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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 2025, 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 out of 5 stars in 2025.
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 $230.00 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 (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $230.00. During the initial coverage phase, you will pay coinsurance for your prescriptions. For example, you will pay 23% coinsurance for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Dual Complete (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have an $1800 copay per stay, while emergency services cost $110, and urgently needed services cost $40. Many services, including primary care, outpatient services, and hearing exams, have a 20% coinsurance. Many services have no copay, including preventive services, home health services, and dental cleanings. The plan also covers prescription hearing aids with a $4,000 maximum benefit every two years, and provides up to $150 every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is an $1800 copay per stay for a Medicare-covered stay, and additional days (91-999) have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric does not cover additional days or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have 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 (HMO D-SNP) plan covers Primary Care Physician Services, Physician Specialist Services, Physical Therapy, Speech-Language Pathology Services, and Additional Telehealth Benefits with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, but Routine Chiropractic Care is not covered. Occupational Therapy Services, Individual and Group Sessions for Mental Health, Other Health Care Professional, and Psychiatric Services are covered with a 20% coinsurance. The plan covers Podiatry Services and Opioid Treatment Program Services with a 20% coinsurance and no copay. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services. Kidney Disease Education Services have a 20% coinsurance. 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 includes hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum benefit of $4,000 every two years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and routine eye exams have no copay. Eyewear is covered with no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. Upgrades are not covered, and there is a combined maximum of $650 per year for eyewear.
Dental Services See details
Dental services include a 20% coinsurance for Medicare dental services. Other dental services have a maximum plan benefit of $3,500 every year, and other services such as oral exams, dental x-rays, and cleanings have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan, which includes coverage for Medicare Part B Insulin Drugs with no copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan, requiring a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, although DME for use outside the home is not covered. DME has a coinsurance between 0% and 20%, and prosthetics and medical supplies have 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 under the Kaiser Permanente Dual Complete (HMO D-SNP) plan. 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%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan, with prior authorization and a doctor's referral required. There is no copay for days 1-20 and days 65-100, but there is a $214 copay for days 21-64.
Other Services See details
The Kaiser Permanente Dual Complete (HMO D-SNP) plan's "Other Services" benefit covers over-the-counter (OTC) items up to $150 every three months, and DME and medical supplies not covered by Medicare with 0%-20% coinsurance. 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.
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