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Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Care Plus 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 Care Plus VA (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Care Plus 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 Care Plus 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 Care Plus 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 Care Plus VA (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $5500.00 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 Care Plus VA (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and where you fill your prescription. For example, a preferred generic drug will cost $12 at a preferred pharmacy, and a standard generic drug will cost $45. The plan offers an enhanced alternative drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you'll pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium will be $18.40.
Additional Benefits
The Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a $280 copay for the first six days, and then no copay for the remainder of the stay. Outpatient services, primary care, and preventive services often have no copay. This plan includes coverage for hearing aids with a $1,000 allowance, vision services with a $250 allowance, and dental services with copays ranging from $0 to $40. It also covers ambulance services, emergency services, and home health services with copays or coinsurance. Additionally, the plan provides coverage for home infusion services, dialysis services, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, with a $280 copay for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, are covered. Outpatient Hospital Services and Observation Services have a copay of $0-$225, Ambulatory Surgical Center (ASC) Services have a $225 copay, and Outpatient Blood Services have no copay. Individual Sessions for Outpatient Substance Abuse have a $20 copay, while Group Sessions for Outpatient Substance Abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $5 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $225 copay, and transportation services to a plan-approved health-related location with no copay. 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 have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, a $40 copay for Worldwide Urgent Coverage, and a $225 copay for Worldwide Emergency Transportation; all services have no coinsurance.
Primary Care See details
The Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan covers primary care physician services and chiropractic services for a $5 copay, occupational therapy services for a $40 copay, and physician specialist services and physical therapy for a $40 copay. The plan also covers mental health services with a $20 copay for individual sessions and a $10 copay for group sessions, and other healthcare professionals for a copay between $5 and $40. Additionally, the plan covers additional telehealth benefits with no copay.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered by the Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan. Annual physical exams, health education, Home-Based Palliative Care, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs after a Welcome Visit have no copay. However, 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, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay. Fitting and evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a plan-specified maximum amount of $1,000 per ear every three years. Routine hearing exams, inner ear hearing aids, outer ear hearing aids, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$40, while eyewear has a 20% coinsurance for contact lenses. Eyewear has a combined maximum plan benefit coverage amount of $250 every two years.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $40 copay, and Other Dental Services with a copay of $0-$40. Additional covered services include oral exams, dental x-rays, diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontics with a $2,000 maximum benefit, restorative services with 50% coinsurance, adjunctive general services with 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics (removable) with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with a $40 copay and 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, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $12-$47 and 0%-20% coinsurance, and Other Medicare Part B Drugs with a copay of $12-$47 and 0%-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, with Durable Medical Equipment for use outside the home not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have a coinsurance between 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $180.00, Therapeutic Radiological Services have a copay of at most $40.00, and Outpatient X-Ray Services have a $15.00 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Care Plus 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 covered with prior authorization and a doctor's referral, but the plan states that Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan does not provide any information on cost sharing for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $203 copay for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $50 every three months, and Other 1, which covers DME and medical supplies not covered by Medicare with 0% to 20% coinsurance. 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. Other 2 covers surgical procedures performed in an ASC not covered by Medicare, with a copay of $225.
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