This is an educational letter sent to all Kaiser Permanente Medicare health plan members. It isn’t
specific to your health care circumstances or any treatment you may receive.
Dear Member,
This information is being provided to all Kaiser Permanente Medicare health plan members for educational
purposes only about opioid pain medicines. Opioid pain medicines such as Oxycodone (Percocet®),
Hydrocodone (Norco®), Fentanyl, and Morphine are strong medications. They carry serious risks of
addiction and overdose. As your health plan provider, we want you to be informed about the potential risks
of using opioids.
What are opioid pain medicines?
Opioid medicines can be used to help treat moderate to severe pain when other options have not worked.
They may not improve all your pain and over time opioids may also change the way your brain handles pain
signals. This may lead to even more pain and/or other health symptoms like change in mood or sleep and
less ability to perform daily activities. For these reasons, long-term use of opioids should be monitored
closely by a doctor.
What are the side effects and long-term risks of taking opioids?
• Tolerance – Over time, opioids are less effective, with people needing higher doses to get the same
level of pain relief.
• Physical dependence – Withdrawal symptoms can happen when either suddenly stopping the
medicine or lowering the dose by a large amount.
• Addiction – You may not be able to control your opioid use.
• Physical side effects – Opioids can cause nausea, vomiting, and constipation.
• Drowsiness – Opioids can affect judgment and decision making. These side effects can cause falls
and motor vehicle accidents with serious injuries.
• Problems thinking clearly, low energy, and depression – These side effects can impact a person's
ability to work and do daily activities.
• Sleep apnea or impaired breathing while sleeping – Opioids may cause sleep problems that can
cause daytime fatigue, impair thinking, and in some cases slow or even stop your breathing with
inappropriate use.
• Low hormone levels – Long-term opioid use may lead to low sex drive, low energy, depressed
mood, slower recovery from muscle injuries, and thinning of the bones.
• Accidental overdose and death – These risks increase the longer a person takes opioids.
How do I safely take opioid medicines?
• Follow directions carefully. Always follow your doctor’s directions and never share your medicines
with others.
• Be cautious. Do not take your medicines more often than prescribed. Talk to your doctor or
pharmacist before you take any extra doses.
• Stay away from dangerous drug interactions. Talk to your doctor or pharmacist about all the
medicines you take. Mixing opioids with any of the following can greatly add to the risk of overdose:
alcohol, sleeping pills (such as zolpidem [Ambien®] or zaleplon [Sonata®]), anxiety drugs (such as
diazepam [Valium®], alprazolam [Xanax®], and lorazepam [Ativan®]), and muscle relaxers (such as
carisoprodol [Soma®], baclofen [Lioresal®], and others).
Y0043_H8794_00036389_C
• Talk to your doctor about alternative pain relievers. If your pain is under control, ask your
doctor if you should take them less often or change to other pain relief options.
• Naloxone: Ask your doctor or pharmacist about a naloxone rescue kit. Opioids can
sometimes slow or even stop your breathing. Naloxone is a medicine that can undo the effect of
opioids in your body. Naloxone is safe and can save your life. Talk to your doctor or pharmacist to
see if it should be prescribed to you. Having naloxone on hand is recommended for all patients
taking opioids regularly.
• Safe storage of opioids. Keep your opioid medicines in their original package and with the original
labels. Store them in a place that is out of reach of children and cannot be easily accessed by others
(e.g., locked cabinet).
• Follow safe disposal procedures. For safety reasons, unused medicines should be promptly
disposed of by depositing medication into a collection kiosk available at many
Kaiser Permanente pharmacies, using an approved send-away envelope, or at a
"Drug Take Back Day" event. Send-away envelopes are available for members at select
Kaiser Permanente pharmacies.
What alternative pain management options should I consider?
Talk to your doctor about ways to manage your pain that do not involve opioids and what is most
appropriate for you. Some of these options may work better and have fewer risks and side effects.
Depending on the type of pain you are experiencing, options may include:
• Over-the-counter medications such as ibuprofen (Motrin®), acetaminophen (Tylenol®), naproxen
(Aleve®), or topicals like capsaicin, diclofenac gel (Voltaren®), or trolamine salicylate
(Aspercreme®).
• Prescription-strength anti-inflammatory medications such as meloxicam (Mobic®), diclofenac
(Voltaren®), and etodolac (Lodine®). Long-term use is not recommended for older adults due to
risk of side effects.
• Some prescription non-opioid medications that target pain-producing nerves, such as gabapentin
(Neurontin®) and pregabalin (Lyrica®).
• Chiropractor services, physical and other therapies, heat or cold compresses, exercise, acupuncture,
and cognitive behavioral therapy.
Your doctor may recommend treatment options that your plan does not cover. If this happens, contact
Member Services at the phone number on the back of your ID card or visit the CMS web page that describes
coverage under Medicare Parts A and B to understand your options
(https://www.medicare.gov/coverage/pain-management).
What Opioid Treatment Services are available?
Medicare under Part B (medical insurance) covers Opioid Treatment Programs (OTPs) for opioid use
disorder (OUD) treatment. For information on your plan’s benefits related to treatment for prescription drug
abuse, including medication-assisted treatment, mental health, and counseling services, please see your
Evidence of Coverage or call Member Services at the phone number on the back of your ID card.
We’re here for you
If you have any questions about this information provided in this insert or you would like to find out more about
ways to manage pain, please call Member Services at the phone number on the back of your ID card.
Sincerely,
Kaiser Permanente
Y0043_H8794_00036389_C
Kaiser Permanente Senior Advantage Ventura County Plan (HMO) Offered by Kaiser
Foundation Health Plan, Inc., Southern California Region (Ventura County Plan)
Annual Notice of
Changes for 2024
You are currently enrolled as a member of Kaiser Permanente Senior Advantage Ventura County
plan. Next year, there will be changes to our plan's costs and benefits. Please see page 4 for a
summary of important costs, including premium.
This document tells you about the changes to your plan. To get more information about costs,
benefits, or rules, please review the Evidence of Coverage, which is located on our website at
kp.org. You may also call Member Services to ask us to mail you an Evidence of Coverage.
You have from October 15 until December 7 to make changes to your Medicare coverage
for next year.
What to do now
1. Ask: Which changes apply to you?
Check the changes to our benefits and costs to see if they affect you.
Review the changes to medical care costs (doctor, hospital).
Review the changes to our drug coverage, including authorization requirements and
costs.
Think about how much you will spend on premiums, deductibles, and cost-sharing.
Check the changes in our 2024 "Drug List" to make sure the drugs you currently take are
still covered.
Check to see if your primary care doctors, specialists, hospitals, and other providers,
including pharmacies, will be in our network next year.
Think about whether you are happy with our plan.
2. Compare: Learn about other plan choices.
Check coverage and costs of plans in your area. Use the Medicare Plan Finder at the
www.medicare.gov/plan-compare website or review the list in the back of your
Medicare & You 2024 handbook.
H0524_24A034_M
1068129148 S 034
PBP #: 034
OMB Approval 0938-1051 (Expires: February 29, 2024)
2 Senior Advantage Ventura County Annual Notice of Changes for 2024
Once you narrow your choice to a preferred plan, confirm your costs and coverage on the
plan's website.
3. Choose: Decide whether you want to change your plan.
• If you don't join another plan by December 7, 2023, you will stay in
Senior Advantage Ventura County plan.
• To change to a different plan, you can switch plans between October 15 and
December 7. Your new coverage will start on January 1, 2024. This will end your
enrollment with Senior Advantage Ventura County plan.
• If you recently moved into, currently live in, or just moved out of an institution (like a
skilled nursing facility or long-term care hospital), you can switch plans or switch to
Original Medicare (either with or without a separate Medicare prescription drug plan) at
any time.
Additional resources
• This document is available for free in Spanish. Please contact our Member Services
number at 1-800-443-0815 for additional information. (TTY users should call 711.)
Hours are 8 a.m. to 8 p.m., 7 days a week. This call is free.
• Este documento está disponible de manera gratuita en español. Para obtener información
adicional, comuníquese con Servicio a los Miembros al 1-800-443-0815. (Los usuarios
de la línea TTY deben llamar al 711). El horario de atención es de 8:00 a. m. a 8:00 p. m.,
los 7 días de la semana. Esta llamada no tiene costo.
• This document is available in braille, large print, or CD if you need it by calling
Member Services.
• Coverage under this plan qualifies as Qualifying Health Coverage (QHC) and
satisfies the Patient Protection and Affordable Care Act's (ACA) individual shared
responsibility requirement. Please visit the Internal Revenue Service (IRS) website at
www.irs.gov/Affordable-Care-Act/Individuals-and-Families for more information.
About Kaiser Permanente Senior Advantage Ventura County plan
• Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in
Kaiser Permanente depends on contract renewal.
• When this document says "we," "us," or "our," it means Kaiser Foundation Health Plan,
Inc., Southern California Region (Health Plan). When it says "plan" or "our plan," it
means Kaiser Permanente Senior Advantage Ventura County Plan (Senior Advantage).
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
Annual Notice of Changes for 2024
Table of Contents
Summary of important costs for 2024 ......................................................................... 4
— Changes to benefits and costs for next year ........................................ 6
Section 1.1 – Changes to the monthly premium........................................................................6
Section 1.2 – Changes to your maximum out-of-pocket amount ..............................................7
Section 1.3 – Changes to the provider and pharmacy networks ................................................7
Section 1.4 – Changes to benefits and costs for medical services .............................................8
Section 1.5 – Changes to Part D prescription drug coverage ..................................................11
— Deciding which plan to choose ............................................................ 14
Section 2.1 – If you want to stay in Senior Advantage Ventura County plan .........................14
Section 2.2 – If you want to change plans ...............................................................................14
— Deadline for changing plans................................................................. 14
— Programs that offer free counseling about Medicare ......................... 15
— Programs that help pay for prescription drugs................................... 15
— Questions? ............................................................................................. 16
Section 6.1 – Getting help from our plan.................................................................................16
Section 6.2 – Getting help from Medicare...............................................................................17
4 Senior Advantage Ventura County Annual Notice of Changes for 2024
Summary of important costs for 2024
The table below compares the 2023 costs and 2024 costs for Senior Advantage Ventura County
plan in several important areas. Please note this is only a summary of costs.
Cost
2023 (this year)
2024 (next year)
Monthly plan premium*
*Your premium may be higher or lower than this
amount. (See
Section 1.1
for details.)
$0
*
$0
*
Maximum out-of-pocket amount
This is the most
you will
pa
y out
-
of
-
po
c
ke
t for
your
c
ove
red Part A and Part B services. (See
Section 1.2
for details.)
$1,999
$1,999
Doctor office visits
Primary care visits:
$0
Specialist visits:
$0
Primary care visits:
$0
Specialist visits:
$0
Inpatient hospital stays
$0
Per admission,
$50 per day for
days 1–5 ($0 for
the rest of your
stay).
Part D prescription drug coverage
(See Section 1.5 for details.)
Deductible: $0
Cost-sharing during
the Initial
Coverage Stage
(up to a 30-day
supply):
Drug Tier 1: $0
Drug Tier 2: $3
Drug Tier 3: $40
You pay $35 per
month supply of
each covered
insulin product on
this tier.
Drug Tier 4: $100
You pay $35 per
month supply of
Deductible: $0
Cost-sharing during
the Initial
Coverage Stage
(up to a 30-day
supply):
Drug Tier 1: $0
Drug Tier 2: $5
Drug Tier 3: $42
You pay $35 per
month supply of
each covered
insulin product on
this tier.
Drug Tier 4: $100
You pay $35 per
month supply of
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5 Senior Advantage Ventura County Annual Notice of Changes for 2024
Cost
2023 (this year)
2024 (next year)
each covered
insulin product on
this tier.
Drug Tier 5: 33%
You pay $35 per
month supply of
each covered
insulin product on
this tier.
Drug Tier 6: $0
each covered
insulin product on
this tier.
Drug Tier 5: 33%
You pay $35 per
month supply of
each covered
insulin product on
this tier.
Drug Tier 6: $0
Catastrophic
Cove
r
age:
Dur
ing t
his
pa
yment st
a
ge
,
our
plan pays most of
the cost for
your
covered drugs.
For each
prescription, you
pay a copayment:
$0 for covered
generic drugs
(includes drugs
treated like
generics), $12 for
covered brand-
name drugs, and $0
for covered
injectable Part D
vaccines.
Catastrophic
Coverage:
During this
payment stage, our
plan pa
ys the full
cost for
your
covered Part D
drugs. You pay
nothing.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
6 Senior Advantage Ventura County Annual Notice of Changes for 2024
— Changes to benefits and costs for next year
Section 1.1 – Changes to the monthly premium
Cost
2023 (this year)
2024 (next year)
Monthly premium without optional
supplemental benefits
(You must also continue to pay your Medicare
Part B premium.)
$0
$0
Monthly premium with optional
supplemental benefits
This plan premium applies to you only if you are
enrolled in our optional supplemental benefits
package.
(You must also continue to pay your Medicare
Part B premium.)
$15
$21
• Your monthly plan premium will be more if you are required to pay a lifetime Part D late
enrollment penalty for going without other drug coverage that is at least as good as
Medicare drug coverage (also referred to as creditable coverage) for 63 days or more.
• If you have a higher income, you may have to pay an additional amount each month
directly to the government for your Medicare prescription drug coverage.
• Your monthly premium will be less if you are receiving "Extra Help" with your
prescription drug costs. Please see Section 5 regarding "Extra Help" from Medicare.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
7 Senior Advantage Ventura County Annual Notice of Changes for 2024
Section 1.2 – Changes to your maximum out-of-pocket amount
Medicare requires all health plans to limit how much you pay out-of-pocket for the year. This
limit is called the maximum out-of-pocket amount. Once you reach this amount, you generally
pay nothing for covered Part A and Part B services (and other health care services not covered by
Medicare as described in Chapter 4 of the Evidence of Coverage) for the rest of the year.
Cost
2023 (this year)
2024 (next year)
Maximum out-of-pocket
amount
Your costs for covered medical
services (such as copayments) count
toward your maximum out-of-
pocket amount. Your plan premium
and your costs for prescription
drugs do not count toward your
maximum out-of-pocket amount.
$1,999
$1,999
Once you have paid $1,999 out-
of-pocket for covered Part A and
Part B services (and certain
health care services not covered
by Medicare), you will pay
nothing for these covered
services for the rest of the
calendar year.
Section 1.3 – Changes to the provider and pharmacy networks
Updated directories are located on our website at kp.org/directory. You may also call Member
Services for updated provider and/or pharmacy information or to ask us to mail you a directory,
which we will mail within three business days.
There are changes to our network of providers for next year. Please review the 2024 Provider
Directory to see if your providers (primary care provider, specialists, hospitals, etc.) are in
our network.
The directory will be updated with in-network hospice providers effective January 1, 2024, or
later, under the plan's hospice benefit.
There are changes to our network of pharmacies for next year. Please review the
2024 Pharmacy Directory to see which pharmacies are in our network.
It is important that you know that we may make changes to the hospitals, doctors, and specialists
(providers), and pharmacies that are part of your plan during the year. If a midyear change in our
providers affects you, please contact Member Services so we may assist.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
8 Senior Advantage Ventura County Annual Notice of Changes for 2024
Section 1.4 – Changes to benefits and costs for medical services
We are making changes to costs and benefits for certain medical services next year. The
information below describes these changes.
Cost
2023 (this year)
2024 (next year)
Emergency Department
visits
You pay $120 per visit.
You pay $135 per visit.
Eyewear
You receive a $100 eyewear
allowance every 24 months.
If the eyewear you purchase
costs more than $100, you
pay the difference.
Your allowance is increased
if you have signed up for
Advantage Plus.
Not covered. However, if
you have signed up for
Advantage Plus, you receive
the eyewear benefit
described below in the
"Optional supplemental
benefits (Advantage Plus)"
row.
Fitness benefit (the
Silver&Fit® Healthy Aging
and Exercise Program)
Covered. You pay $0 and
receive the following:
• A standard gym
membership.
• A home fitness kit to
exercise at home (you
can also choose a kit that
includes an activity
tracker).
Not covered. However, if
you have signed up for
Advantage Plus, you receive
the fitness benefit described
below in the "Optional
supplemental benefits
(Advantage Plus)" row.
Hearing aids and services
•
Evaluation and fitting exam
for hearing aids.
You pay $0. Not covered. However, if
you have signed up for
Advantage Plus, you receive
the hearing benefit described
below in the "Optional
supplemental benefits
(Advantage Plus)" row.
•
Hearing aid allowance.
You receive a $500 hearing
aid allowance per ear, per
aid, every 36 months. If the
hearing aid(s) you purchase
costs more than $500, you
pay the difference.
Not covered. However, if
you have signed up for
Advantage Plus, you receive
the hearing benefit described
below in the "Optional
supplemental benefits
(Advantage Plus)" row.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
9 Senior Advantage Ventura County Annual Notice of Changes for 2024
Cost
2023 (this year)
2024 (next year)
Your allowance is increased
if you have signed up for
Advantage Plus.
Home-delivered meals
Meals delivered to your home
following discharge from a
hospital due to congestive heart
failure (referral required).
You pay $0 for up to t
wo
meals per day in a
consecutive four-week
period, once per calendar
year.
Not covered.
Inpatient care
• Inpatient acute and mental
health care
You pay $0.
You pay $50 per day for
days 1–5 ($0 for the rest of
your stay).
•
Inpatient mental health care
stays: Covered services
include mental health care
services that require a
hospital stay.
• We cover up to 190 days
per lifetime for inpatient
stays in a Medicare-
certified psychiatric
hospital.
• The 190-day limit does
not apply to mental
health stays in a
psychiatric unit of a
general hospital. It also
doesn’t apply to stays in
a psychiatric hospital
associated with the
following conditions:
schizophrenia,
schizoaffective disorder,
bipolar disorder (manic-
depressive illness), major
depressive disorders,
panic disorder,
obsessive-compulsive
disorder, pervasive
developmental disorder
or autism, anorexia
nervosa, bulimia nervosa,
and Serious Emotional
Disturbance (SED) of a
child under age 18.
We cover unlimited stays.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
10 Senior Advantage Ventura County Annual Notice of Changes for 2024
Cost
2023 (this year)
2024 (next year)
Medicare Part B drugs
Up to a 30-day supply from a
network pharmacy.
You pay $3 for generic
drugs and
$40 for brand-
name drugs per
prescription, except you pay
$35 for Part B insulin drugs
furnished through an item
of DME.
You pay $5 for generic drugs
and $42 for brand-name
drugs per prescription,
except you pay $35 for
Part B insulin drugs
furnished through an item
of DME.
MRI, CT, and PET
You pay $120 per
procedure.
You pay $200 per procedure.
Outpatient observation
You pay $120 per stay
when admitted directly to
the hospital for observation
as an outpatient.
You pay $135 per stay when
admitted directly to the
hospital for observation as an
outpatient.
Residential substance use
disorder and mental health
treatment
You pay $0.
You pay $50 per admission.
Skilled nursing facility
(SNF) care
Per benefit period, you pay
$0 per day for days 1–20
and $75 per day for days
21–100.
Per benefit period, you pay
$0 per day for days 1–20 and
$100 per day for days
21–100.
Optional supplemental
benefits (Advantage Plus)
This change only applies to
members who have signed up
for optional supplemental
benefits, called Advantage
Plus.
• Eyewear.
You receive an additional
$280 eyewear allowance
added to your standard
allowance every 24 months,
which results in a combined
allowance of $380.
If the eyewear you purchase
c
osts
more
than
$
380
, yo
u
p
ay the difference.
You receive a $300 eyewear
allowance every 24 months.
If the eyewear you purchase
costs more than $300, you
pay the difference.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
11 Senior Advantage Ventura County Annual Notice of Changes for 2024
Cost
2023 (this year)
2024 (next year)
•
Fitness benefit (the
Silver&Fit® Healthy Aging
and Exercise Program).
Not covered as part of our
Advantage P
lus package.
Covered as part of our
Advantage Plus package.
You pay $0 and receive the
following:
• A standard fitness center
membership.
• One home fitness kit per
c
alendar year to exercise
at home (you can also
choose a kit that includes
an activity tracker).
• Evaluation and fitting for
he
a
ring a
ids.
Not covered as part of our
Advantage Plus package.
Covered as part of our
Advantage Plus package.
You pay $0.
• Hearing aids.
You receive an additional
$500 hearing aid allowance
added to your standard
allowance per ear, per aid,
every 36 months, which
results in a combined
allowance of $1,000.
If the hearing aid(s) you
purchase costs more than
$1,000, you p
ay the
difference.
You receive a $1,000
hearing aid allowance p
er
ear, per aid, every
36 months.
If the hearing aid(s) you
purchase costs more than
$1,000, you
pay the
difference.
Section 1.5 – Changes to Part D prescription drug coverage
Changes to our "Drug List"
Our list of covered drugs is called a formulary, or "Drug List." A copy of our "Drug List" is
provided electronically at kp.org/seniorrx.
We made changes to our "Drug List," which could include removing or adding drugs, changing
the restrictions that apply to our coverage for certain drugs or moving them to a different cost-
sharing tier. Review our "Drug List" to make sure your drugs will be covered next year and
to see if there will be any restrictions, or if your drug has been moved to a different cost-
sharing tier.
Most of the changes in our "Drug List" are new for the beginning of each year. However, during
the year, we might make other changes that are allowed by Medicare rules. For instance, we can
immediately remove drugs considered unsafe by the FDA or withdrawn from the market by a
product manufacturer. We update our online "Drug List" to provide the most up-to-date list of
drugs.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
12 Senior Advantage Ventura County Annual Notice of Changes for 2024
If you are affected by a change in drug coverage at the beginning of the year or during the year,
please review Chapter 9 of your Evidence of Coverage and talk to your doctor to find out your
options, such as asking for a temporary supply, applying for an exception, and/or working to find
a new drug. You can also contact Member Services for more information.
Changes to prescription drug costs
Note: If you are in a program that helps pay for your drugs ("Extra Help"), the information
about costs for Part D prescription drugs does not apply to you. We sent you a separate
insert, called the Evidence of Coverage Rider for People Who Get Extra Help Paying for
Prescription Drugs (also called the Low-Income Subsidy Rider or the LIS Rider), which tells
you about your drug costs. If you receive "Extra Help" and you haven't received this insert by
September 30, 2023, please call Member Services and ask for the LIS Rider.
There are four drug payment stages. The information below shows the changes to the first two
stages—the Yearly Deductible Stage and the Initial Coverage Stage. (Most members do not
reach the other two stages—the Coverage Gap Stage or the Catastrophic Coverage Stage.)
Changes to the Deductible Stage
Stage
2023 (this year)
2024 (next year)
Stage 1: Yearly
Deductible Stage
Because we have no
deductible, this payment
stage does not apply to you.
Because we have no
deductible, this payment
stage does not apply to you.
Changes to your cost-sharing in the Initial Coverage Stage
Stage
2023 (this year)
2024 (next year)
Stage 2: Initial Coverage
Stage
During this stage, the plan
pays its share of the cost of
your drugs and you pay your
share of the cost.
The costs in this row are for a
one-month (30-day) supply
when you fill your
prescription at a network
pharmacy that provides
standard cost-sharing. For
information about the costs
for a long-term supply or for
mail-order prescriptions, look
in Chapter 6, Section 5, of
your Evidence of Coverage.
Your cost for a one-month
supply filled at a network
pharmacy with standard cost-
sharing:
• Tier 1 – Preferred generic
drugs: You pay $0 per
prescription.
• Tier 2 – Generic drugs:
You pay $3 per
prescription.
• Tier 3 – Preferred brand-
name drugs: You pay $40
per prescription. You pay
$35 per month supply of
each covered insulin
product on this tier.
Your cost for a one-month
supply filled at a network
pharma
cy with standard cost-
sharing:
• Tier 1 – Preferred generic
drugs: You pay $0 per
prescription.
• Tie
r 2 – Generic drugs:
You pay $5 per
prescription.
• Tier 3 – Preferred brand-
name drugs: You pay $42
per prescription. You pay
$35 per month supply of
each covered insulin
product on this tier.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
13 Senior Advantage Ventura County Annual Notice of Changes for 2024
Stage
2023 (this year)
2024 (next year)
We changed the tier for some
of the drugs on our "Drug
List." To see if your drugs
will be in a different tier, look
them up on our "Drug List."
Most adult Part D vaccines
are covered at no cost to you.
• Tier 4 – Nonpreferred
brand-name drugs: You
pay $100 per prescription.
You pay $35 per month
supply of each covered
insulin product on this tier.
• Tier 5 – Specialty-tier
drugs: You pay 33% of
the total cost. You pay $35
per month supply of each
covered insulin product on
this tier.
• Tier 6 – Injectable Part D
vaccines: You pay $0 per
prescription.
Once your total drug costs
ha
ve
re
a
c
h
e
d $4,66
0
, yo
u
will
move to the ne
xt st
a
ge
(the
C
ove
ra
ge Gap Stage).
• Tier 4 – Nonpreferred
drugs: You pay $100 per
prescription. You pay $35
per month supply of each
covered insulin product on
this tier.
• Tier 5 – Specialty-tier
drugs: You pay 33%
of
the total cost.
You pay $35
per month supply of each
covered insulin product on
this tier.
• Tier 6 –
Injectable Part
D
vaccines: You pay $0
per
prescription.
Once your total drug costs
have reached $5,030, you
will move to the next stage
(the Coverage Gap Stage).
Changes to the Coverage Gap and Catastrophic Coverage Stages
The other two drug coverage stages—the Coverage Gap Stage and the Catastrophic Coverage
Stage—are for people with high drug costs. Most members do not reach the Coverage Gap
Stage or the Catastrophic Coverage Stage.
Beginning in 2024, if you reach the Catastrophic Coverage Stage, you pay nothing for
covered Part D drugs.
For specific information about your costs in these
stages, look at Chapter 6,
Sections 6 and 7, in
your Evidence of Coverage.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
14 Senior Advantage Ventura County Annual Notice of Changes for 2024
— Deciding which plan to choose
Section 2.1 – If you want to stay in Senior Advantage Ventura County
plan
To stay in our plan, you don't need to do anything. If you do not sign up for a different plan
or change to Original Medicare by December 7, you will automatically be enrolled in
Senior Advantage Ventura County plan.
Section 2.2 – If you want to change plans
We hope to keep you as a member next year, but if you want to change plans for 2024, follow
these steps:
Step 1: Learn about and compare your choices
• You can join a different Medicare health plan.
• Or you can change to Original Medicare. If you change to Original Medicare, you will
need to decide whether to join a Medicare drug plan. If you do not enroll in a Medicare
drug plan, please see Section 1.1 regarding a potential Part D late enrollment penalty.
To learn more about Original Medicare and the different types of Medicare plans, use the
Medicare Plan Finder (www.medicare.gov/plan-compare), read the Medicare & You 2024
handbook, call your State Health Insurance Assistance Program (see Section 4), or call Medicare
(see Section 6.2).
As a reminder, Kaiser Permanente offers other Medicare health plans. These other plans may
differ in coverage, monthly premiums, and cost-sharing amounts.
Step 2: Change your coverage
• To change to a different Medicare health plan, enroll in the new plan. You will
automatically be disenrolled from Senior Advantage Ventura County plan.
• To change to Original Medicare with a prescription drug plan, enroll in the new drug
plan. You will automatically be disenrolled from Senior Advantage Ventura County plan.
• To change to Original Medicare without a prescription drug plan, you must either:
Send us a written request to disenroll. Contact Member Services if you need more
information on how to do so.
Or contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day,
7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048.
— Deadline for changing plans
If you want to change to a different plan or to Original Medicare for next year, you can do it
from October 15 until December 7. The change will take effect on January 1, 2024.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
15 Senior Advantage Ventura County Annual Notice of Changes for 2024
Are there other times of the year to make a change?
In certain situations, changes are also allowed at other times of the year. Examples include
people with Medicaid, those who get "Extra Help" paying for their drugs, those who have or are
leaving employer coverage, and those who move out of the service area.
If you enrolled in a Medicare Advantage plan for January 1, 2024, and don't like your plan
choice, you can switch to another Medicare health plan (either with or without Medicare
prescription drug coverage) or switch to Original Medicare (either with or without Medicare
prescription drug coverage) between January 1 and March 31, 2024.
If you recently moved into, currently live in, or just moved out of an institution (like a skilled
nursing facility or long-term care hospital), you can change your Medicare coverage at any time.
You can change to any other Medicare health plan (either with or without Medicare prescription
drug coverage) or switch to Original Medicare (either with or without a separate Medicare
prescription drug plan) at any time.
— Programs that offer free counseling about Medicare
The State Health Insurance Assistance Program (SHIP) is an independent government program
with trained counselors in every state. In California, the SHIP is called the Health Insurance
Counseling and Advocacy Program (HICAP).
It is a state program that gets money from the federal government to give free local health
insurance counseling to people with Medicare. The Health Insurance Counseling and Advocacy
Program counselors can help you with your Medicare questions or problems. They can help you
understand your Medicare plan choices and answer questions about switching plans. You can
call the Health Insurance Counseling and Advocacy Program at 1-800-434-0222 (TTY users
should call 711).
You can learn more about the Health Insurance Counseling and Advocacy Program by visiting
their website (www.aging.ca.gov/HICAP/).
— Programs that help pay for prescription drugs
You may qualify for help paying for prescription drugs. Below we list different kinds of help:
• "Extra Help" from Medicare. People with limited incomes may qualify for "Extra
Help" to pay for their prescription drug costs. If you qualify, Medicare could pay up to
75% or more of your drug costs, including monthly prescription drug premiums, annual
deductibles, and coinsurance. Additionally, those who qualify will not have a coverage
gap or late enrollment penalty. To see if you qualify, call:
1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048,
24 hours a day/7 days a week;
The Social Security office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday
through Friday, for a representative. Automated messages are available 24 hours a
day. TTY users should call 1-800-325-0778; or
Your state Medi-Cal (Medicaid) office (applications).
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
16 Senior Advantage Ventura County Annual Notice of Changes for 2024
• Prescription cost-sharing assistance for persons with HIV/AIDS. The AIDS Drug
Assistance Program (ADAP) helps ensure that ADAP-eligible individuals living with
HIV/AIDS have access to life-saving HIV medications. Individuals must meet certain
criteria, including proof of state residence and HIV status, low income as defined by the
state, and uninsured/underinsured status. Medicare Part D prescription drugs that are also
covered by ADAP qualify for prescription cost-sharing assistance through the
California AIDS Drug Assistance Program (ADAP).
For information on eligibility criteria, covered drugs, or how to enroll in the program, please call
the ADAP call center at 1-844-421-7050 between 8 a.m. and 5 p.m., Monday through Friday
(excluding holidays).
— Questions?
Section 6.1 – Getting help from our plan
Questions? We're here to help. Please call Member Services at 1-800-443-0815. (TTY only, call
711.) We are available for phone calls 7 days a week, 8 a.m. to 8 p.m. Calls to these numbers
are free.
Read your 2024 Evidence of Coverage (it has details about next year's benefits and
costs)
This Annual Notice of Changes gives you a summary of changes in your benefits and costs for
2024. For details, look in the 2024 Evidence of Coverage for our plan. The
Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your
rights and the rules you need to follow to get covered services and prescription drugs. A copy of
the Evidence of Coverage is located on our website at kp.org/eocscal. You may also call
Member Services to ask us to mail you an Evidence of Coverage.
Visit our website
You can also visit our website at kp.org. As a reminder, our website has the most up-to-date
information about our provider network (Provider Directory) and our list of covered drugs
(Formulary/Drug List).
To get information about the hospice benefit, please contact:
Kaiser Foundation Hospitals Valley Continuing Care
Director of Patient Care Services
1-800-863-9293 (TTY 711)
24 hours a day, 7 days a week
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
17 Senior Advantage Ventura County Annual Notice of Changes for 2024
Section 6.2 – Getting help from Medicare
To get information directly from Medicare:
Call 1-800-MEDICARE (1-800-633-4227)
You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users
should call 1-877-486-2048.
Visit the Medicare website
Visit the Medicare website (www.medicare.gov). It has information about cost, coverage, and
quality star ratings to help you compare Medicare health plans in your area. To view the
information about plans, go to www.medicare.gov/plan-compare.
Read Medicare & You 2024
Read the Medicare & You 2024 handbook. Every fall, this document is mailed to people with
Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most
frequently asked questions about Medicare. If you don't have a copy of this document, you can
get it at the Medicare website
(https://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf) or by calling
1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call
1-877-486-2048.
1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
Kaiser Permanente Senior Advantage Member Services
METHOD
Member Services – contact information
CALL
1-800-443-0815
Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m.
Member Services also has free language interpreter services available for
non-English speakers.
TTY
711
Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m.
WRITE
Your local Member Services office (see the Provider Directory for
locations).
WEBSITE
kp.org
OMB Approval 0938-1051 (Expires: February 29, 2024)
Notice of Nondiscrimination
Kaiser Permanente complies with applicable federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability, or sex. Kaiser Permanente does not
exclude people or treat them differently because of race, color, national origin, age, disability,
or sex. We also:
• Provide no cost aids and services to people with disabilities to communicate effectively
with us,
such as:
ο Qualified sign language interpreters.
ο Written infor
mation in other formats, such as large print, audio, and accessible
electronic formats.
• Provide no cost language services to people whose primary language is not English,
such as:
ο Qualified interpreters.
ο Information wr
itten in other languages.
If you need these services, call Member Services at 1-800-443-0815 (TTY 711),
8 a.m. to 8 p.m., seven days a week.
If you believe that Kaiser Permanente has failed to provide these services or discriminated in
another way on the basis of race, color, national origin, age, disability, or sex, you can file a
grievance with our Civil Rights Coordinator by writing to One Kaiser Plaza, 12th Floor, Suite 1223,
Oakland, CA 94612 or calling Member Services at the number listed above. You can file a
grievance by mail or phone. If you need help filing a grievance, our Civil Rights Coordinator is
available to help you. You can also file a civil rights complaint with the U.S. Department of Health
and Human Services, Office for Civil Rights electronically through the Office for Civil Rights
Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone
at: U.S. Department of Health and Human Services, 200 Independence Avenue SW.,
Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
1126306860 CA
June 2023
Form Approved
OMB# 0938-1421
Multi-Language
Insert
Multi-language In
terpreter Services
English: We have free interpreter services to answer any questions you
may have about our health or drug plan. To get an interpreter, just call us
at
1-800-443-0815 (TTY 711). Someone who speaks English/Language can help
you. This is a free service.
Spanish: Tenemos servicios de intérprete sin costo alguno para responder
cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos.
Para hablar con un intérprete, por favor llame al 1-800-443-0815 (TTY 711). Alguien
que hable español le podrá ayudar. Este es un servicio gratuito.
Chinese Mandarin: 我们提供免费的翻译服务，帮助您解答关于健康或药物保险的任何疑 问。
如果您需要此翻译服务，请致电
1-800-443-0815 (TTY 711)。我们的中文工作人员很乐意帮助
您。 这是一项免费服务。
Chinese Cantonese: 您對我們的健康或藥物保險可能存有疑問，為此我們提供免費的翻譯 服
務。如需翻譯服務，請致電
1-800-443-0815 (TTY 711)。我們講中文的人員將樂意為您提供幫
助。這 是一項免費服務。
Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot
ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o
panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa
1-800-443-0815 (TTY 711). Maaari kayong tulungan ng isang nakakapagsalita ng
Tagalog. Ito ay libreng serbisyo.
French: Nous proposons des services gratuits d'interprétation pour répondre à
toutes vos questions relatives à notre régime de santé ou d'assurance-
médicaments. Pour accéder au service d'interprétation, il vous suffit de nous
appeler au
1-800-443-0815 (TTY 711). Un interlocuteur parlant Français pourra vous
aider. Ce service est gratuit.
Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về
chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin
gọi
1-800-443-0815 (TTY 711) sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là
dịch vụ miễn phí .
German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu
unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie
unter
1-800-443-0815 (TTY 711). Man wird Ihnen dort auf Deutsch weiterhelfen.
Dieser Service ist kostenlos.
Form CMS-10802
(Expires 12/31/25)
Y0043_N00036258_C
Form Approved
OMB# 0938-1421
Korean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를
제공하고
있습니다 . 통역 서비스를 이용하려면 전화
1-800-443-0815 (TTY 711) 번으로 문의해
주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다 . 이 서비스는 무료로 운영됩니다 .
Russian: Если у вас возникнут вопросы относительно страхового или
медикаментного плана, вы можете воспользоваться нашими бесплатными
услугами переводчиков. Чтобы воспользоваться услугами переводчика,
позвоните нам по телефону
1-800-443-0815 (TTY 711). Вам окажет помощь
сотрудник, который говорит по-pусски. Данная услуга бесплатная.
Arabic :
1-800-443-0815 (TTY 711)
.
Hindi:
,
1-800-443-0815 (TTY 711)
Italian: È dispon
ibile un se
rvizio di interpretariato gratuito per rispondere a
eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete,
contattare il numero 1-800-443-0815 (TTY 711). Un nostro incaricato che parla
Italianovi fornirà l'assistenza necessaria. È un servizio gratuito.
Portuguese: Dispomos de serviços de interpretação gratuitos para responder a
qualquer questão que tenha acerca do nosso plano de saúde ou de medicação.
Para obter um intérprete, contacte-nos através do número
1-800-443-0815 (TTY 711).
Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é
gratuito.
French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta
genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis
rele nou nan 1-800-443-0815 (TTY 711). Yon moun ki pale Kreyòl kapab ede w. Sa a
se yon sèvis ki gratis.
Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który
pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania
leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy
zadzwonić pod numer 1-800-443-0815 (TTY 711). Ta usługa jest bezpłatna.
Japanese: 当
社の健康 健康保険と薬品 処方薬プランに関するご質問にお答えするため
に、無料の通訳サービスがありますございます。通訳をご用命になるには、
1-800-443-0815 (TTY 711) にお電話ください。日本語を話す人 者 が支援いたします。これ
は無料のサー ビスです。
Form CMS-10802
(Expires 12/31/25)
1140823727
June 2023
Plan Information
As member of this plan, we may occasionally contact you to inform you of other Kaiser Permanente
plans or products that may be available to you. If you wish to opt-out of these types of calls, please
contact Member Services at the phone number on the back of your member ID card.
Provider Directories
If you need help finding a network provider or pharmacy, please visit kp.org/directory to search our
online directory (Note: the 2024 directories are available online starting 10/15/2023 in accord with
Medicare requirements).
To get a Provider Directory, Dental Provider Directory or Pharmacy Directory (if applicable), mailed
to you, you can call Kaiser Permanente at 1-800-443-0815 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
Medicare Part D Prescription Drug Formulary
Our formulary lists the Medicare Part D drugs we cover. The formulary may change at any time.
You’ll be notified when necessary. If you have a question about covered drugs, see our online formulary
at kp.org/seniorrx (Note: the 2024 formulary is available online starting 10/15/2023 in accord with
Medicare requirements).
To get a formulary mailed to you, you can call Kaiser Permanente at 1-800-443-0815 (TTY 711),
7 days a week, 8 a.m. to 8 p.m.
Evidence of Coverage (EOC)
Your EOC explains how to get medical care and prescription drugs covered through your plan. It explains
your rights and responsibilities, what’s covered, and what you pay as a Kaiser Permanente member. If
you have a question about your coverage, visit kp.org/eocscal to view your EOC online (Note: the 2024
EOC for Southern California is available online starting 10/15/2023 in accord with Medicare
requirements).
To get an EOC mailed to you, you can call Kaiser Permanente at 1-800-443-0815 (TTY 711),
7 days a week, 8 a.m. to 8 p.m.
Y0043_H8794_N00036398_C
1154886472 SCAL
July 2023
