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Kaiser Permanente Maryland Medicare health plans and rates for 2023

Premiums and benefits

Premiums and benefits

Kaiser Permanente Medicare Advantage Value Balt (HMO) and Kaiser Permanente Medicare Advantage Value MD (HMO) plans

Kaiser Permanente Medicare Advantage Standard MD (HMO-POS)

Kaiser Permanente Medicare Advantage High MD (HMO-POS)

DESCRIPTION

YOU PAY

YOU PAY

YOU PAY

Monthly premium

$0

$23

$141

Annual deductible

None

None

None

Doctor office visits

$10 Primary

$40 Specialist

$10 Primary

$35 Specialist

$5 Primary

$25 Specialist

Emergency care

We cover emergency care anywhere in the world

$95 per emergency department visit

$95 per emergency department visit

$110 per emergency department visit

Urgently needed services

We cover urgent care anywhere in the world

$40 per office visit

$35 per office visit

$25 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

$270 per day for days 1 through 5

No charge for the remainder of your stay

$190 per day for days 1 through 5

No charge for the remainder of your stay

Outpatient surgery

$300

$250

$125

Skilled nursing facility

Up to 100 days per benefit period

$0 per day for days 1 through 20

$196 per day for days 21 through 100

$0 per day for days 1 through 20

$180 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

$15 X-ray

$0 Lab

$10 X-ray

MRI, CT, PET

$190

$100

$40

Durable medical equipment

20%

20%

20%

Ambulance service

Per one-way trip

$275

$275

$225

Fitness program Silver&Fit®2

Not provided

No cost for membership to any of the participating facilities, exercise programs, digital fitness and well-being choices

No cost for membership to any of the participating facilities, exercise programs, digital fitness and well-being choices

Annual maximum out-of-pocket

$7,200

$6,900

$5,700

NEW Comprehensive dental plan*

  • Oral exams, up to two per year
  • Cleanings, up to two per year
  • Bitewing X-rays, one set per year
  • Topical fluoride, one per year
  • Full mouth series X-rays, one every
    three years

The comprehensive dental plan also include a $1,000 annual allowance with a 50% coinsurance for more extensive care, such as fillings, crowns, dentures, root canals, and more.

$0 copay per visit

$0 copay per visit

$0 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

Hearing aids3

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

Medicare Explorer by Kaiser Permanente4

Not available

$1,200 annual allowance for out-of-area routine care, such as office visits, labs, X-rays, physical therapy, and mental health care

$1,200 annual allowance for out-of-area routine care, such as office visits, labs, X-rays, physical therapy, and mental health care

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 Care Plus (HMO-POS), 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 2023 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.5

Part D prescription drug coverage

Kaiser Permanente Medicare Advantage Value Balt (HMO) and Kaiser Permanente Medicare Advantage Value MD (HMO) plans Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) Kaiser Permanente Medicare Advantage High MD (HMO-POS)
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 $4,660, you move into the Coverage Gap Stage.

$5​ 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)

$0​ 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)

$0​ 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. When the total drug costs paid by you and any Part D plan reach $7,400, you move into the Coverage Gap 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)

$0 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 $7,400, 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 Pharmacy5

Save time and money with prescriptions mailed right to your home.

$0​ for generic drugs in Tier 1 and Tier 2 for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.

$0​ for generic drugs in Tier 1 and Tier 2 for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.

$0 for generic drugs in Tier 1 and Tier 2 for a 31-90 day supply. Drugs in other tiers are 2 copays for up to a 90-day supply.

5 For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente Mail Order Pharmacy. You should receive them within 3 to 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. 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.

Add dental, hearing, and eyewear—just $20

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 $20 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)

$20

Comprehensive dental services6

  • Endodontics
  • Extractions
  • Non-routine services
  • Periodontics
  • Prosthodontics, including dentures
  • Restorative services, including fillings and crowns

$500 annual allowance towards comprehensive dental services with a 50% coinsurance for a total of $1,500 when added together with the preventive dental benefit included in your Kaiser Permanente Medicare Advantage plan

Hearing aids

$1,000​ allowance per ear every 3 years for a total of $2,000 when added together with the hearing aid benefit included in your Kaiser Permanente Medicare Advantage plan

Eyeglasses and contact lenses

$175​ allowance per eyewear every 2 years which can be combined with the eyewear allowance included in your Kaiser Permanente Medicare Advantage plan. To see your vision allowance, please refer to your Evidence of Coverage.

6Dental benefits provided by Dominion National. 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, 2022, through March 31, 2023. Your Advantage Plus coverage will start:

  • On January 1, 2023, if you enroll between October 15 and December 31, 2022.
  • 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, 2023.
†​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.

Concerned about affording coverage? We may be able to help.

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.

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, 8 a.m. – 8 p.m. 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.
You are leaving this website and going to the Kaiser Permanente Medicare health plan enrollment site.

After clicking “Let’s go” below, please enter your ZIP code, then click the “Search for plans” button, and then click on the plan you want to enroll in.