You are looking at information for: Virginia
| Premiums and benefits |
Kaiser Permanente Medicare Advantage Value VA (HMO-POS) |
Kaiser Permanente Medicare Advantage Standard VA (HMO-POS) |
Kaiser Permanente Medicare Advantage High VA (HMO-POS) |
|---|---|---|---|
|
DESCRIPTION |
YOU PAY |
YOU PAY |
YOU PAY |
|
Monthly premium |
$0 |
$17 |
$139 |
|
Annual deductible |
None |
None |
None |
|
Doctor office visits |
$5 Primary $35 Specialist |
$0 Primary $35 Specialist |
$5 Primary $25 Specialist |
|
Emergency care We cover emergency care anywhere in the world |
$95 per emergency department visit |
$110 per emergency department visit |
$110 per emergency department visit |
|
Urgently needed services
We cover urgent care anywhere in the world |
$35 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 |
$200 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 | $275 | $175 | $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 $196 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, PET |
$140 |
$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 digital fitness and well-being choices |
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 |
$6,500 |
$5,900 |
$5,700 |
|
NEW Comprehensive dental plan*
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. |
$50 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 |
$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 |
$1,200 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
| Kaiser Permanente Medicare Advantage Value VA (HMO-POS) | Kaiser Permanente Medicare Advantage Standard VA (HMO-POS) | KP Medicare Advantage High VA (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. |
$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) $10 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) $10 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 $7,400, 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) |
$0 Preferred Generic (Tier 1) $10 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) 5% Specialty (Tier 5) |
|
Our Mail-Order Pharmacy5 Save time and money with prescriptions mailed right to your home. |
$0 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 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 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.
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:
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
|
$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.
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:
Concerned about affording coverage? We may be able to help.
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.
Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.
Kaiser Permanente is an HMO and HMO-POS 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 March 17, 2023 at 9 a.m. EST
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