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Kaiser Permanente Medicare Advantage Value VA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Value 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 Value VA (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Value 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 2025.
It's important to know that Kaiser Permanente Medicare Advantage Value 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 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 Value VA (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6500.00 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 Value VA (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs, so you will not have to pay anything out-of-pocket before your coverage kicks in. During the initial coverage phase, you will pay a copay depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $12 copay at preferred pharmacies, and standard generic drugs have a $45 copay at preferred pharmacies. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Value VA (HMO-POS) plan offers a range of benefits. It covers inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with copays. The plan also provides coverage for primary care, preventive services, hearing, vision, and dental services, with copays or coinsurance depending on the specific service. Additional benefits include ambulance and transportation services, home infusion, dialysis services, and medical equipment with copays or coinsurance. The plan also covers skilled nursing facility stays with copays, and other services like OTC items. However, some services like cardiac rehabilitation and certain other specialized care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays, with a $270 copay for days 1-5 and no copay for days 6-90. Additional days for acute inpatient hospital stays are covered with no copay, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $270, observation services with a copay between $0 and $270, and outpatient substance abuse services, with individual sessions costing a $10 copay and group sessions costing a $5 copay. Ambulatory Surgical Center (ASC) Services have a $270 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Medicare Advantage Value VA (HMO-POS) plan, with a $5 copay. Prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $275 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered with no copay and no coinsurance, up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, Urgently Needed Services has a $40 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Kaiser Permanente Medicare Advantage Value VA (HMO-POS) plan. Primary Care Physician Services and Chiropractic Services have a $5 copay, Physician Specialist Services and Physical Therapy have a $40 copay, and Mental Health Specialty Services and Psychiatric Services have varying copays depending on the service. Additional Telehealth Benefits has no copay.
Preventive Services See details
Preventive Services include Medicare-covered zero-dollar preventive services, annual physical exams with no copay, and other preventive services, including health education, fitness benefits, remote access technologies, home-based palliative care, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing exams are covered with a $40 copay, while fitting and evaluation for hearing aids has no copay. Prescription hearing aids are covered up to $1,000 every three years, and prescription hearing aids (all types) are covered for 2 visits every three years. Routine hearing exams, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with 20% coinsurance for contact lenses, but upgrades are not covered. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services, and other dental services have a copay of $0-$40. Orthodontic Services are covered up to a maximum of $1,500 per year, while Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery all have a 50% coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay of $12-$35, and Medicare Part B Chemotherapy/Radiation Drugs with a copay of $12-$47 and a coinsurance between 0-20%. Other Medicare Part B Drugs have a copay of $12-$47 and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies and Diabetic Equipment, both with a 20% coinsurance for some services. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Kaiser Permanente Medicare Advantage Value VA (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $170.00 (minimum $20.00), Therapeutic Radiological Services have a copay of at most $40.00 (minimum $40.00), and Outpatient X-Ray Services have a $20.00 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Value VA (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 Value VA (HMO-POS) plan. Prior authorization and a doctor referral are required, but the plan does not cover any of the listed sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Medicare Advantage Value VA (HMO-POS) plan, with a doctor's referral and prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months, and other services such as DME and medical supplies not covered by Medicare which have a coinsurance of 0% - 20% and surgical procedures performed in an ASC not covered by Medicare which have a copay of $270. Acupuncture, Meal Benefit, 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.
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