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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 2026, 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 4.5 out of 5 stars in 2026.
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 $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 $8850.00 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:
Sign up for Kaiser Permanente Dual Complete Pueblo (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 vaccines when using standard pharmacies or standard mail order services. Tier 2 generic drugs are available with a 16% coinsurance for one, two, or three-month supplies. For higher-tier medications, the plan transitions to a standard coinsurance model. Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all carry a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance rate applies consistently across one-month, two-month, and three-month supply options.
Additional Benefits
The Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) plan offers comprehensive medical coverage with many essential services featuring no copay, though specific copayments and coinsurance apply to select benefits. Inpatient hospital stays require a $1,475 copayment per admission with no coinsurance, whereas outpatient services and diagnostic tests generally carry no copay and a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgent care is available with a $40 copay. Supplemental benefits are a key highlight, featuring dental coverage up to a $3,500 annual maximum and vision eyewear up to a $500 annual limit with no copay or coinsurance. Members also receive prescription hearing aid coverage up to $4,000 per ear every two years and unlimited transportation to plan-approved locations with no copay or coinsurance. Skilled nursing facility stays are covered with no copay for days 1 to 20, followed by a $214 daily copay for days 21 to 62.
Inpatient Hospital See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,475 copayment per admission and no coinsurance, though prior authorization and referrals are required. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, and prior authorization or referrals may be required for certain services.
Partial Hospitalization See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Both prior authorization and a referral are required for these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering unlimited rides to plan-approved locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are covered at these same copays with no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and podiatry services with no copay and 20% coinsurance, while telehealth benefits are available with no copay and no coinsurance. Chiropractic services are not covered in practice, and some services require referrals or prior authorizations.
Preventive Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and health education, while kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered because sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) provides partially covered hearing services with no deductible, featuring routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $4,000 per ear every two years with a referral, but OTC hearing aids and inner, outer, or over the ear prescription models are not covered.
Vision Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) offers partially covered vision services, featuring routine eye exams with no copay, no deductible, and 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no deductible, and no coinsurance up to a $500 annual limit for contacts and eyeglasses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Dual Complete Pueblo (HMO D-SNP), which offers Medicare-covered dental services with no copay and a 20% coinsurance. Other covered dental services feature no copay, no coinsurance, and a $3,500 annual maximum, though other preventive services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers Home Infusion bundled Services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with no copay and no coinsurance, while chemotherapy, radiation, and other Medicare Part B drugs require a coinsurance ranging from 0% (no coinsurance) to 20%.
Dialysis Services See details
Dialysis services are covered under Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) with no copay and a 20% coinsurance, and a referral is required to receive care.
Medical Equipment See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers medical equipment, prosthetics, and diabetic supplies with no copays and coinsurance ranging from 0% to 20% depending on the item. Prior authorization is required for these benefits, which include durable medical equipment, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers diagnostic and radiological services with no copayment and a 20% coinsurance, though prior authorization and referrals are required. These covered benefits include lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers some cardiac rehabilitation services with no copay, provided you have a referral. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 63 to 100, a $214 daily copay for days 21 to 62, and additional days beyond the 100-day Medicare benefit period are not covered.
Other Services See details
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) partially covers other services, offering over-the-counter items and select non-Medicare medical supplies with no copay and no coinsurance. Prior authorization is required for the medical supplies, while acupuncture and meal benefits are not covered.
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