Read or download 2021 plan documents
Evidence of Coverage (EOC) and Annual Notice of Changes (ANOC)
2021 Evidence of Coverage
For complete information on grievance, coverage determination (including exceptions), and appeals processes, you can refer to the Evidence of Coverage for your plan.
For complete information on grievance, coverage determination (including exceptions), and appeals processes, you can refer to the Evidence of Coverage for your plan.
There is also an Annual Notice of Changes, which summarizes changes to plans and programs for 2021.
We encourage you to read this document and hold onto it because it explains your benefits and rights. If you would like to request a hard copy, please call 1-877-201-2757, 24 hours a day, 7 days a week. If you have questions regarding benefits, please call Member Services at 1-888-901-4600 or (TTY) 711 from 8 a.m. to 8 p.m., 7 days a week.
Summary of Benefits
For a listing of benefits each plan covers, see the Summary of Benefits for Kaiser Permanente Medicare Advantage (HMO) health plans in each region or the Summary of Benefits for the Kaiser Permanente Medicare Advantage Basic (HMO) health plan in all regions.
Read plan documents for your region
Medicare Advantage Basic (HMO) plan - No Part D
Available in Island, King, Kitsap, Lewis, Pierce, Skagit, Snohomish, Spokane, Thurston and Whatcom counties, and in Grays Harbor County
ZIP codes 98541, 98557, 98559, and 98568 and Mason County ZIP codes 98524, 98528, 98546, 98548,
98555, 98584, 98588, and 98592.
- Medicare Advantage Basic (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Basic (HMO) Summary of Benefits (PDF)
Medicare Advantage Key (HMO) plan
Available in Island, King, Pierce, Snohomish, and Thurston counties.
- Medicare Advantage Key (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Key (HMO) Summary of Benefits (PDF)
Medicare Advantage Vital, Essential, and Optimal (HMO) plans
Available in King, Pierce, Thurston, Kitsap, Lewis, and Snohomish counties; in Grays Harbor County
ZIP codes 98541, 98557, 98559, and 98568; and in Mason County ZIP codes 98524, 98528, 98546, 98548,
98555, 98584, 98588, and 98592.
- Medicare Advantage Vital (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Essential (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Optimal (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Vital, Essential, and Optimal (HMO) Summary of Benefits (PDF)
Medicare Advantage Harbor (HMO) plan
Available in Island, San Juan, Skagit, and Whatcom counties.
- Medicare Advantage Harbor (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Harbor (HMO) Summary of Benefits (PDF)
Medicare Advantage Anchor (HMO) plan
Available in Skagit and Whatcom counties.
Medicare Advantage Centennial and Columbia plans
Available in Spokane County.
- Medicare Advantage Centennial (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Columbia (HMO) EOC (PDF) and ANOC (PDF)
- Medicare Advantage Centennial and Columbia (HMO) Summary of Benefits (PDF)
For members enrolled in a Kaiser Permanente Medicare health plan through an employer, please call Member Services for your plan documents.
Learn about Medicare health plans for group, state, and federal employees
If you are becoming eligible for Medicare and your employer offers a group retiree Medicare Advantage health plan through Kaiser Permanente Washington, call us at 1-800-581-8252 or TTY 711, from 8 a.m. to 5 p.m., Monday through Friday.
FEHB and PEBB members can also find information online: