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Kaiser Permanente Dual Essential (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Essential (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Dual Essential (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Essential (HMO D-SNP) is a HMO D-SNP plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Denver Metro Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Dual Essential (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Kaiser Permanente Dual Essential (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Dual Essential (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Kaiser Permanente Dual Essential (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $530.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Kaiser Permanente Dual Essential (HMO D-SNP) plan has a $530 deductible for prescription drugs. After the deductible is met, you will pay coinsurance for your prescriptions. In the initial coverage phase, your coinsurance depends on the drug tier and pharmacy. For example, you will pay 23% coinsurance for preferred generic drugs at a standard pharmacy. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Dual Essential (HMO D-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $225 copay for the first six days, and then no copay for the remainder of your stay. Outpatient services, primary care, vision, and dental services generally have no copay, or a very low copay. The plan also includes coverage for ambulance services, with a 20% coinsurance, and emergency services with a $125 copay. Hearing aids are covered up to $3,000 every two years. The plan also covers a wide range of other services, including home health, home infusion, and medical equipment with varying cost-sharing amounts.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor referral. For the first 6 days, there is a $225 copay, and days 7-90 have no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $200 copay, observation services with no copay, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with no copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Dual Essential (HMO D-SNP) plan, with a $45 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services are covered with a $125 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy, Physical Therapy, Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay, while Chiropractic Services have a $20 copay, Physician Specialist Services have a $5 copay, and a $5 copay for Opioid Treatment Program Services. Mental Health and Psychiatric Services have no copay for individual and group sessions, and Podiatry Services have a $5 copay for Medicare-covered services and Routine Foot Care.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, an annual physical exam with no copay, and additional preventive services. Additional preventive services include Health Education, Fitness Benefit, Remote Access Technologies, and In-Home Support Services. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services are covered with a copay between $0 and $5. Other Preventive Services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with no copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered with a maximum of $3,000 every two years for Prescription Hearing Aids (all types), though Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with routine eye exams and eyewear covered with no copay. Eyewear has a combined maximum benefit of $650 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The Kaiser Permanente Dual Essential (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. The plan has a $3,000 maximum benefit per year, and does not cover implant services or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. Medicare Part B Insulin Drugs have no copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a copay between $0 and $47, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $25.00, up to $125.00, and Therapeutic Radiological Services have a copay of at least $5.00. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Dual Essential (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Dual Essential (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Dual Essential (HMO D-SNP) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20 and days 46-100, but a $203 copay for days 21-45; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Other 1; however, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-counter items are covered with a maximum of $100 every three months. Other 1 has a coinsurance of 0% to 20% and requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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