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Kaiser Permanente Dual Complete Pueblo (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Complete Pueblo (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 Complete Pueblo (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Complete Pueblo (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 Southern Colorado - Pueblo County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Dual Complete Pueblo (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 Complete Pueblo (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 Complete Pueblo (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 Complete Pueblo (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.30. 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 $590.00 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 $9350.00 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 Complete Pueblo (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay coinsurance for your prescriptions. During the initial coverage phase, you pay 23-25% coinsurance depending on the drug tier and pharmacy type, with a $0 copay for specialty tier drugs at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1,800 copay per admission, while outpatient services and partial hospitalization have a 20% coinsurance. Ambulance services also have a 20% coinsurance, but transportation to plan-approved health locations has no copay. This plan includes coverage for emergency services with a copay, and primary care services with 20% coinsurance. Preventative services like annual physical exams have no copay, and hearing and dental services are covered, with a $4,000 hearing aid benefit and a $3,500 annual maximum for dental. Home health and home infusion services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, there is a $1,800 copay per admission or stay, and additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a minimum and maximum coinsurance of 20%. Outpatient Blood Services has no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with all ambulance services requiring prior authorization. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $40 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
The Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, individual sessions for mental health specialty services, individual sessions for psychiatric services, and routine foot care have a 20% coinsurance. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional services like Health Education, Fitness Benefit, Remote Access Technologies, and In-Home Support Services, which may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include routine hearing exams with no copay and no coinsurance, and fitting/evaluation for hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to $4,000 every two years, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and eyewear with a $600 combined maximum benefit per year. Routine eye exams have no copay, while contact lenses have a copay. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services with a $3,500 annual maximum. Oral exams, dental X-rays, other diagnostic dental services, cleaning, fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay, and some limitations on the number of visits or services per year. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan, with a doctor referral required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Dual Complete Pueblo (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 Complete Pueblo (HMO D-SNP) plan. A doctor referral is required for this benefit, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan. You will have no copay for days 1-20 and days 65-100, and a $214 copay for days 21-64.
Other Services See details
Other services include coverage for over-the-counter items, with a maximum benefit of $150 every three months, and other services with coinsurance between 0% and 20%. Acupuncture, meal benefits, 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, Self-Directed Personal Assistance Services are not covered.
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