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Kaiser Permanente Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Complete (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete (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 Complete (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 (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 (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 (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:
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Drug Coverage
The Kaiser Permanente Dual Complete (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. Additionally, there is no copay for Tier 6 vaccines when obtaining a one-month supply at standard pharmacies. For higher-tier medications, costs are determined by coinsurance at standard pharmacies and standard mail order. You will pay a 2% coinsurance for Tier 3 preferred brand drugs, a 24% coinsurance for Tier 4 non-preferred drugs, and a 25% coinsurance for Tier 5 specialty drugs. These coinsurance rates remain consistent whether you fill a one-month, two-month, or three-month supply.
Additional Benefits
The Kaiser Permanente Dual Complete (HMO D-SNP) offers robust medical coverage featuring no copay for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies. Inpatient hospital stays require a $1,475 copay per stay with no coinsurance, while emergency room visits carry a $115 copay which is waived if admitted. Additionally, beneficiaries receive home health services and unlimited one-way transportation to approved medical locations with no copay and no coinsurance. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay or coinsurance up to a $3,500 annual limit. Members can access a $500 annual eyewear allowance, up to $4,000 per ear for hearing aids every two years, and a $75 over-the-counter allowance every three months with no copays. Routine preventive services, fitness benefits, and telehealth options are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers inpatient hospital services with no coinsurance and a $1,475 copay per stay, though the benefit is only partially covered since upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Unlimited additional acute care days are covered with no copay, but both acute and psychiatric stays require prior authorization and a referral.
Outpatient Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, with no copay and a 20% coinsurance. Outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Dual Complete (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered, providing unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted) and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent services are covered with matching copays and no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance.
Primary Care See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and 20% coinsurance, while telehealth benefits are offered with no copay and no coinsurance. Chiropractic services are not covered, and routine podiatry is limited to four visits per year with a 20% coinsurance and no copay.
Preventive Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers annual physicals, fitness benefits, in-home support, remote access, and various screenings with no copay and no coinsurance, while kidney disease education is covered with no copay and a 20% coinsurance. Additional preventive services are only partially covered, as the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home modifications, or counseling.
Hearing Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers hearing services with no deductible, offering fitting evaluations with no copay or coinsurance and routine hearing exams with a 20% coinsurance and no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $4,000 per ear every two years, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Dual Complete (HMO D-SNP), offering routine eye exams with no copay and 20% coinsurance, and eyewear with no copay, no coinsurance, and a $500 annual limit. There are no deductibles for these services, but other eye exams and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Dual Complete (HMO D-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental services have no copay and no coinsurance up to a $3,500 annual limit, but other preventive services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have no copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation, require a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment incurs no copay and 0% to 20% coinsurance, diabetic supplies have no copay, and prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers diagnostic and radiological services with no copay, though a 20% coinsurance applies to all lab services, diagnostic procedures, and imaging. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home health services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay and no coinsurance. Access to these services requires both a referral and prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay and a referral, but a 20% coinsurance applies to certain services. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered at the $0 rate and instead require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, although prior authorization and referrals are required. There is no copay for days 1 to 20 and days 63 to 100, a $214 copay for days 21 to 62, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items up to $75 every three months and select non-Medicare medical supplies with no copay and no coinsurance. However, acupuncture, meal benefits, and highly integrated services are not covered under this plan.
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