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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 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 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 $385.00 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 a $385.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you may pay a $6.00 copay at a standard pharmacy for a tier 1 drug. You will pay a $47.00 copay for a standard generic drug at a standard or mail-order pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Dual Complete (HMO D-SNP) plan offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay per admission, while outpatient services have copays between $0 and $325, and primary care services come with a 35% coinsurance. Emergency, urgent, and worldwide emergency services have copays, and ambulance services have a copay, but transportation services to a plan-approved health-related location have no copay. Preventive services and hearing exams are covered with no copay, while vision services have no copay for eye exams and a 20% coinsurance for eyewear. Dental services have a 35% coinsurance for Medicare-covered services, with additional cost-sharing for other dental procedures. Home infusion, dialysis, medical equipment, and diagnostic services are covered with varying copays and coinsurance. Skilled nursing facilities are covered with a copay for days 21-100, while home health services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered with prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission or stay, and for Inpatient Hospital Psychiatric there is a copay of $2,036 per admission or stay. Additional days for Inpatient Hospital-Acute have no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $325, and observation services with a copay between $0 and $325. Ambulatory Surgical Center (ASC) Services have a $325 copay, and outpatient substance abuse services have a coinsurance between 17% and 35% depending on the type of session. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground and air ambulance services have a $300 copay, while transportation services to a plan-approved health-related location have no copay, and 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 by the Kaiser Permanente Dual Complete (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, a $45 copay for Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Dual Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, and speech-language pathology services with a 35% coinsurance. Additional telehealth benefits are covered with no copay. Opioid Treatment Program Services are covered with no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for a yearly physical exam with no copay, and additional services such as Health Education and Fitness Benefit, with no copay for both. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with 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 with no copay, routine hearing exams (1 exam every year) with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount per period of $1000 every three years, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear with a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 35% coinsurance for Medicare Dental Services. Other covered services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services and oral and maxillofacial surgery. These services require a 75% coinsurance, and copays vary from $0 to $580. Endodontics, implant services, prosthodontics (fixed), prosthodontics (removable), and orthodontics are optional supplemental benefits and require additional payment. Maxillofacial prosthetics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with no copay, Medicare Part B Chemotherapy/Radiation Drugs with a copay between $6 and $47, and Other Medicare Part B Drugs with a copay between $6 and $47. Coinsurance may apply for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with a coinsurance between 0% and 20%, and authorization is required. Prosthetics and medical supplies are covered with a coinsurance, and diabetic equipment is covered, including diabetic supplies with no copay and diabetic therapeutic shoes/inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
The Kaiser Permanente Dual Complete (HMO D-SNP) plan covers diagnostic and radiological services with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
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, 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 Complete (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan. You will have no copay for days 1-20, and a $214 copay per day for days 21-100; there is no coinsurance.
Other Services See details
Under "Other Services", acupuncture, meal benefits, 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 (OTC) items and other services are covered. Other 1 has a copay of $2036, while Other 2 has a coinsurance of 0% - 20%.
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