Kaiser Hmo Copay



Kaiser Permanente: TRADITIONAL PLAN. Coverage Period:. Summary of Benefits and Coverage: What this plan covers and what it costs. Coverage for: Individual+Family. This is only a summary. Your Kaiser Permanente Deductible HMO Plan is not just health coverage — it's a partnership in health. You receive preventive care services at little or no cost to you, and online features let you manage most of your care around the clock. Your benefits include: a personal doctor for routine medical care.

  1. Kaiser Copay Waiver
  2. Kaiser Permanente Copay
  3. Kaiser Platinum 90 Hmo Copay
  4. Kaiser Hmo Copay

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Kaiser Permanente Medicare Advantage Value MD (HMO) H2172-011 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Kaiser Permanente available to residents in Maryland. This plan includes additional Medicare prescription drug (Part-D) coverage. The Kaiser Permanente Medicare Advantage Value MD (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,200 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,200 out of pocket. This can be a extremely nice safety net.

Kaiser Permanente Medicare Advantage Value MD (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Kaiser Permanente works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Kaiser Permanente Medicare Advantage Value MD (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Kaiser Permanente and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Kaiser Permanente except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



Ready to Enroll?


Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST



2021 Kaiser Permanente Medicare Advantage Plan Costs

Name:
Kaiser Permanente Medicare Advantage Value MD (HMO)
Plan ID:
Provider:Kaiser Permanente
Year:2021
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $7,200
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H2172-012

Kaiser Permanente Medicare Advantage Value MD (HMO) Part-C Premium

Kaiser Permanente plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H2172-011 Part-D Deductible and Premium

Kaiser Permanente Medicare Advantage Value MD (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Kaiser Permanente plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Kaiser Permanente above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.


Kaiser Permanente Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Kaiser Permanente plan does offer additional coverage through the gap.


H2172-011 Formulary or Drug Coverage

Kaiser Permanente Medicare Advantage Value MD (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



2021 Kaiser Permanente Medicare Advantage Value MD (HMO) Summary of Benefits



Additional Benefits


Copay
No


Comprehensive Dental


Diagnostic services$11-69 copay
Endodontics$47-1,047 copay
Extractions$72-429 copay
Non-routine services$0-55 copay
Periodontics$76-836 copay
Prosthodontics, other oral/maxillofacial surgery, other services$30-3,658 copay
Restorative services$40-755 copay


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$175 copay
Diagnostic tests and procedures$0 copay
Lab services$0 copay
Outpatient x-rays$20 copay


Doctor Visits


Primary$10 copay per visit
Specialist$50 copay per visit


Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$50 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$50 copay
Routine foot careNot covered


Ground Ambulance


$275 copay


Hearing


Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Hearing exam$50 copay


Inpatient Hospital Coverage


$300 per day for days 1 through 5
$0 per day for days 6 through 90


Medical Equipment/Supplies


Diabetes supplies$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item


Medicare Part B Drugs


Chemotherapy$0-47 copay
Other Part B drugs$0-47 copay


Mental Health Services


Inpatient hospital - psychiatric$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit$10 copay
Outpatient group therapy visit with a psychiatrist$10 copay
Outpatient individual therapy visit$20 copay
Outpatient individual therapy visit with a psychiatrist$20 copay


MOOP


$7,200 In-network


Option


No


Optional supplemental benefits


Yes


Outpatient Hospital Coverage


$0-300 copay per visit


Package #1


Deductible
Monthly Premium$25.00


Preventive Care


$0 copay


Preventive Dental


CleaningCovered under office visit
Dental x-ray(s)Covered under office visit
Fluoride treatmentCovered under office visit
Office visit$30.00
Oral examCovered under office visit


Kaiser Copay Waiver

Rehabilitation Services


Occupational therapy visit$40 copay
Physical therapy and speech and language therapy visit$40 copay


Skilled Nursing Facility


$0 per day for days 1 through 20
$167 per day for days 21 through 100


Transportation


$0 copay


Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)$0 copay
OtherNot covered
Routine eye exam$10-50 copay
UpgradesNot covered


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Kaiser Permanente Medicare Advantage Value MD (HMO) H2172


2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Kaiser Permanente Medicare Advantage Value MD (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Kaiser Permanente Medicare Advantage Value MD (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Kaiser Permanente Medicare Advantage Value MD (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Ready to Enroll?


Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST



Coverage Area for Kaiser Permanente Medicare Advantage Value MD (HMO)

(Click county to compare all available Advantage plans)

State: Maryland
County:Anne Arundel,Calvert,Carroll,Charles,Frederick,
Harford,Howard,Montgomery,Prince Georges,

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.


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Kaiser Permanente Senior Advantage Inland Empire (HMO) H0524-015 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Kaiser Permanente available to residents in California. This plan includes additional Medicare prescription drug (Part-D) coverage. The Kaiser Permanente Senior Advantage Inland Empire (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.

Kaiser Permanente Senior Advantage Inland Empire (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Kaiser Permanente works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Kaiser Permanente Senior Advantage Inland Empire (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Kaiser Permanente and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Kaiser Permanente except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



Ready to Enroll?


Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST



2021 Kaiser Permanente Medicare Advantage Plan Costs

Name:
Kaiser Permanente Senior Advantage Inland Empire (HMO)
Plan ID:
Provider:Kaiser Permanente
Year:2021
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $3,400
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H0524-031

Kaiser Permanente Senior Advantage Inland Empire (HMO) Part-C Premium

Kaiser Permanente plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H0524-015 Part-D Deductible and Premium

Kaiser Permanente Senior Advantage Inland Empire (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Kaiser Permanente plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Kaiser Permanente above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.


Kaiser Permanente Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Kaiser Permanente plan does offer additional coverage through the gap.


H0524-015 Formulary or Drug Coverage

Kaiser Permanente Senior Advantage Inland Empire (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



2021 Kaiser Permanente Senior Advantage Inland Empire (HMO) Summary of Benefits



Additional Benefits


No


Comprehensive Dental


Diagnostic servicesNot covered
EndodonticsNot covered
ExtractionsNot covered
Non-routine servicesNot covered
PeriodonticsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Restorative servicesNot covered


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$15-150 copay
Diagnostic tests and procedures$0 copay
Lab services$0 copay
Outpatient x-rays$15 copay


Doctor Visits


Primary$5 copay per visit
Specialist$10 copay per visit


Emergency care/Urgent Care


Emergency$120 copay per visit (always covered)
Urgent care$5 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$10 copay
Routine foot careNot covered


Ground Ambulance


$200 copay


Hearing


Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Hearing exam$10 copay


Inpatient Hospital Coverage


$100 per day for days 1 through 7
$0 per day for days 8 through 90


Medical Equipment/Supplies


Diabetes supplies$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item


Medicare Part B Drugs


Chemotherapy$0-47 copay
Other Part B drugs$0-47 copay


Mental Health Services


Inpatient hospital - psychiatric$100 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient group therapy visit$2 copay
Outpatient group therapy visit with a psychiatrist$2 copay
Outpatient individual therapy visit$5 copay
Outpatient individual therapy visit with a psychiatrist$5 copay


MOOP


$3,400 In-network


Option


Kaiser Permanente Copay

No

Kaiser Platinum 90 Hmo Copay



Optional supplemental benefits


Yes


Outpatient Hospital Coverage


$0-50 copay per visit


Package #1


Deductible
Monthly Premium$16.00


Preventive Care


$0 copay


Preventive Dental


CleaningNot covered
Dental x-ray(s)Not covered
Fluoride treatmentNot covered
Oral examNot covered


Rehabilitation Services


Occupational therapy visit$20 copay
Physical therapy and speech and language therapy visit$0-20 copay


Skilled Nursing Facility


$0 per day for days 1 through 20
$75 per day for days 21 through 100


Transportation


Not covered


Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)$0 copay
OtherNot covered
Routine eye exam$5 copay
UpgradesNot covered


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Kaiser Permanente Senior Advantage Inland Empire (HMO) H0524


2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Copay

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Kaiser Permanente Senior Advantage Inland Empire (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Kaiser Permanente Senior Advantage Inland Empire (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Kaiser Permanente Senior Advantage Inland Empire (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Ready to Enroll?


Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST



Coverage Area for Kaiser Permanente Senior Advantage Inland Empire (HMO)

(Click county to compare all available Advantage plans)


Go to top

Kaiser Hmo Copay


Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.