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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 2026, 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 2026.
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 $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:
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Drug Coverage
The Kaiser Permanente Dual Complete (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, policyholders benefit from no copay for Tier 1 preferred generic and Tier 2 generic medications filled through standard pharmacies or standard mail order. Additionally, Tier 6 vaccines are covered with no copay for a one-month supply at standard pharmacies. For higher-tier medications, cost-sharing is based on coinsurance for both standard pharmacy and standard mail-order services. Tier 3 preferred brand drugs require an 18% coinsurance for one, two, or three-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all available supply durations.
Additional Benefits
The Kaiser Permanente Dual Complete (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies to these medical appointments and diagnostics. Emergency room visits require a $115 copay, which is waived if you are admitted, while inpatient hospital stays require a copay of $2,230 per stay for acute care. Skilled nursing facility care is also covered, offering no copay for the first 20 days and a $218 daily copay for days 21 through 100. In addition to medical care, the plan provides valuable wellness benefits including preventive dental care, routine eye exams, and home health services with no copays and no coinsurance. Members also receive an over-the-counter allowance of up to $200 every three months and a hearing aid allowance of up to $1,500 per ear every three years with no copays. To help you get to your appointments, the plan covers up to 36 one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
Kaiser Permanente Dual Complete (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Dual Complete (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance rides. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with a copay ranging from $0 to $125 and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $40 copay and no coinsurance, and worldwide emergency services are covered with copays up to $115 and a 20% coinsurance for emergency transportation.
Primary Care See details
Primary care, specialist, therapy, and mental health services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Podiatry services are not covered, and chiropractic services are only partially covered, with routine chiropractic care and other chiropractic services not covered.
Preventive Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for covered services such as annual physical exams, fitness benefits, and health education. Excluded sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, 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, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers hearing services with no deductible, offering one routine exam per year with no copay and 20% coinsurance, alongside unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear every three years, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Dual Complete (HMO D-SNP), which offers one routine eye exam annually with no copay and no coinsurance, while other eye exams and eyewear upgrades are not covered. Covered eyewear has no copay up to a $575 maximum every two years, carrying a 20% coinsurance for contact lenses and no coinsurance for eyeglasses.
Dental Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) offers partially covered dental services, featuring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for covered preventive and comprehensive services. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copays, though coinsurance ranges from 0% to 20% depending on the item. Prior authorization is required for durable medical equipment and prosthetics, which carry up to 20% coinsurance, while diabetic therapeutic shoes and inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance for diagnostic tests, lab services, radiological services, and outpatient X-rays. Prior authorization and referrals are required for all of these services.
Home Health Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers cardiac rehabilitation services with no copay, though some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Dual Complete (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copayment for days 21 through 100. Prior authorization and referrals are required for these services, and additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Dual Complete (HMO D-SNP) partially covers other services, excluding acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance up to $200 every three months, residential mental health and chemical dependency treatment with a $2,080 copay and no coinsurance, and select DME and prosthetic supplies with no copay and 0% to 20% coinsurance.
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