantage for Postal Workers Evidence of Coverage.
This Plan and another plan’s Medicare Advantage plan: You may enroll in another non-PSHB plan’s Medicare Advantage plan and also remain enrolled in our PSHB plan. We will still provide benefits when your Medicare Advantage plan is primary, even out of the Medicare Advantage plan’s network and/or service area (if you use our Plan providers).
However, we will not waive any of our copayments, coinsurance, or deductibles. If you enroll in a Medicare Advantage plan, tell us. We will need to know whether you are in the Original Medicare Plan or in a Medicare Advantage plan so we can correctly coordinate benefits with Medicare.
Suspended PSHB coverage to enroll in a Medicare Advantage plan: If you are an annuitant, you can suspend your PSHB coverage to enroll in a Medicare Advantage plan, eliminating your PSHB premium. (OPM does not contribute to your Medicare Advantage plan premium.) For information on suspending your PSHB enrollment, contact your retirement or employing office. If you later want to re-enroll in the PSHB Program, generally you may do so only at the next Open Season unless you involuntarily lose coverage or move out of the Medicare Advantage plan’s service area. |