Newsroom · San Diego County, California

Kaiser Senior Advantage San Diego 2027: What Is Changing?

Most of this fall's Medicare news in San Diego is about plans that are ending. Kaiser's are not. Both Senior Advantage plans continue for 2027 at a $0 premium, and the county's largest plan carries a number its 76,379 members should read before December 7: the yearly cap on what you can be asked to pay nearly doubles.

Medicare On Main Data Desk

Published October 11, 2026 · 7 min read · Reviewed by Brian Penner

I pulled Kaiser Permanente's San Diego County rows out of the CMS 2026 and 2027 landscape files on October 11 and matched them by contract and plan number. This post reports what those files show, and it is just as careful about what they do not show. Carrier and health-system names are factual reporting, not endorsement or criticism. Nothing here is a recommendation, and we do not offer every plan available in your area.

Kaiser's three San Diego County plans, 2026 and 2027

Sources: CMS CY2026 and CY2027 landscape files, San Diego County rows, matched by Contract Plan ID on October 11, 2026; CMS Monthly Enrollment by Contract/Plan/State/County, September 2026. "Cap" is the file's in-network maximum out-of-pocket; "drug ded." is the Part D deductible. Premiums are the consolidated Part C + D premium; everyone also pays the Part B premium. The Dual Complete plan is for people with both Medicare and Medi-Cal only. Listing a plan is not a recommendation.

Sources: CMS landscape files · CMS September 2026 enrollment · CMS 2027 Star Ratings data tables.

What a higher cap means, and what it does not

The cap, which CMS calls the in-network maximum out-of-pocket, is the ceiling on your copays and coinsurance for covered Part A and Part B services in a calendar year. It is not a bill. A member who sees a doctor a few times and fills a few prescriptions will never come near it at $1,800 or at $3,400. The cap is what a hard year costs: a hospital stay, a surgery, a course of cancer treatment.

So the honest way to read this change is as a change in your worst case. On the standard plan, a hard year could cost up to $1,600 more in 2027 than in 2026. On the Value plan, up to $1,550 more. Whether your ordinary costs change depends on the copays under the cap, and those are not in the CMS file.

Some context from the same file. San Diego County's 2027 shelf has 41 general Medicare Advantage plans with drug coverage, down from 54, with caps running from $295 to $9,850. 19 of the 41 have a cap below $3,400. The Value plan's $4,450 is the same figure carried by four other plans in the county, including the three UnitedHealthcare plans with Sharp in the name. A cap is one line of a plan, and a lower one somewhere else comes with a different network, different copays and a different drug list. It is still worth knowing where yours now sits.

Two things did not move. The premium is $0 on both plans in both years, and the Part D deductible is $0 in both years, in a county where 11 of the 41 plans carry a $700 drug deductible for 2027. The 2027 Star Rating for the contract is 4.5 overall, 4 on the medical side and 5 on the drug side. Every San Diego County plan's 2027 rating is in this post.

What the CMS file cannot show you

Kaiser Permanente posts each plan's 2027 Annual Notice of Changes, Evidence of Coverage and formulary on its 2027 Medicare plan documents page. We have not quoted a copay from those documents, because a copay out of context is how people misjudge a plan. Medicare Plan Compare shows copays and estimated drug costs for every plan in the county.

The Annual Notice of Changes is the document built for exactly this question. It prints this year's cost beside next year's, line by line. If you read one thing this month, read its cost tables for the services you actually use: specialist visits, the hospital, outpatient surgery, your prescriptions by tier.

If your plan is Sharp Direct Advantage and you are looking at Kaiser

Around 19,700 San Diego County members of Sharp Health Plan are choosing new coverage this fall because Sharp Direct Advantage is being discontinued, and a $0 plan with a 4.5-star rating will be on many of their lists. Three facts to hold before you compare:

• Kaiser Senior Advantage is an HMO. In an HMO you generally get your care from doctors and hospitals in the plan's network, except in an emergency or for urgent care away from home (Medicare.gov).
• Sharp's own list does not include it. Sharp HealthCare's accepted-plans page lists Original Medicare, all Medigap plans, TRICARE for Life, Sharp Health Plan and a set of UnitedHealthcare plans. No Kaiser plan appears on it.
• So this is a change of doctors, not only a change of card. For some people that is fine, even welcome. For someone in the middle of treatment with a Sharp specialist it is the whole decision. Look up each doctor in Kaiser's 2027 directory before you enroll, not after.

If keeping your Sharp doctors is the point, the routes that do that are in the doctors post, and the side-by-side of the old Sharp plans against the UnitedHealthcare plans Sharp lists is here. The full county list of what left and what arrived is on the San Diego County reference page.

A plan that changed is not a plan that ended

This is the part most likely to be misunderstood this year, because San Diego is full of news about special rights for people whose plans are ending. Those rights do not belong to a Kaiser member, because a Kaiser member's plan is not ending.

• October 15 – December 7. The Annual Enrollment Period. Any Medicare beneficiary can switch plans or return to Original Medicare, with the change starting January 1 (Medicare.gov). This is your main window.
• January 1 – March 31. The Medicare Advantage Open Enrollment Period. If you are in a Medicare Advantage plan on January 1, you can make one switch to another plan or to Original Medicare. It is a second look, not a second full season.
• The December 8 – February 28 Special Enrollment Period you may have read about is for members of discontinued plans. A higher cap does not open it.
• Medigap with no health questions from November 1 to March 4 is also tied to a plan ending (Medicare.gov). A member leaving a continuing plan for Original Medicare can apply for a Medigap policy, but in most cases the insurer may ask health questions and may decline. Get a decision on the Medigap application before you give up the plan you have.
• California's birthday rule lets someone who already owns a Medigap policy move to one of equal or lesser benefits around their birthday each year (Insurance Code § 10192.11). It does not help someone coming from Medicare Advantage.

None of this is a reason to leave or to stay. It is the map. A plan with a $0 premium, a $0 drug deductible and a 4.5-star rating has a higher ceiling next year than this year, and you have until December 7 to decide whether that matters for you.

What I would do this week

1. Find your Annual Notice of Changes and confirm the plan name and number on it match your card.
2. Read the cost table for the services you used in 2026. The cap matters in a hard year; the copays matter every year.
3. Check your prescriptions against the 2027 formulary, tier by tier.
4. Ask yourself what a hard year would cost now, and whether you could carry $3,400 or $4,450 if it came.
5. If you want to compare, do it before December 7, with your doctors' names in hand, because any other Medicare Advantage plan means a different network.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, the CMS CY2026 and CY2027 landscape files compared by Contract Plan ID on October 11, 2026, the CMS September 2026 county enrollment file, the CMS 2027 Star Ratings data tables published October 8, 2026, Sharp HealthCare's accepted-plans page read the same day, and Medicare.gov's pages on plan notices, HMOs, enrollment periods and Medigap. Copays, formularies and networks are not in any CMS file and are deliberately not described; your Annual Notice of Changes and Kaiser Permanente's plan documents are the authority on those. Medicare On Main is a licensed independent insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program. Mentioning a carrier or a health system is factual reporting, not endorsement or criticism. This is education, not advice; confirm your plan, costs and eligibility with the plan, a licensed agent, HICAP or Medicare.gov.