On this page13 sections
- Ratings and complaints
- Kaiser Permanente vs. competitors
- Pricing
- Step by step
- Kaiser Permanente legitimacy and licensing
- How much Kaiser Permanente costs
- How Kaiser's network works
- Kaiser Permanente complaints and legal record
- Appeals and the rules that protect you
- Who should choose another plan
- What customers say
- Alternatives
- FAQ
Kaiser Permanente suits people who live in a Kaiser service area and are happy to get care from Kaiser's doctors: in 2026 it held 8 of NCQA's 18 five-star plan ratings, and its Medicare Advantage plans averaged 4.41 stars. It is a legitimate, nonprofit health plan that also runs its own hospitals and medical groups, so your insurance, doctors and records sit in one system. The tradeoffs are a closed network with little outside coverage, and a record that includes a $556 million False Claims Act settlement in January 2026, a $50 million California behavioral health fine in 2023, and a four-week nurses' strike in early 2026. Check that your county is in a Kaiser service area and that you can accept its doctors before you enroll.
- Members
- 12.9 million, as of June 30, 20261
- Where it operates
- California, Colorado, Georgia, Hawaii, Maryland, Virginia, Washington, D.C., Nevada, Oregon and Washington, in its service areas only1
- Care system
- 40 hospitals, 610 medical offices, 25,270 physicians and 78,630 nurses1
- Marketplace plan types
- HMO and EPO; no PPO plans on the marketplace, per MoneyGeek's 2026 comparison3
- Quality ratings
- 8 of NCQA's 18 five-star plan ratings in 2026; Medicare Advantage average 4.41 stars in 2026 (NerdWallet's enrollment-weighted figure)4
- Medicare
- Sells Medicare Advantage; does not sell Medicare Supplement (Medigap) plans, per NerdWallet5
- Federal settlement
- $556 million in January 2026 to resolve allegations that it added invalid diagnoses to raise Medicare Advantage payments from 2009 to 2018; no admission of liability6
- Founded
- Kaiser Foundation Health Plan, Inc. dates to 1955 in BBB records; nonprofit8
Pros
- Top quality ratings: 8 of NCQA's 18 five-star plans in 2026
- Coordinated care and records in one system
- Low average Medicare Advantage out-of-pocket maximum
- Highly rated member app
Cons
- Closed network with little coverage outside Kaiser
- Only sold in 8 states and D.C., and only in service areas
- $556 million federal settlement in 2026 and a $50 million California fine in 2023
- Complaints about appointment waits and phone access
Best for: People in a Kaiser service area who want insurance and care coordinated in one system and do not need doctors outside it.
Skip it if: You want to keep doctors who are not in Kaiser's system, need a PPO, travel or live part of the year outside Kaiser's areas, or want Medigap.
Kaiser Permanente vs. competitors
| Company | How it works | Avg. Medicare Advantage stars (2026) | Avg. Medicare Advantage out-of-pocket max (2026) | NCQA 5-star plans (2026) |
|---|---|---|---|---|
| Kaiser Permanente | Insurer, hospitals and doctors in one system | 4.41 | $4,133 | 8 of 18 |
| Anthem | Blue Cross Blue Shield insurer with contracted networks | 3.63 | $7,175 | None |
| UnitedHealthcare | National insurer with its own network | 4.11 | $6,492 | None |
| Aetna | Insurer owned by CVS Health; no marketplace plans since 2025 | 4.2 | $6,693 |
Kaiser Permanente pricing at a glance
Average 2026 Silver marketplace premiums for a 40-year-old before tax credits, from MoneyGeek's analysis3
| Plan type | Kaiser Permanente | Anthem |
|---|---|---|
| HMO | $598 a month | $683 a month |
| EPO | $548 a month | $777 a month |
| POS | Not offered | $806 a month |
| PPO | Not offered | $874 a month |
These are averages across states and counties. Your price depends on ZIP code, age, tobacco use, household size and income, and premium tax credits can lower it. Compare the deductible and out-of-pocket maximum too. Open Enrollment for 2027 runs November 1, 2026 to January 15, 2027.
Kaiser Permanente, step by step
Check your service area
Kaiser only sells coverage inside its service areas, so enter your ZIP code on Kaiser's site or HealthCare.gov or your state marketplace first.
Pick a plan
Buy through an employer, the marketplace, Medicare or Medi-Cal and other Medicaid programs where Kaiser takes part. Marketplace plans are HMOs and EPOs.
Choose a Kaiser doctor
You pick a primary care doctor in Kaiser's network and get most care at Kaiser medical offices and hospitals.
Use the app and portal
Book visits, message your care team, see test results and order mail-order prescriptions in the Kaiser Permanente app or on kp.org.
Appeal if care is denied
File a grievance with Kaiser first, then ask your state regulator for an independent review if you disagree with the decision.
Kaiser Permanente legitimacy and licensing
Yes. Kaiser Permanente is one of the largest nonprofit health systems in the U.S., with 12.9 million members, 40 hospitals and 610 medical offices as of June 30, 2026. It combines Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and the Permanente Medical Groups, so the same organization insures you and provides your care.
It also scores well on independent quality measures. NCQA’s 2026 Health Plan Ratings gave 5 stars to 18 plans nationwide, and 8 were Kaiser plans. Its Medicare Advantage plans averaged 4.41 stars in 2026, and for 2027 Kaiser again held at least one of the country’s 15 five-star contracts.
How much Kaiser Permanente costs
Kaiser’s price depends on how you get coverage. Through an employer, your employer sets your share. On the marketplace, MoneyGeek’s 2026 averages for a 40-year-old Silver HMO are $598 a month for Kaiser and $683 for Anthem, before tax credits. Kaiser’s EPO averaged $548.
Most marketplace buyers get premium tax credits that lower these numbers. For Medicare Advantage, Kaiser’s 2026 plans had an average out-of-pocket maximum of $4,133, against $7,175 at Anthem, and 54% of its plans had a $0 premium. Always compare the deductible, copays and out-of-pocket maximum, not just the premium.
How Kaiser's network works
Kaiser’s marketplace plans are HMOs and EPOs. You choose a Kaiser primary care doctor and generally get care from Kaiser doctors and facilities. Care from outside doctors is covered mainly for emergencies, urgent care while traveling outside your area, or when Kaiser approves a referral.
That setup is why Kaiser tends to score well on coordination: your doctors, lab results, pharmacy and records are in one system you can reach through the app. It is also why Kaiser is a poor fit if you want to keep a doctor who works outside it.
What customers say about Kaiser Permanente
Recurring themes across the review sites and complaint records listed above, not individual quotes.
Common praise
- Coordinated care with doctors, labs, pharmacy and records in one system
- A well rated app for messages, results and appointments
- Strong work from individual specialists and surgical teams
- Lower out-of-pocket maximums on Medicare Advantage plans than many rivals
Common complaints
- Long waits for appointments and specialist referrals
- Hard to reach the right person by phone
- Rising premiums and copays
- Little or no coverage outside Kaiser's own network
- Delays in mental health care, which led to a 2023 state fine
Kaiser Permanente complaints and legal record
Common member complaints are long waits for appointments and referrals, hard-to-reach phone lines, rising premiums and copays, and limited coverage outside the network. Kaiser has an A+ BBB rating with 160 complaints in three years, but a 1.9 Trustpilot score from 349 reviews.
- January 2026: Kaiser affiliates agreed to pay $556 million to resolve Justice Department allegations that they pressured doctors to add diagnoses after visits to raise Medicare Advantage payments from 2009 to 2018. Kaiser did not admit liability.
- 2026 strike: About 31,000 UNAC/UHCP nurses and health professionals in California and Hawaii struck from January 26 to February 24, 2026, with tentative agreements reached in March.
- October 2023: California’s Department of Managed Health Care fined Kaiser $50 million and required $150 million in investments over five years over delays in behavioral health care.
- Website tracking case: Kaiser agreed to a class settlement of at least $46 million over tracking code that shared data on about 13.4 million people with tech companies; it denied wrongdoing.
Appeals and the rules that protect you
If Kaiser denies a service or a claim, file a grievance or appeal with Kaiser in writing and keep copies. If you still disagree, you can ask for an independent medical review through your state regulator, such as the California Department of Managed Health Care or your state insurance department, and urgent cases can be fast-tracked. Medicare Advantage members have their own federal appeal process through Medicare.
Under the Affordable Care Act, marketplace plans cannot deny you or charge more for preexisting conditions, and you can change plans during Open Enrollment, November 1, 2026 to January 15, 2027 for 2027 coverage, or after qualifying life events.
Who should choose another plan
Kaiser is a weak fit if your current doctors are outside its system, if you split the year between states, or if you want Original Medicare with a Medigap plan, which Kaiser does not sell. In those cases a PPO from Anthem, a Blue Cross Blue Shield plan or UnitedHealthcare may cost more but give you the choice you need.
Alternatives to Kaiser Permanente
- Anthem Better if you want a PPO, doctors outside one system, or a Medicare Supplement plan. Read review
- UnitedHealthcare Worth comparing if you live outside Kaiser's areas or travel often and want a national network. Read review
- Blue Cross Blue Shield The Blue plan in your state usually has the broadest local network of doctors and hospitals. Read review
- Medicaid, CHIP or marketplace subsidies If your income is limited, check HealthCare.gov or your state marketplace for free or low cost coverage before buying a plan at full price.
Kaiser Permanente reviews
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Frequently asked questions
Is Kaiser Permanente good insurance?
On quality ratings, yes: it held 8 of NCQA's 18 five-star plan ratings in 2026, and its Medicare Advantage plans averaged 4.41 stars. It works best if you are happy using Kaiser's own doctors and hospitals.
What states is Kaiser Permanente in?
California, Colorado, Georgia, Hawaii, Maryland, Virginia, Washington, D.C., Nevada, Oregon and Washington. It only covers its service areas within those places, so check your ZIP code.
Can I see non-Kaiser doctors?
Generally only for emergencies, urgent care while traveling, or when Kaiser approves a referral. Kaiser's marketplace plans are HMOs and EPOs built around its own network.
Does Kaiser offer PPO plans?
Not on the marketplace, where its plans are HMOs and EPOs. Some employer plans may offer other options, so ask your employer.
How much is Kaiser insurance per month?
It depends on your age, location, income and plan. MoneyGeek's 2026 average for a 40-year-old Silver HMO was $598 a month before tax credits, and most marketplace buyers pay less after subsidies.
Is Kaiser a nonprofit?
Yes. Kaiser Foundation Health Plan and Kaiser Foundation Hospitals are nonprofit organizations, working with the Permanente Medical Groups.
Why did Kaiser pay $556 million?
In January 2026 Kaiser affiliates settled Justice Department allegations that they added invalid diagnoses to Medicare Advantage patients' records to raise payments from 2009 to 2018. Kaiser did not admit liability.
Does Kaiser sell Medicare Supplement plans?
No. Kaiser sells Medicare Advantage plans but not Medigap. If you want Original Medicare with a supplement, you will need another insurer.
What is Kaiser's BBB rating?
The BBB rates Kaiser Foundation Health Plan, Inc. A+, though it is not accredited. It had 160 complaints in the last three years as of October 2026.
How do I appeal a Kaiser denial?
File a grievance with Kaiser first and keep copies. If you disagree with the result, request an independent medical review from your state regulator, or use Medicare's appeal process if you have a Medicare plan.
Sources (14)
Facts on this page come from company websites, government agencies and regulators, checked on the dates shown. Editorial standards
- Kaiser Permanente: Fast facts (as of June 30, 2026) (accessed October 12, 2026)
- Apple App Store: Kaiser Permanente app (accessed October 12, 2026)
- MoneyGeek: Kaiser Permanente vs. Anthem, 2026 comparison (accessed October 12, 2026)
- NCQA (via Newswire): NCQA unveils 2026 Health Plan Ratings (accessed October 12, 2026)
- NerdWallet: Kaiser Permanente vs. Anthem Medicare Advantage (accessed October 12, 2026)
- U.S. Department of Justice: Kaiser Permanente affiliates pay $556M to resolve False Claims Act allegations (January 14, 2026) (accessed October 12, 2026)
- CBS News: Kaiser Permanente agrees to $200 million settlement over behavioral health care (October 13, 2023) (accessed October 12, 2026)
- BBB: Kaiser Foundation Health Plan, Inc. profile (accessed October 12, 2026)
- Trustpilot: Kaiser Permanente reviews (accessed October 12, 2026)
- Google Play: Kaiser Permanente app (accessed October 12, 2026)
- UNAC/UHCP: Largest open-ended health care strike in U.S. history ends at Kaiser Permanente (accessed October 12, 2026)
- HealthExec: Kaiser Permanente agrees to $46M settlement over data incident affecting 13.4M people (accessed October 12, 2026)
- Healthcare Dive: 2027 Medicare Advantage star ratings winners and losers (October 9, 2026) (accessed October 12, 2026)
- HealthCare.gov: Dates and deadlines for 2027 coverage (accessed October 12, 2026)
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