A non-government entity
Kaiser Permanente Medicare Advantage High MD (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage High MD (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Medicare Advantage High MD (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage High MD (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in MD. 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 MD (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 MD (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.
For Kaiser Permanente Medicare Advantage High MD (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5700.00 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 Medicare Advantage High MD (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Medicare Advantage High MD (HMO-POS) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, there is no copay at preferred pharmacies or through standard mail order services. Tier 2 generics start at a $12 copay for a one-month supply at preferred pharmacies, and standard mail order options offer no copay for two- or three-month fills. Tier 3 preferred brand drugs require a $42 copay at preferred pharmacies, while Tier 4 non-preferred drugs carry a $100 copay. Specialty medications in Tier 5 are subject to a 29% coinsurance, and Tier 6 vaccines are covered with no copay for a one-month supply. This plan offers a variety of cost-saving pharmacy and mail-order options to help manage your healthcare budget.
Additional Benefits
The Kaiser Permanente Medicare Advantage High MD (HMO-POS) plan offers robust medical coverage with predictable out-of-pocket costs, including no coinsurance for inpatient hospital stays, outpatient services, and primary care. Inpatient hospital care requires a $300 daily copay for the first six days and no copay for days seven through 90, while primary care visits carry a low $5 copay and specialist visits require a $30 copay. Emergency services are covered with a $130 copay that is waived upon admission, and urgent care visits require a $30 copay. Preventive services, home health care, and laboratory tests are fully covered with no copays and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear every three years with no copay, and dental care options range from no copay for preventive services up to a 50% coinsurance for comprehensive care. Skilled nursing facility stays require no copay for the first 20 days, and there is no copay or coinsurance for up to 24 one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Kaiser Permanente Medicare Advantage High MD (HMO-POS) plan with no coinsurance for all services, featuring copays ranging from no copay up to $225 for outpatient hospital and ambulatory surgical center visits. Outpatient substance abuse sessions require a $5 to $10 copay, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers partial hospitalization with a $5.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and this copay is waived if you are admitted to the hospital. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $225.
Primary Care See details
Primary care benefits are partially covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS), as chiropractic and podiatry services are not covered. Covered services require no coinsurance, with copays ranging from no copay for telehealth, $5 for primary care visits, $10 for individual mental health or psychiatric sessions, and $30 for specialists and physical therapy.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits. This benefit is partially covered because several services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS), offering Medicare-covered hearing exams with a $30 copay and no coinsurance, while routine hearing exams and OTC hearing aids are not covered. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear every three years, though inner ear, outer ear, and over-the-ear prescription aid types are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) provides partially covered vision services, excluding eyewear upgrades and other eye exam services. Covered eye exams require a $0 to $30 copay with no coinsurance, while covered eyewear has no copay and a 20% coinsurance up to a $225 maximum benefit every two years.
Dental Services See details
Dental Services are partially covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS), with exclusions for maxillofacial prosthetics, implant services, and orthodontics. Preventive and diagnostic care ranges from no copay to a $30 copay with no coinsurance, while covered comprehensive dental services require either no copay or a $30 copay and 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with prior authorization, offering insulin with a $12.00 to $35.00 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation drugs, require a copay of $12.00 to $47.00 and no coinsurance to 20% coinsurance.
Dialysis Services See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this covered benefit.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with no copays, though prior authorization is required. There is no coinsurance for diabetic supplies, a 0% to 20% coinsurance for durable medical equipment, and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services and diagnostic tests, while outpatient X-rays and diagnostic radiology services require a copay starting at $10, and therapeutic radiology services require a copay starting at $30.
Home Health Services See details
Home health services are covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with no coinsurance, but require prior authorization and referrals. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered, carrying copayments of $25 to $30.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS) with no coinsurance, requiring prior authorization and a referral. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, and no prior three-day hospital stay is required.
Other Services See details
Other services are partially covered by Kaiser Permanente Medicare Advantage High MD (HMO-POS), which excludes acupuncture and meal benefits. Covered options include over-the-counter items with no copay and no coinsurance, non-Medicare medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare surgical procedures in an ambulatory surgical center for a $225 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved