Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP)

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 2026.

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.

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.

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:

Drug Coverage

The Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) features an annual prescription drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard retail pharmacies or through standard mail order for any supply length. Additionally, Tier 6 vaccines are available with no copay for a one-month supply at standard pharmacies. For higher-tier medications, costs are structured as coinsurance for standard pharmacy and standard mail order options. Tier 3 preferred brand drugs require a 17% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty tier drugs carry a 25% coinsurance. These coinsurance percentages remain consistent across one-month, two-month, and three-month supply durations.

Additional Benefits

The Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) offers robust coverage with no copay and no coinsurance for many essential services, including primary care and specialist visits, preventive care, dental, and routine vision and hearing exams. For inpatient hospital stays, members pay a $325 daily copay for days one through six and no copay for remaining days, while skilled nursing facility care is covered with no copay for the first 20 days. Emergency room visits feature a $115 copay which is waived if admitted, and urgent care visits require a low $15 copay. Outpatient services, diagnostics, and routine lab tests are highly accessible, often requiring no copay or low copays up to $250. While many medical supplies and durable medical equipment have no copays, some specialized treatments like dialysis, chemotherapy, and prosthetic devices require a 20% coinsurance. Additionally, the plan provides valuable extra benefits like a $150 quarterly over-the-counter allowance and up to 36 one-way transportation trips per year with no coinsurance.