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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 2026, 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 4.5 out of 5 stars in 2026.
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 $615.00 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 features a yearly prescription drug deductible of $615.00, though individuals qualifying for Extra Help may receive premium reductions. During the initial coverage phase, Tier 1 preferred generic drugs and Tier 5 specialty drugs have no copay at standard pharmacies. For other tiers, you will pay a 15% coinsurance for standard generics and a 25% coinsurance for preferred brands and non-preferred drugs. These cost-sharing rates apply until your drug spending reaches the next coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Kaiser Permanente Dual Essential (HMO D-SNP) plan offers comprehensive coverage with many essential services available with no copay, including primary care visits, preventive screenings, and home health care. For specialized and urgent medical needs, members pay low out-of-pocket costs, such as a $5 copay for specialist visits and a $130 copay for emergency services. Inpatient hospital stays require a $225 daily copay for the first six days, after which there is no copay or coinsurance for days 7 through 90. In addition to medical care, this plan provides valuable supplemental benefits with no copay, including routine dental, vision, and hearing exams. Members can take advantage of generous allowances, such as up to $3,000 every two years for prescription hearing aids, a $500 annual limit for eyewear, and a $50 quarterly over-the-counter allowance. Unlimited transportation to plan-approved health-related locations is also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Dual Essential (HMO D-SNP) partially covers inpatient hospital services, requiring a $225 daily copay for days 1 through 6 and no copay or coinsurance for days 7 through 90. While unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Dual Essential (HMO D-SNP) with no coinsurance, featuring a $200 copay for outpatient hospital services and a $150 copay for ambulatory surgical center services. There is no copay for outpatient blood services, outpatient substance abuse sessions, or observation services.
Partial Hospitalization See details
Kaiser Permanente Dual Essential (HMO D-SNP) covers partial hospitalization benefits with a $45.00 copay and no coinsurance. A doctor referral and prior authorization are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Dual Essential (HMO D-SNP), requiring a 20% coinsurance and no copay for prior-authorized ground and air ambulance transport. Transportation benefits are partially covered, offering unlimited rides with no copay or coinsurance to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Dual Essential (HMO D-SNP) with a $130 copay and no coinsurance, while urgently needed services require a $15 copay and no coinsurance. Worldwide emergency and urgent care are covered at these same copay rates with no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Kaiser Permanente Dual Essential (HMO D-SNP) covers primary care physician visits, occupational therapy, physical therapy, and telehealth services with no copay and no coinsurance. Specialist visits require a $5 copay with no coinsurance, while chiropractic services have a $15 copay with no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Dual Essential (HMO D-SNP) plan, with no copay or coinsurance for annual physical exams, screenings, and fitness benefits, and a $0 to $5 copay with no coinsurance for kidney disease education. However, the plan does not cover alternative therapies, therapeutic massage, counseling, weight management, nutritional or dietary benefits, adult day health, personal emergency response systems (PERS), caregiver support, home-based palliative care, telemonitoring, home and bathroom safety modifications, wigs, medical nutrition therapy, medication reconciliation, re-admission prevention, enhanced disease management, and additional smoking cessation sessions.
Hearing Services See details
Kaiser Permanente Dual Essential (HMO D-SNP) features partially covered hearing services, which include routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to a $3,000 limit every two years, but OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription models, are not covered.
Vision Services See details
Kaiser Permanente Dual Essential (HMO D-SNP) partially covers vision services, offering routine eye exams and eyewear with no deductible, no copay, and no coinsurance. While eyeglasses and contact lenses are covered up to a combined maximum of $500 every year, eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Dual Essential (HMO D-SNP), though implant services and orthodontics are not covered. Covered Medicare-covered dental services require a $5 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $3,000 annual maximum.
Home Infusion bundled Services See details
Kaiser Permanente Dual Essential (HMO D-SNP) covers Home Infusion bundled Services, which require prior authorization. Medicare Part B insulin drugs have no copay, while chemotherapy, radiation, and other Part B drugs range from no copay to a $47 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Dual Essential (HMO D-SNP) with no copay and a 20% coinsurance. A doctor referral is required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Dual Essential (HMO D-SNP) covers medical equipment, including durable medical equipment with 0% to 20% coinsurance and no copay, and prosthetics and medical supplies with 20% coinsurance and no copay. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Kaiser Permanente Dual Essential (HMO D-SNP) with no coinsurance, though prior authorization and referrals are required. There is no copay for diagnostic procedures, lab services, and outpatient X-rays, while therapeutic radiology requires a $5 copay and diagnostic radiology copays range from $25 to $250.
Home Health Services See details
Kaiser Permanente Dual Essential (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Dual Essential (HMO D-SNP) plan. This exclusion applies to all related sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kaiser Permanente Dual Essential (HMO D-SNP), as additional days beyond the Medicare-covered limit are not covered. Covered stays have no coinsurance, featuring no copay for days 1 to 20 and days 46 to 100, and a $203 daily copay for days 21 to 45.
Other Services See details
Kaiser Permanente Dual Essential (HMO D-SNP) partially covers other services, providing a $50 quarterly over-the-counter allowance with no copay or coinsurance, as well as non-Medicare medical supplies with no copay and 0% to 20% coinsurance. Acupuncture, meal benefits, and highly integrated services for dual eligible SNPs are not covered.
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