Switch to the region’s leading health system1 for flexible coverage with highly skilled doctors and 24/7 access. You’ll experience convenient access to care with both in-person visits and a variety of telehealth options like video visits,2 24/7 phone advice, and Mail Order Pharmacy3 that keeps you on top of your care from anywhere.
You’ll also have an annual $1,500 allowance4 to see a licensed physician of your choosing outside of our network.
For the best experience, see any provider that accepts Medicare. To find a provider that accepts Medicare, visit medicare.gov. The Care Plus allowance can only be used inside the United States and its territories.
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$30 |
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Annual deductible |
None |
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Doctor office visits |
$5 Primary $40 Specialist |
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Emergency care We cover emergency care anywhere in the world. |
$100 per emergency department visit |
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Urgently needed services We cover urgent care anywhere in the world. |
$40 per office visit |
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Preventive services12 |
No charge |
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Inpatient hospitalization |
$250 per day for days 1 through 5 No charge for the remainder of your stay |
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Outpatient surgery |
$225 |
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Skilled nursing facility Up to 100 days per benefit period |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 |
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Lab, X-ray |
$0 Lab $15 X-ray |
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MRI, CT, and PET |
$100 |
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Durable Medical Equipment |
20% |
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Ambulance service Per one-way trip |
$225 |
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Transportation |
$0 for 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only. |
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Fitness program Silver&Fit®11 |
No cost for membership to any of the participating facilities, exercise programs, and digital fitness and well-being choices. |
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Over-the-counter (OTC) wellness credit8 Quarterly allowance to purchase items such as cold remedies, antacids, pain relievers, etc. |
$50 quarterly allowance |
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Annual maximum out-of-pocket |
$6,500 |
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Comprehensive dental plan13
The comprehensive dental plan also includes a $1,000 annual allowance7 for more extensive care, such as fillings, crowns, dentures, root canals, and more. |
$0 copay per visit |
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Hearing aids9 |
$1,000 allowance per ear every 36 months to use at Kaiser Permanente audiology centers |
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Kaiser Permanente Medicare Advantage Care Plus (HMO-POS) |
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|---|---|
DESCRIPTION |
YOU PAY |
Initial Coverage StageFor 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 $5,030, you move into the Coverage Gap Stage. |
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Coverage Gap StageFor up to a 30-day supply from an in-network pharmacy with preferred cost sharing. If your annual out-of-pocket costs reach $8,000, you move into the Catastrophic Coverage Stage. |
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Catastropic Coverage Stage |
If you or others on your behalf spend $8,000 on your Part D prescription drugs in 2024, you'll enter the catastrophic coverage stage. Most people never reach this stage, but if you do, you pay nothing for covered Part D drugs in 2024.
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Our Mail-Order Pharmacy*Save time and money with prescriptions mailed right to your home. |
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For each insulin product covered by our plan, you will not pay more than $35 for a 30-day supply, $70 for a 31- to 60-day supply, and $105 for a 61- to 90-day supply, regardless of the tier.
*For 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. 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.
For each insulin product covered by our plan, you will not pay more than $35 for a 30-day supply, $70 for a 31 to 60-day supply, $84 for a 61- to 90-day supply of Tier 3 drugs for High plan members, $90 for a 61- to 90-day supply of Tier 3 drugs for Standard or Value plan members, and $105 for a 61- to 90-day supply of Tiers 4-5 drugs, regardless of the tier.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
1 In the survey Best Health Insurance Companies of 2023 by Insure.com, Kaiser Permanente as a national enterprise is rated #1 overall among 60+ insurance carriers. In the NCQA Medicare Health Plan Ratings 2023, our Medicare plan is rated 4.5 out of 5, the highest rating in the region. The 2022 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest multispecialty medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Arlington Magazine (2023), Bethesda magazine (2023), Northern Virginia Magazine (2023), Washingtonian magazine (2022), and Baltimore magazine (2022). According to NCQA’s Quality Compass® 2023, we’re rated 5 out of 5 in 30 measures, including: controlling high blood pressure (heart disease), blood pressure control (140/90) and glucose control (diabetes), breast cancer screening, and colorectal cancer screening, Quality Compass is a registered trademark of the NCQA.
2 If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from providing care across state lines. Laws differ by state.
3 For 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.
4 Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,500. Coverage limited to inside the United States and its territories. This benefit covers limited services. See your Evidence of Coverage for details.
5 Best Health Insurance Companies of 2023 by Insure.com, January 23, 2023. The rankings are based on the National Committee for Quality Assurance’s annual health plan ratings as well as member surveys.
6 The physicians who practice at Kaiser Permanente are recognized as Top Doctors in Northern Virginia Magazine (2023), Washingtonian magazine (2022), and Baltimore magazine (2022).
7 With a 50% coinsurance. $500 annual allowance with Kaiser Permanente Medicare Advantage High (HMO-POS) and Liberty (HMO) plans.
8 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.
9 Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers.
10 Twenty-four one-way rides per contract year. For nonemergency transportation only.
11 Not available with Kaiser Permanente Medicare Advantage Value Balt (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), or Kaiser Permanente Medicare Advantage Value DC (HMO-POS) 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.
12 $0 copay for all preventive services covered under Original Medicare at zero cost sharing.
13 Dental benefits are underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by LIBERTY Dental Plan. To find an in-network dentist, call 1-888-650-1859 or visit LibertyDentalPlan.com/kaiserdentists.
For more information about benefits, please view the 2024 Summary of Benefits.
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 1-866-975-7803 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.
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Page last updated on May 18, 2024 at 12 a.m. EST
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If you’re turning 65, moving, or losing your benefits at work, you may be eligible to enroll today. Call 1-866-975-7803 (TTY 711) 7 days a week, 8 a.m. to 8 p.m. with questions or to speak with a Kaiser Permanente Medicare specialist.
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