Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS)

Kaiser Permanente Medicare Advantage Value 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 Alexandria, Arlington, Fairfax/City, Falls Church. 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 Value 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 Value 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.

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 Value 1 VA (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail order, and Tier 6 vaccines are also available with no copay. Tier 2 generic drugs are highly affordable, starting with a $12 copay for a one-month supply at preferred pharmacies and standard mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs require a $100 copay. Tier 5 specialty drugs require a 29% coinsurance across all pharmacy types. Utilizing preferred pharmacies or standard mail order services will consistently help you secure the lowest out-of-pocket costs under this plan.

Additional Benefits

The Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS) plan offers robust medical coverage with predictable out-of-pocket costs, including no copay and no coinsurance for primary care, telehealth, and preventive services. Specialist visits, physical therapy, and urgent care require a $35 copay with no coinsurance, while emergency room services carry a $130 copay. For hospital stays, inpatient care requires a $250 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $225 copay. Supplemental benefits include vision and dental coverage, featuring routine eye exams with a no copay to $35 copay and a $200 eyewear allowance every two years. Dental services are partially covered with a no copay to $35 copay for preventive care, while comprehensive dental services require a 50% coinsurance and no copay. Additionally, members receive up to 24 one-way health-related transportation trips per year with no copay, along with a $25 allowance for over-the-counter items every three months with no copay and no coinsurance.