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Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Essential Plan 1 (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 Plan 1 (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Essential Plan 1 (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 Atlanta Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Dual Essential Plan 1 (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 Plan 1 (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 Plan 1 (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 Plan 1 (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 $400.00 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 Essential Plan 1 (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) has a $400 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, if you use a standard pharmacy, you will pay a $7 copay for Tier 1 preferred generic drugs, $47 for Tier 2 standard generic drugs, and $100 for Tier 3 preferred brand drugs. For Tier 4 non-preferred drugs, you will pay 28% coinsurance. For Tier 5 specialty drugs, there is no copay. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Part D covered drugs.
Additional Benefits
The Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $1,880 to $2,000 per admission, while outpatient services can have copays up to $300. Many services, like primary care, preventive services, hearing exams, vision exams, and home health services, are available with no copay. This plan includes coverage for ambulance services with a $280 copay and transportation services with no copay for up to 36 one-way trips per year. Emergency services have a $110 copay, and prescription hearing aids are covered up to $500 every three years. Dental services include no copay for Medicare dental services, with other services having coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $2,000 per admission or stay for Inpatient Hospital-Acute and a copay of $1,880 per admission or stay for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services with a copay between $0 and $300, Ambulatory Surgical Center (ASC) Services with a $300 copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for all ambulance services with a $280 copay and no coinsurance, and transportation services to a plan-approved health-related location with no copay and no coinsurance, limited to 36 one-way trips per year. 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. Emergency Services have a $110 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services have different copays depending on the service: Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $280 copay. There is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) offers primary care physician services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, and additional telehealth benefits with no copay. Chiropractic Services have a 35% coinsurance, and physical therapy and speech-language pathology services have a $20 copay. Occupational therapy services have a $20 copay, and routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including annual physical exams with no copay. Additional preventive services are covered, including Health Education, Fitness Benefit, and Remote Access Technologies, which may have a copay. Other services like In-Home Safety Assessment, Personal Emergency Response System, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids also has no copay. Prescription hearing aids are covered up to $500 every three years, with a limit of two visits every three years for prescription hearing aids (all types). Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers routine eye exams once per year. Eyewear has a combined maximum benefit of $575 every two years. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with no copay. Upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare dental services, while other services like oral exams, dental x-rays, and cleanings have a 75% coinsurance and no copay. Restorative services have a 75% coinsurance and a copay between $28 and $580, and oral and maxillofacial surgery has a 75% coinsurance and a $22 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have no copay, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $7 and $47, and Other Medicare Part B Drugs have a copay between $7 and $47.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a coinsurance of 0% to 20% and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with coinsurance, and Prosthetic Devices are covered with 20% coinsurance. Diabetic Equipment is covered, with 0% coinsurance and no copay for Diabetic Supplies, and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $35, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay of at most $290, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP). Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with prior authorization and a doctor referral required. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP), 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. Over-the-counter items are covered with a maximum benefit of $150 every three months. Other 1 benefits are covered with a copay of $1880, and Other 2 benefits are covered with a coinsurance of 0% to 20%.
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