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Kaiser Permanente DC Medicare health plans and rates for 2024

Premiums and benefits

Premiums and benefits

Kaiser Permanente Medicare Advantage Value DC (HMO-POS)

Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)

Kaiser Permanente Medicare Advantage High DC (HMO-POS)

DESCRIPTION

YOU PAY

YOU PAY

YOU PAY

Monthly premium

$0

$30

$125

Annual deductible

None

None

None

Doctor office visits

$5 Primary

$40 Specialist

$5 Primary

$40 Specialist

$5 Primary

$30 Specialist

Emergency care

We cover emergency care anywhere in the world

$100 per emergency department visit

$100 per emergency department visit

$120 per emergency department visit

Urgently needed services

We cover urgent care anywhere in the world

$40 per office visit

$40 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

$295 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

$203 per day for days 21 through 100

$0 per day for days 1 through 20

$203 per day for days 21 through 100

$0 per day for days 1 through 20

$160 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

$170

$100

$40

Durable medical equipment

20%

20%

20%

Ambulance service

Per one-way trip

$275

$275

$225

Transportation
We cover up to 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only.

Not covered

$0 $0

Fitness program Silver&Fit®2

Not provided

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, and digital fitness and well-being choices

Annual maximum out-of-pocket

$6,900

$6,900

$5,700

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

$0 copay per visit
$1,000 comprehensive dental annual allowance* with 50% coinsurance for more extensive care such as fillings, crowns, dentures, root canals, and more.

$0 copay per visit
$1,000 comprehensive dental annual allowance* with 50% coinsurance for more extensive care such as fillings, crowns, dentures, root canals, and more.

$0 copay per visit
$500 comprehensive dental annual allowance* with 50% coinsurance for more extensive care such as fillings, crowns, dentures, root canals, and more.

Over the counter (OTC) wellness benefit

Quarterly allowance to order items such as cold remedies, antacids, pain relievers, etc.

$50​ quarterly allowance

$60​ 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 (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.

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.

*With a 50% coinsurance. $500 annual allowance with Kaiser Permanente Medicare Advantage High (HMO-POS) and Liberty (HMO) plans. Dental benefits underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by LIBERTY Dental Plan.

†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 2024 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. 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.

Part D Prescription Drug Coverage

Kaiser Permanente Medicare Advantage Value DC (HMO-POS) Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) Kaiser Permanente Medicare Advantage High DC (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 $5,030, 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)

$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. If your annual out-of-pocket costs reach $8,000, 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)

$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

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.

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.

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.

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 coverage — get extra benefits for an affordable monthly premium with Advantage Plus

Enhance your health and well-being by combining the affordable benefits of Advantage Plus with your Kaiser Permanente Medicare Advantage (HMO) plan. Choose Option 1, Option 2, or both options for maximum coverage. 

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 1-866-975-7803​ (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.

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.