Kaiser Permanente Medicare Advantage High DC (HMO-POS)

Kaiser Permanente Medicare Advantage High DC (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in DC. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Kaiser Permanente Medicare Advantage High DC (HMO-POS) 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 Medicare Advantage High DC (HMO-POS).

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 Medicare Advantage High DC (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic medications cost a $12 copay per month at preferred pharmacies, and Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Tier 3 preferred brand drugs require a $42 monthly copay at preferred pharmacies and standard mail order, compared to a $47 copay at standard pharmacies. Tier 4 non-preferred drugs carry a $100 copay across all pharmacy options, while Tier 5 specialty medications require a 29% coinsurance. Utilizing standard mail order can also offer significant savings, such as no copay for two- and three-month supplies of Tier 2 generic drugs.

Additional Benefits

The Kaiser Permanente Medicare Advantage High DC (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, telehealth, and preventive care. For inpatient hospital stays, you will pay a $225 daily copay for days one through five, followed by no copay for additional days. Emergency care is available with a $130 copay, which is waived upon hospital admission, while urgent care visits require a $30 copay. This plan also provides robust supplemental benefits, including up to 24 free one-way transportation trips to approved locations and a $25 quarterly allowance for over-the-counter items with no copay. Hearing aid fittings have no copay, and the plan covers up to $1,000 per ear every three years, while routine dental and eye exams feature low copays ranging from no copay to $30. Most durable medical equipment, diabetic supplies, and home health services require no copay, though some equipment carries up to a 20 percent coinsurance.