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Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Standard 1 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 Standard 1 VA (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Standard 1 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 Standard 1 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 Standard 1 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 Standard 1 VA (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. 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 $5900.00 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 Standard 1 VA (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, costing a $10 copay for a one-month supply at preferred pharmacies, or no copay for multi-month supplies filled via standard mail order. Brand-name and specialty medications under this plan have structured cost-sharing, with Tier 3 preferred brand drugs requiring a $45 copay for a one-month supply at preferred pharmacies. Tier 4 non-preferred drugs carry a $100 copay per month, while Tier 5 specialty drugs require a 29% coinsurance across all pharmacy options. Additionally, Tier 6 vaccines are available with no copay for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care doctor visits, telehealth services, and home health care. For hospital needs, inpatient stays require a $300 daily copay for the first six days and no copay thereafter, while emergency room visits have a $130 copay that is waived if you are admitted. Specialists and urgent care visits are highly accessible with a $30 copay and no coinsurance. This plan also features valuable routine benefits, including preventive dental care and routine eye exams featuring either no copay or a copay up to $30. Additionally, members receive a $1,000 allowance per ear every three years for prescription hearing aids with no copay and a $250 allowance every two years for contact lenses with a 20% coinsurance. Other convenient perks include up to 24 one-way transportation trips to plan-approved locations per year with no copay and a $25 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days are covered with no copay for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital and observation services, and a $300 copay for ambulatory surgical center visits. Outpatient substance abuse services require a $5 to $10 copay with no coinsurance, while outpatient blood services have no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any other health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital, and no coinsurance. Urgently needed services require a $30 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $30, and $225 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits and therapy services require a $30 copay and no coinsurance. Mental health and psychiatric sessions feature no coinsurance and copays ranging from $5 to $10, but chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits, including annual physical exams and glaucoma screenings. However, several sub-services are not covered, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered under the Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) plan, offering Medicare-covered exams for a $30 copay and no coinsurance, and fitting evaluations and prescription hearing aids with no copay and no coinsurance up to a $1,000 allowance per ear every three years. Routine hearing exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) vision services are partially covered, offering routine eye exams with a $0 to $30 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is also partially covered with no copay, no deductible, and a 20% coinsurance for contact lenses up to a $250 allowance every two years, though upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) plan, with maxillofacial prosthetics, implant services, and orthodontics being excluded from coverage. Preventive care is offered with a $0 to $30 copay and no coinsurance, while covered comprehensive services require a 50% coinsurance and either no copay or a $30 copay up to a $1,500 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) plan with prior authorization, featuring a $10.00 to $35.00 copay and no coinsurance for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation, require a copay ranging from $10.00 to $47.00 and 0% to 20% coinsurance.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment features a 0% to 20% coinsurance, diabetic supplies have no coinsurance, and medical supplies, prosthetic devices, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (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 procedures, 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
Home health services are covered by the Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) plan with no copay and no coinsurance. Members will need to obtain prior authorization and a referral to receive these covered services.
Cardiac Rehabilitation Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) offers no coinsurance for cardiac rehabilitation services, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered. These services require a referral and prior authorization, with copayments of $30 for the rehabilitation services and $25 for SET for PAD.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS) partially covers other services, excluding acupuncture and meal benefits. Covered services include over-the-counter items with no copay and no coinsurance up to a $25 quarterly limit, non-Medicare durable medical equipment with no copay and 0% to 20% coinsurance, and select non-Medicare surgical procedures for a $300 copay and no coinsurance.
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