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Kaiser Permanente Medicare Advantage High VA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage High VA (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 VA (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage High VA (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Northern Virginia. 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 VA (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 VA (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 VA (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $137.00. 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:
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Drug Coverage
The Kaiser Permanente Medicare Advantage High VA (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies and through standard mail order, as well as no copay for Tier 6 vaccines. Tier 2 generic medications are also highly affordable, costing just a $10 copay for a one-month supply at preferred pharmacies or through standard mail order. For brand-name and specialized medications, Tier 3 preferred brands carry a $42 copay at preferred pharmacies, while Tier 4 non-preferred drugs require a $100 copay. Tier 5 specialty drugs are subject to a 29% coinsurance across all pharmacy options, including preferred, standard, and mail-order services. Choosing preferred pharmacies or standard mail-order options generally offers the lowest out-of-pocket costs under this plan.
Additional Benefits
The Kaiser Permanente Medicare Advantage High VA (HMO-POS) plan offers robust medical coverage with affordable cost-sharing, featuring a $5 copay for primary care visits, a $30 copay for specialists, and no copay for telehealth. Inpatient hospital stays require a $290 daily copay for days one through six, after which there is no copay, while outpatient lab tests also carry no copay. Emergency room visits have a $130 copay that is waived upon admission, and urgent care services are available for a $30 copay. Preventive care, including annual physicals and fitness programs, is fully covered with no copay or coinsurance. The plan also features valuable supplemental benefits, such as a $1,000 hearing aid allowance per ear every three years with no copay, and routine dental care with copays ranging from no copay to $30. Additionally, members can take advantage of a $250 eyewear allowance every two years with 20% coinsurance, up to 24 free one-way transportation trips annually, and a $25 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $290 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 additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital and observation services which carry a copay of $0 to $285. Ambulatory surgical center services require a $285 copay and no coinsurance, while outpatient substance abuse services have a $5 to $10 copay and no coinsurance. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers partial hospitalization services with a $5.00 copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Kaiser Permanente Medicare Advantage High VA (HMO-POS) plan, featuring a $225 copay and no coinsurance for ground and air ambulance transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted, and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $30, and $225, respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers primary care visits for a $5 copay and specialist visits for a $30 copay, both with no coinsurance, while telehealth benefits are available with no copay and no coinsurance. Physical, occupational, and speech therapy require a $30 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Medicare Advantage High VA (HMO-POS) with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. This benefit is partially covered, as it excludes in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, 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 VA (HMO-POS), featuring Medicare-covered hearing exams for a $30 copay and no coinsurance, and hearing aid fittings with no copay. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear every three years, while routine hearing exams, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered under the Kaiser Permanente Medicare Advantage High VA (HMO-POS) plan, offering routine eye exams with a $5 to $30 copay and no coinsurance, while other eye exam services and eyewear upgrades are not covered. Covered eyewear options have no copay and a 20% coinsurance for contact lenses, up to a $250 maximum limit every two years with no deductibles.
Dental Services See details
Dental Services are partially covered under the Kaiser Permanente Medicare Advantage High VA (HMO-POS) plan, with preventive services like cleanings and exams requiring a $0 to $30 copay and no coinsurance. Medicare-covered dental services have a $30 copay and no coinsurance, while most comprehensive services carry no copay and 50% coinsurance, except for oral surgery which has a $30 copay and 50% coinsurance. Implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin with a $10.00 to $35.00 copay and no coinsurance. Chemotherapy, radiation, and other covered Part B drugs require a copay between $10.00 and $47.00 alongside coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Medicare Advantage High VA (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Medicare Advantage High VA (HMO-POS) with no copays, subject to prior authorization. Durable medical equipment incurs a 0% to 20% coinsurance, diabetic supplies have no coinsurance, and prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Outpatient diagnostic procedures, tests, and lab services have no copay, while outpatient x-rays and diagnostic radiological services require a minimum $10 copay, and therapeutic radiological services require a minimum $30 copay.
Home Health Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers some Cardiac Rehabilitation Services with no coinsurance, although cardiac, intensive cardiac, and pulmonary rehabilitation services (each with a $30 copay) and SET for PAD services (with a $25 copay) are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required for these services, and coverage does not extend to additional days beyond the standard 100-day limit.
Other Services See details
Kaiser Permanente Medicare Advantage High VA (HMO-POS) provides partially covered other services, which exclude acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance up to $25 every three months, non-Medicare durable medical equipment and supplies with no copay and 0% to 20% coinsurance, and non-Medicare ambulatory surgical center procedures for a $285 copay and no coinsurance.
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