You are looking at information for: Virginia
Kaiser Permanente Virginia Medicare health plans and rates for 2022
Premiums and Benefits
Kaiser Permanente Medicare Advantage Value VA (HMO)
Kaiser Permanente Medicare Advantage Standard VA (HMO)
KP Medicare Advantage High VA (HMO)
DESCRIPTION
YOU PAY
YOU PAY
YOU PAY
Monthly Premium
$0
$22
$142
Annual Deductible
None
None
None
Doctor Office Visits
$10 Primary
$45 Specialist
$5 Primary
$35 Specialist
$5 Primary
$30 Specialist
Emergency Care
We cover emergency care anywhere in the world
$90 per Emergency Department visit
$90 per Emergency Department visit
$90 per Emergency Department visit
Urgently Needed Services
We cover urgent care anywhere in the world
$45 per office visit
$35 per office visit
$30 per office visit
Preventive Services1
No charge
No charge
No charge
Inpatient Hospitalization
$300 per day for days 1 through 5
No charge for the remainder of your stay
$200 per day for days 1 through 5
No charge for the remainder of your stay
$200 per day for days 1 through 5
No charge for the remainder of your stay
Outpatient Surgery
$275
$175
$125
Skilled Nursing Facility
Up to 100 days per benefit period
$0 per day for days 1 through 20
$188 per day for days 21 through 100
$0 per day for days 1 through 20
$188 per day for days 21 through 100
$0 per day for days 1 through 20
$150 per day for days 21 through 100
Lab, X-Ray
$0 Lab
$20 X-Ray
$0 Lab
$10 X-Ray
$0 Lab
$10 X-Ray
MRI, CT, and PET
$175
$65
$40
Durable Medical Equipment
20%
20%
20%
Ambulance Service
Per one-way trip
$275
$225
$225
Fitness Program Silver&Fit®2
No cost for membership to any of the participating facilities, exercise programs, and home fitness programs.
No cost for membership to any of the participating facilities, exercise programs, and home fitness programs.
No cost for membership to any of the participating facilities, exercise programs, and home fitness programs.
Annual Maximum Out-of-Pocket
$6,500
$6,200
$5,700
Preventive Dental Plan*
- Cleanings — 1 every 6 months
- Oral exams — 1 every 6 months
- Most X-rays — 1 every 6 months
Other covered dental services are provided at a reduced fee. Learn more.
$30 copay per visit
$30 copay per visit
$30 copay per visit
Over-the-counter (OTC) wellness benefit†
Quarterly allowance to order items such as cold remedies, antacids, pain relievers, etc.
$30 quarterly allowance
$50 quarterly allowance
$60 quarterly allowance
NEW for 2022
Hearing Aids3
$500 allowance per ear every 36 months through Kaiser Permanente audiology centers
$500 allowance per ear every 36 months through Kaiser Permanente audiology centers
$500 allowance per ear every 36 months through Kaiser Permanente audiology centers
Medicare Explorer by Kaiser Permanente4
$1,200 annual allowance for out-of-area routing care such as office visits, labs, X-rays, physical therapy, and mental health care
$1,200 annual allowance for out-of-area routing care such as office visits, labs, X-rays, physical therapy, and mental health care
$1,200 annual allowance for out-of-area routing care such as office visits, labs, X-rays, physical therapy, and mental health care
Click or tap to see disclosures and footnotes
1$0 copay for all preventive services covered under Original Medicare at zero cost sharing.
2Not available with Kaiser Permanente Medicare Advantage Value Balt, Kaiser Permanente Medicare Advantage Value MD, or Kaiser Permanente Medicare Advantage Value DC plans. The Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein. All programs and services are not available in all areas. Participating fitness centers and fitness chains may vary by location and are subject to change.
3Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers. To find the nearest Kaiser Permanente audiology center, visit kp.org/hearingcare.
4Not available with Kaiser Permanente Medicare Advantage Value Baltimore (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), and Kaiser Permanente Medicare Advantage Liberty (HMO) plans. Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,200. Coverage limited to inside the United States and its territories. See your Evidence of Coverage for details.
*Dental benefits are underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by Dominion National.
†Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1. Each order must be at least $20. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Your order may not exceed your quarterly benefit limit. Limitations and restrictions may apply. Cash, check, credits cards, or money orders are not accepted.
For more information about benefits, please view the 2022 Summary of Benefits.
These plans include Medicare Part D prescription drug coverage. Copay and coinsurance amounts below are for up to a month’s supply. You can save on most refills of a 3-month supply through our prescription home delivery and have them mailed to your home at no extra charge.
Part D Prescription Drug Coverage
Kaiser Permanente Medicare Advantage Value VA (HMO)
Kaiser Permanente Medicare Advantage Standard VA (HMO)
KP Medicare Advantage High VA (HMO)
DESCRIPTION
YOU PAY
YOU PAY
YOU PAY
Initial Coverage Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. When the total drug costs paid by you and any Part D plan reach $4,130, you move into the Coverage Gap Stage.
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$42 Preferred Brand-name (Tier 3)
$80 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Coverage Gap Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. If your annual out-of-pocket costs reach $6,550, you move into the Catastrophic Coverage Stage.
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Catastrophic Coverage Stage
When your annual out-of-pocket costs exceed $6,550, you pay these amounts for the remainder of the calendar year.
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
5% Specialty (Tier 5)
Our Mail-Order Pharmacy3
Save time and money with prescriptions mailed right to your home.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
Click or tap to see disclosures and footnotes
3For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 3-5 days. If not, please call 1-800-700-1479 (TTY 711), 24 hours a day, 7 days a week.
To find out how much you'll pay for your prescription drugs, you can use Kaiser Permanente's drug pricing tool. drug pricing tool. Sign on to your registered account on kp.org and select “Coverage & Costs” from the menu bar and select “Drug cost” to search for drug information, pharmacy pricing, and lower cost options. If you don’t have an account yet, register for a secure account to use the service.
See which areas† are covered by this plan.
Click or tap to see disclosures and footnotes
3For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 3-5 days. If not, please call 1-800-700-1479 (TTY 711), 24 hours a day, 7 days a week.
To find out how much you'll pay for your prescription drugs, you can use Kaiser Permanente's drug pricing tool. drug pricing tool. Sign on to your registered account on kp.org and select “Coverage & Costs” from the menu bar and select “Drug cost” to search for drug information, pharmacy pricing, and lower cost options. If you don’t have an account yet, register for a secure account to use the service.
See which areas† are covered by this plan.
Add dental, hearing, and eyewear—just $25
Get Advantage Plus for a healthier, more vibrant you
Enhance your health and well–being by combining the affordable benefits of Advantage Plus with your Kaiser Permanente Medicare Advantage (HMO) plan.
Only $25 a month added to your Medicare Advantage premium gets you Advantage Plus coverage. You’ll get these benefits:
- Comprehensive dental
- Hearing
- Eyewear
ADVANTAGE PLUS
(optional supplemental package) premium and benefits
YOU PAY
Monthly premium in addition to monthly Medicare Advantage individual plan premium and monthly Medicare premium(s)
$25
Preventive dental services4
- Cleanings — 1 every 6 months
- Oral exams — 1 every 6 months
- Most X-rays — 1 every 6 months
$10 copay per visit
Comprehensive dental services
- Non-routine services4
- Diagnostic services4
- Restorative services4
- Endodontics4
- Periodontics4
- Extractions4
- Prosthodontics, other oral/maxillofacial surgery, other services4
$0 to $36
$0 to $36
$22 to $531
$28 to $527
$39 to $576
$45 to $227
$35 to $3,658
Hearing aids
$1,000 allowance per ear every 3 years
Eyeglasses and contact lenses
$175 allowance for eyewear every 2 years
Click or tap to see disclosures and footnotes
4Dental benefits provided by Dominion National. To access Advantage Plus dental services, you must select a primary dentist by calling Dominion National at 1-855-733-7524. The Advantage Plus dental plan network differs from the Preventive plan network that is included with your Kaiser Permanente Medicare health plan. To find an in-network dentist, call 1-855-733-7524 or visit DominionNational.com/kaiserdentists.
You must be enrolled in a Kaiser Permanente Medicare Advantage individual plan to be eligible to enroll in Advantage Plus.
Your enrollment window
You can enroll in Advantage Plus at the same time as or within 30 days after you enroll in Medicare Advantage.
Are you a new member?
You're a new member if one of the following applies to you:
- You're enrolling for the first time in a Kaiser Permanente Medicare Advantage plan.
- You're switching to a new Kaiser Permanente Medicare health plan.
- You're moving to a different Kaiser Permanente service area.
New members can add Advantage Plus within 30 days of your enrollment start date. Coverage typically starts the first day of the month following the date we received your completed Advantage Plus enrollment form.†
Are you an existing member?
If you're already a member of a Kaiser Permanente Medicare Advantage plan, you can add Advantage Plus anytime from October 15, 2021 through March 31, 2022. Your Advantage Plus coverage will start:
- On January 1, 2022, if you enroll between October 15 and December 31, 2021.
- The first day of the month following the date we received your completed Advantage Plus enrollment form† if you enroll between January 1 and March 31, 2022.
†You will need the free Adobe Acrobat Reader to read this file. Kaiser Permanente is not responsible for the content or policies of external websites. Details.
Kaiser Permanente Virginia Medicare health plans and rates for 2021
Premiums and Benefits
Kaiser Permanente Medicare Advantage Value VA (HMO)
Monthly Premium
$0
Annual Deductible
None
Doctor Office Visits
$10 Primary
$45 Specialist
Emergency Room
$90
Urgent Care
$45
Preventive Services1
No charge
Inpatient Hospitalization
$275 per day for days 1 through 5
No charge for the remainder of your stay
Outpatient Surgery
$275
Skilled Nursing Facility
Up to 100 days per benefit period
$0 per day for days 1 through 20
$167 per day for days 21 through 100
Lab, X-Ray
$0 Lab
$20 X-Ray
MRI, CT, and PET
$175
Durable Medical Equipment
20%
Ambulance Service
Per one-way trip
$275
Fitness Program Silver&Fit®2
Not provided
Annual Maximum Out-of-Pocket
$6,900
Preventive Dental Plan*
$30 copay per visit
NEW FOR 2021
Over-the-counter (OTC) wellness credit†
$30 quarterly allowance
Part D Prescription Drug Coverage
Kaiser Permanente Medicare Advantage VALUE VA (HMO)
DESCRIPTION
YOU PAY
Initial Coverage Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. When the total drug costs paid by you and any Part D plan reach $4,130, you move into the Coverage Gap Stage.
$3 Preferred Generic (Tier 1)
$15 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$15 Generic (Tier 2)
$42 Preferred Brand-name (Tier 3)
$80 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Coverage Gap Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. If your annual out-of-pocket costs reach $6,550, you move into the Catastrophic Coverage Stage.
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Catastrophic Coverage Stage
When your annual out-of-pocket costs exceed $6,550, you pay these amounts for the remainder of the calendar year.
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Our Mail-Order Pharmacy3
Save time and money with prescriptions mailed right to your home.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
Kaiser Permanente Medicare Advantage Standard VA (HMO)
Monthly Premium
$22
Annual Deductible
None
Doctor Office Visits
$5 Primary
$35 Specialist
Emergency Room
$90
Urgent Care
$35
Preventive Services1
No charge
Inpatient Hospitalization
$200 per day for days 1 through 5
No charge for the remainder of your stay
Outpatient Surgery
$125
Skilled Nursing Facility
Up to 100 days per benefit period
$0 per day for days 1 through 20
$160 per day for days 21 through 100
Lab, X-Ray
$0 Lab,
$10 X-Ray
MRI, CT, and PET
$65
Durable Medical Equipment
20%
Ambulance Service
Per one-way trip
$200
Fitness Program Silver&Fit®2
No cost for membership to any of the participating facilities, exercise programs, and home fitness programs.
Annual Maximum Out-of-Pocket
$6,900
Preventive Dental Plan*
$30 copay per visit
NEW FOR 2021
Over-the-counter (OTC) wellness credit†
$50 quarterly allowance
Part D Prescription Drug Coverage
Kaiser Permanente Medicare Advantage Standard VA (HMO)
DESCRIPTION
YOU PAY
Initial Coverage Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. When the total drug costs paid by you and any Part D plan reach $4,130, you move into the Coverage Gap Stage.
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$12 Generic (Tier 2)
$45 Preferred Brand-name (Tier 3)
$100 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
$3 Preferred Generic (Tier 1)
$15 Generic (Tier 2)
$42 Preferred Brand-name (Tier 3)
$80 Nonpreferred Brand-name (Tier 4)
33% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Coverage Gap Stage
For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. If your annual out-of-pocket costs reach $6,550, you move into the Catastrophic Coverage Stage.
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
25% Preferred Generic (Tier 1)
25% Generic (Tier 2)
25% Preferred Brand-name (Tier 3)
25% Nonpreferred Brand-name (Tier 4)
25% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Catastrophic Coverage Stage
When your annual out-of-pocket costs exceed $6,550, you pay these amounts for the remainder of the calendar year.
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
5% Preferred Generic (Tier 1)
5% Generic (Tier 2)
5% Preferred Brand-name (Tier 3)
5% Nonpreferred Brand-name (Tier 4)
5% Specialty (Tier 5)
$0 Injectable Part D Vaccines (Tier 6)
Our Mail-Order Pharmacy3
Save time and money with prescriptions mailed right to your home.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
$0 for preferred generics (Tier 1) for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.
Kaiser Permanente Medicare Advantage High VA (HMO)
Monthly Premium
$142
Annual Deductible
None
Doctor Office Visits
$5 Primary
$30 Specialist
Emergency Room
$90
Urgent Care
$30
Preventive Services1
No charge
Inpatient Hospitalization
$200 per day for days 1 through 5
No charge for the remainder of your stay
Outpatient Surgery
$100
Skilled Nursing Facility
Up to 100 days per benefit period
$0 per day for days 1 through 20
$110 per day for days 21 through 100
Lab, X-Ray
$0 Lab,
$10 X-Ray
MRI, CT, and PET
$40
Durable Medical Equipment
20%
Ambulance Service
Per one-way trip
200
Fitness Program Silver&Fit®2
No cost for membership to any of the participating facilities, exercise programs, and home fitness programs.
Annual Maximum Out-of-Pocket
$5,700
Preventive Dental Plan*
$30 copay per visit
NEW FOR 2021
Over-the-counter (OTC) wellness credit†
$60 quarterly allowance
Click or tap to see disclosures and footnotes
1$0 copay for all preventive services covered under Original Medicare at zero cost sharing.
2Silver&Fit® is a federally registered trademark of American Specialty Health, Inc.
*Dental benefits are underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by Dominion National.
†Please refer to your Evidence of Coverage for details regarding the OTC benefit. OTC benefits may change each year on January 1. Each purchase must be at least $20. Any unused portion of the quarterly credit will not carry forward to the next quarter. Your order may not exceed your maximum benefit allowance.
Limitations and restrictions may apply. Cash, Checks, credit cards, or money orders are not accepted.
For more information about benefits, please view the 2021 Summary of Benefits.
These plans include Medicare Part D prescription drug coverage. Copay and coinsurance amounts below are for up to a month’s supply. You can save on most refills of a 3-month supply through our prescription home delivery and have them mailed to your home at no extra charge.
3For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 3-5 days. If not, please call 1-800-700-1479 (TTY 711), 24 hours a day, 7 days a week.
To find out how much you'll pay for your prescription drugs, you can use Kaiser Permanente's drug pricing tool. drug pricing tool. Sign on to your registered account on kp.org and select “Coverage & Costs” from the menu bar and select “Drug cost” to search for drug information, pharmacy pricing, and lower cost options. If you don’t have an account yet, register for a secure account to use the service.
See which areas† are covered by this plan.
Add dental, hearing, and eyewear—just $25
Get Advantage Plus for a healthier, more vibrant you
Enhance your health and well–being by combining the affordable benefits of Advantage Plus with your Kaiser Permanente Medicare Advantage (HMO) plan.
Only $25 a month added to your Medicare Advantage premium gets you Advantage Plus coverage. You’ll get these benefits:
- Comprehensive dental
- Hearing
- Eyewear
ADVANTAGE PLUS
(optional supplemental package) premium and benefits
YOU PAY
Monthly premium in addition to monthly Medicare Advantage individual plan premium and monthly Medicare premium(s)
$25
Preventive dental services4
- Cleanings — 1 every 6 months
- Oral exams — 1 every 6 months
- Most X-rays — 1 every 6 months
$10 copay per visit
Comprehensive dental services
- Non-routine services4
- Diagnostic services4
- Restorative services4
- Endodontics4
- Periodontics4
- Extractions4
- Prosthodontics, other oral/maxillofacial surgery, other services4
$0 to $36
$0 to $36
$22 to $531
$28 to $527
$39 to $576
$45 to $227
$35 to $3,658
Hearing aids
$1,000 allowance per ear every 3 years
Eyeglasses and contact lenses
$175 allowance for eyewear every 2 years
Click or tap to see disclosures and footnotes
4Dental benefits provided by Dominion National. To access Advantage Plus dental services, you must select a primary dentist by calling Dominion National at 1-855-733-7524. The Advantage Plus dental plan network differs from the Preventive plan network that is included with your Kaiser Permanente Medicare health plan. To find an in-network dentist, call 1-855-733-7524 or visit DominionNational.com/kaiserdentists.
You must be enrolled in a Kaiser Permanente Medicare Advantage individual plan to be eligible to enroll in Advantage Plus.
Your enrollment window
You can enroll in Advantage Plus at the same time as or within 30 days after you enroll in Medicare Advantage.
Are you a new member?
You're a new member if one of the following applies to you:
- You're enrolling for the first time in a Kaiser Permanente Medicare Advantage plan.
- You're switching to a new Kaiser Permanente Medicare health plan.
- You're moving to a different Kaiser Permanente service area.
New members can add Advantage Plus within 30 days of your enrollment start date. Coverage typically starts the first day of the month following the date we received your completed Advantage Plus enrollment form.†
Are you an existing member?
If you're already a member of a Kaiser Permanente Medicare Advantage plan, you can add Advantage Plus anytime from October 15, 2020 through March 31, 2021. Your Advantage Plus coverage will start:
- On January 1, 2021, if you enroll between October 15 and December 31, 2020.
- The first day of the month following the date we received your completed Advantage Plus enrollment form† if you enroll between January 1 and March 31, 2021.
We’re here to help
If you have questions, call one of our Kaiser Permanente Medicare specialists at 1-888-777-5536 (toll free) or TTY 711 for the hearing/speech impaired, 8 a.m. to 8 p.m., 7 days a week.
†You will need the free Adobe Acrobat Reader to read this file. Kaiser Permanente is not responsible for the content or policies of external websites. Details.
Ready to get started?
Call us at 1-877-218-9489 (TTY 711) or schedule a Personal Appointment, and we’ll walk you through your options. Our friendly representatives are available, 7 days a week, 8 a.m. to 8 p.m. Hablamos español.
Enroll now
Ready to enroll?
Call to enroll
Call 1-877-218-9489 (TTY 711) to speak with a Kaiser Permanente Medicare Advisor, 7AM-7PM M-F They will walk you through your options and get you signed up right over the phone.
Attend a seminar
Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.
Enroll online
Enrolling in our Medicare Advantage Plans online is simple. Click or tap to be taken to our enrollment site, answer a few questions, and you're done.
Ready to enroll?
Set up a personal appointment
Connect with a licensed Kaiser Permanente Medicare Specialist in your area, on your schedule. Simply complete the form (click or tap to open) and we'll contact you to set up an appointment.
Connect now
Attend a seminar
Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.
Call to enroll
Call 1-877-218-9489 (TTY 711) to speak with a Kaiser Permanente Medicare Specialist 7 days a week, 8AM-8PM. They will walk you through your options and get you signed up right over the phone.
Enroll online
Enrolling in our Medicare Advantage Plans online is simple. Click or tap to be taken to our enrollment site, answer a few questions, and you're done.
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St., Rockville, MD 20852
Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.
For accommodations of persons with special needs at meetings, call 1-877-218-9489 (TTY 711).
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Page last updated on February 4, 2022 at 12 a.m. EST