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Kaiser Permanente Dual Essential Plan 2 (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 2 (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 2 (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Essential Plan 2 (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 Barrow, Butts, Newton, Rockdale, Spalding, Walton. 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 2 (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 2 (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 2 (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 2 (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 $320.00 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 Essential Plan 2 (HMO D-SNP) has a $320 deductible for prescription drugs. After the deductible is met, you will pay the following costs for your medications. For preferred generic drugs, you will have no copay at a standard or mail-order pharmacy. Standard generic drugs have a $47 copay, and preferred brand drugs have a $100 copay. Non-preferred drugs have a 29% coinsurance, and specialty tier drugs have no copay.
Additional Benefits
The Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) offers a wide range of benefits with varying costs. Many services have no copay, including primary care, preventive services, hearing and vision exams, and home health services. However, some services, like inpatient hospital stays, emergency services, and ambulance services, have copays ranging from $110 to $325. The plan also provides coverage for dental, hearing aids, and eyewear, with specific limits and coinsurance for certain services. Additionally, the plan covers home infusion, dialysis, medical equipment, and diagnostic services, with costs depending on the specific service. The plan also provides an over-the-counter (OTC) allowance of up to $200 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-6, and no copay for days 7-90, while Additional Days (91-999) have no copay; however, Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $325 copay for days 1-6, and no copay for days 7-90, but Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services and observation services with a copay between $0 and $250, ambulatory surgical center services with a $250 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 with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP). Ground and air ambulance services have a $250 copay, and transportation services to plan-approved health-related locations have no copay for up to 36 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP). Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a $15 copay and no coinsurance, and Worldwide Emergency Services have varying copays depending on the service.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Additional Telehealth Benefits, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have no copay. Chiropractic Services have a 20% coinsurance, while Occupational Therapy Services have a $15 copay, and Physical Therapy and Speech-Language Pathology Services have a $15 copay. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education, and other preventive services. Annual physical exams have no copay. Some additional preventive services, such as Health Education, have no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services 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, while fitting/evaluation for hearing aids also has no copay. Prescription hearing aids are covered up to $500 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay. Eyewear has no copay, and a combined maximum plan benefit of $575 every two years, but upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare dental services, with a 75% coinsurance for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Restorative services have a copay between $28 and $580 with 75% coinsurance, while adjunctive general services have no copay with 75% coinsurance, and oral and maxillofacial surgery has a $22 copay with 75% coinsurance. Maxillofacial prosthetics are not covered, and endodontics, implant services, prosthodontics fixed, prosthodontics removable, and orthodontics are optional supplemental benefits.
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 $0 and $47, and Other Medicare Part B Drugs have a copay between $0 and $47. Both Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP). The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP), including Durable Medical Equipment (DME) with 0% to 20% coinsurance, though equipment for use outside the home is not covered. Prosthetics and medical supplies are covered with no copay, and coinsurance applies to Medicare-covered prosthetic devices and medical supplies. Diabetic equipment is covered, with no copay for diabetic supplies, and 20% coinsurance for therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $245, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) 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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A referral and prior authorization from your doctor are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) with prior authorization and a doctor's referral required. You will have no copay for days 1-20, and a $214 copay for days 21-100; there is no coinsurance.
Other Services See details
The Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) covers Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $200 every three months, and offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. Other services such as Acupuncture, Meal Benefit, 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. Other 1 services have a copay of $325.00 - $1950.00, and Other 2 services have a coinsurance of 0% - 20%.
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