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Kaiser Permanente Medicare Advantage High MD (HMO-POS)

Health Insurance Company: Kaiser Permanente

Medicare Advantage Plan Details

Kaiser Permanente
$104 /mo
monthly premium
Kaiser Permanente Medicare Advantage High MD (HMO-POS)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
4.5
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$5700
Rx Drug Coverage
Yes
Rx Deductible
$0
Primary Doctor Office Visit
$10 copay per visit
Specialist Office Visit
$35 copay per visit

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
Yes
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
Yes

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $10 copay per visit
Out-of-network: $0-25 copay per visit
Specialist Office Visit
In-network: $35 copay per visit
Out-of-network: $0-50 copay per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0-25 copay

Emergency Room

$125 copay per visit (always covered)

Ambulance Coverage

In-network: $225 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0 copay
Out-of-network: $0-25 copay
Medicare-covered lab services: In-network: $0 copay
Out-of-network: $0-25 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $10-100 copay
Out-of-network: $0-25 copay
Medicare-covered x-ray services: In-network: $10 copay
Out-of-network: $0-25 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-125 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $270 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable
Inpatient hospital psychiatric:
In-network: $270 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: Not Applicable

Rehabilitation Coverage

Occupational therapy services:
In-network: $35 copay
Out-of-network: $0-50 copay
Physical therapy and speech and language therapy services:
In-network: $35 copay
Out-of-network: $0-50 copay

Urgent Care Coverage

$35 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $0 per day for days 1 through 20
$160 per day for days 21 through 100
Out-of-network: Not Applicable

Mental Health Coverage

Medicare-covered individual sessions: In-network: $10 copay
Out-of-network: $15-25 copay
Medicare-covered group sessions: In-network: $5 copay
Out-of-network: $15-25 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0-$35 copay
Out-of-network: $0-$35 copay
Prophylaxis (cleaning):
In-network: $0-$35 copay
Out-of-network: $0-$35 copay
Dental x-rays:
In-network: $0-$35 copay
Out-of-network: $0-$35 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $10-35 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Eyeglasses: In-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $35 copay
Out-of-network: $0-50 copay
Hearing aids:
Hearing aids (all types): In-network: $0 copay

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$12.00 copay (30-day supply)
$36.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$126.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)
33% coinsurance (90-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)
33% coinsurance (90-day supply)

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$12.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$84.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$200.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)
33% coinsurance (90-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
No
Massage Therapy
No
Health Education
Yes
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
No

Plan Links

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Where This Plan is Available

State:
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Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Kaiser Permanente

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint