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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 Islands of Oahu and Maui. 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 $580.00 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:
Sign up for Kaiser Permanente Dual Complete (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Complete (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $580. After the deductible is met, you will pay the following costs for drugs. For preferred generic drugs at a standard pharmacy, you will pay 4% coinsurance. For standard generic drugs at a standard or mail order pharmacy, you will pay 24% coinsurance. For preferred brand and non-preferred drugs at a standard or mail order pharmacy, you will pay 25% coinsurance. For specialty tier drugs at a standard pharmacy, there is no copay. Once your total drug costs reach $2000, 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 wide range of benefits with many services available at no copay, including inpatient and outpatient services, emergency services, primary care, preventive services, home health, and more. This plan provides comprehensive coverage for essential healthcare needs, focusing on affordability through a $0 copay for many services. You should note that some services may require prior authorization and/or a doctor referral to be covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with no copay for days 1-90 and days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under the Kaiser Permanente Dual Complete (HMO D-SNP) plan. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, or outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and a doctor referral, and there is no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan. Ground and Air Ambulance Services have no copay and no coinsurance, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with no copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with no copay. Chiropractic Services are covered with no copay, but routine care is not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered and additional preventive services, such as an annual physical exam, with no copay. Additional preventive services include Health Education, Fitness Benefit, and Remote Access Technologies, with no copay. Some services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing services are covered, with hearing exams available at no copay, but routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with no copay, but routine eye exams are not covered. Eyewear is covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare dental services, oral exams, prophylaxis (cleaning), and periodontics, and no coinsurance for dental x-rays, other diagnostic dental services, fluoride treatment, other preventive dental services, and restorative services. Endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for any of these services.
Dialysis Services See details
Dialysis services are covered, but require prior authorization and a doctor's referral. There is no coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and no coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment with no copay and coinsurance for Medicare-covered items. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have no copay, and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan with no copay and no coinsurance. 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 the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Dual Complete (HMO D-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other services include coverage for Other 1 and Other 2, with prior authorization and a doctor referral required for both. Other 1 has no copay, and Other 2 has no coinsurance. Acupuncture, over-the-counter items, meal benefits, 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.
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