A non-government entity
Kaiser Permanente Medicare Advantage Standard MD (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Standard 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 Standard MD (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Standard 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 2025.
It's important to know that Kaiser Permanente Medicare Advantage Standard 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 Standard 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 Standard MD (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. 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 $6900.00 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 Standard 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 Standard MD (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. The copay varies based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $12 copay at preferred pharmacies and a $20 copay at standard pharmacies. The plan covers specialty tier drugs with 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 Medicare Advantage Standard MD (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service type. Emergency and ambulance services are covered with copays, and primary care visits have a $5 copay. Preventive services and many diagnostic tests have no copay, while hearing and vision services have copays and coinsurance. Dental services include copays and coinsurance depending on the service. The plan also covers home health services and skilled nursing with copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $270 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a copay of $0-$125, ambulatory surgical center services have a copay of $125, individual outpatient substance abuse sessions have a $20 copay, and group outpatient substance abuse sessions have a $10 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $5 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services each have a $225 copay, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $25 copay, and Worldwide Emergency Transportation has a $225 copay; all services have no coinsurance.
Primary Care See details
The Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan covers primary care physician services and chiropractic services for a $5 copay, occupational therapy services for a $25 copay, physician specialist services and physical therapy services for a $25 copay, mental health specialty services for a copay between $10-20, and additional telehealth benefits with no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with a doctor referral, annual physical exams with no copay, and additional preventive services including health education, fitness benefits, and remote access technologies with no copay. Other services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a plan-specified amount of $1,000 per ear every three years, and Prescription Hearing Aids (all types) are covered for 2 visits every three years. Routine hearing exams, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan covers vision services, including eye exams with a copay of $5-25, and eyewear with a 20% coinsurance, with a combined maximum benefit of $200 every two years. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, and Other Dental Services with a copay between $0 and $25; other services like orthodontics, maxillofacial prosthetics, and implant services are not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are covered with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The copay for Medicare Part B Insulin Drugs is $12.00 - $35.00, and the copay for Medicare Part B Chemotherapy/Radiation Drugs is $12.00 - $47.00, while the copay for Other Medicare Part B Drugs is $12.00 - $47.00. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is 0% - 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan, with prior authorization and a doctor referral required. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan. Durable medical equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have no coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with no copay, lab services with no copay, diagnostic radiological services with a copay between $15 and $100, therapeutic radiological services with a $25 copay, and outpatient X-ray services with a $15 copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) 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 not covered by the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan, with a doctor's referral and prior authorization required. There is no copay for days 1-20, and a $190 copay for days 21-100, with additional days beyond Medicare-covered and non-Medicare-covered stays not covered.
Other Services See details
The "Other Services" benefit in the Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) plan covers over-the-counter items with a maximum benefit coverage amount of $110 every three months, and other services including DME and medical supplies not covered by Medicare with 0-20% coinsurance. Acupuncture, 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. Other 2 benefits are covered with a $125 copay.
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