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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 2026, 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 2026.
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 $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 $9250.00 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) drug coverage includes an annual prescription deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs, as well as Tier 6 vaccines, at standard pharmacies and standard mail-order services. This plan offers affordable access to everyday medications to help keep your healthcare costs low. For higher-tier medications, the plan utilizes a coinsurance cost-sharing structure. Tier 3 preferred brand drugs require a 10% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance for standard pharmacy and mail-order fills. These coinsurance rates apply to one-month, two-month, and three-month supplies, providing flexible options for managing your prescriptions.
Additional Benefits
The Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for primary care, specialist visits, preventive care, and home health services. For hospitalizations, members pay a $2,000 copay per stay for acute inpatient care and an $1,880 copay per stay for psychiatric care, both with no coinsurance. Outpatient hospital services require copays ranging from no copay up to $300, while emergency room visits carry a $115 copay that is waived upon admission. Additional benefits include dental, vision, and hearing care with no copay and no coinsurance, which features a $575 eyewear allowance every two years and a $1,000 hearing aid allowance per ear every three years. Members can also access over-the-counter items with no copay up to $100 every three months and up to 36 one-way transportation trips per year with copays ranging from no copay to $125. Essential medical equipment and supplies are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) inpatient hospital services are partially covered, requiring a $2,000 copay per stay for acute care and an $1,880 copay per stay for psychiatric care, both with no coinsurance. Prior authorization and referrals are required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital and observation services and a $300 copay for ambulatory surgical center visits. Outpatient substance abuse and blood services are fully covered with no copay and no coinsurance, though prior authorization or referrals may be required.
Partial Hospitalization See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers ambulance services with a $280 copay and no coinsurance for both ground and air transport. Transportation services are partially covered with no coinsurance and copays ranging from $0 to $125 for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $35 for urgent care, $115 for emergency services, and $280 for emergency transportation.
Primary Care See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, telehealth, and opioid treatment services with no copay and no coinsurance. Occupational, physical, and speech therapy services require a $20 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay and no coinsurance for covered care, which includes annual physicals, fitness benefits, and health education. Sub-services not covered by the plan include in-home safety assessments, PERS, 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, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers hearing services with no copay and no coinsurance, including routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,000 per ear every three years, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) partially covers vision services with no copay and no coinsurance, offering one routine eye exam per year and a $575 allowance for eyewear every two years. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive care. While diagnostic, preventive, restorative, and oral surgery treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Dual Essential Plan 1 (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 chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers medical equipment with no copays and coinsurance ranging from no coinsurance up to 20%. This coverage includes durable medical equipment, prosthetics, medical supplies, and diabetic supplies, though coinsurance of up to 20% applies to prosthetic devices, medical supplies, and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) covers diagnostic and radiological services, requiring referrals and prior authorization for all services. Diagnostic procedures and tests have no coinsurance and copays ranging from no copay up to $35, lab and outpatient X-ray services have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no copay and no coinsurance, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) with no coinsurance, offering no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP), as acupuncture and meal benefits are not covered. Covered services include over-the-counter items with no copay and no coinsurance up to $100 every three months, residential mental health or chemical dependency treatment for an $1,880 copay and no coinsurance, and select DME and prosthetic supplies with no copay and 0% to 20% coinsurance.
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