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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 2026, 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 2026.
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 features no drug deductible, allowing prescription coverage to begin immediately. For Tier 1 preferred generic drugs and Tier 6 vaccines, members enjoy no copay when using preferred pharmacies or standard mail order. Tier 2 generic drugs cost as low as a $12 copay for a one-month supply, with no copay required for two- or three-month supplies filled through standard mail order. 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. Specialty drugs in Tier 5 incur a 29% coinsurance across all pharmacy options, including mail order. Standard mail order and preferred pharmacies consistently offer the lowest out-of-pocket costs for this plan.
Additional Benefits
The Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan offers comprehensive medical coverage with many services requiring no copay and no coinsurance. For inpatient hospital stays, members pay a $355 daily copay for the first six days and no copay for days seven through 90, with no coinsurance. Additionally, primary care visits, telehealth services, and preventive care are available with no copay and no coinsurance, while specialist visits require a $40 copay. Emergency room visits carry a $130 copay, and urgent care is available for a $35 copay, both with no coinsurance. The plan also covers routine dental and vision exams with low to no copays and no coinsurance, alongside a $1,000 hearing aid allowance per ear every three years. For other essential needs, home health services feature no copay and no coinsurance, while durable medical equipment requires no copay and a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $355 daily copayment for days 1 through 6 and no copayment for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) with no coinsurance across all benefits. Depending on the service, copays range from no copay for blood services, $10 to $20 for substance abuse sessions, and up to $300 for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance per service. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital, and no coinsurance. Urgently needed care requires a $35 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $35, and $225 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $40 copay and no coinsurance. Mental health and psychiatric individual sessions have a $20 copay (group sessions are $10) with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and health education. Excluded sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) partially covers hearing services, offering Medicare-covered exams for a $40 copay and no coinsurance, and prescription hearing aids up to $1,000 per ear every three years with no copay or coinsurance. 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
Vision services are partially covered by Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) with no deductibles. Covered routine eye exams have a $0 to $40 copay and no coinsurance, while covered eyewear carries no copay and a 20% coinsurance for contact lenses, up to a $250 allowance every two years. Upgrades and other eye exam services are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) provides partially covered dental services, featuring preventive care with no coinsurance and a copay ranging from no copay to $40. Medicare-covered services require a $40 copay and no coinsurance, while covered comprehensive services carry a 50% coinsurance and either no copay or a $40 copay; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers home infusion bundled services with prior authorization, offering covered insulin at a copay of $12.00 to $35.00 with no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require a copay of $12.00 to $47.00 and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers medical equipment with no copays, though prior authorization is required. Under this plan, you will pay 0% to 20% coinsurance for durable medical equipment, 20% coinsurance for prosthetics, medical supplies, and diabetic shoes, and no coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. Diagnostic procedures, tests, and lab services have no copay, while outpatient X-rays and diagnostic radiology require a minimum $15 copay, and therapeutic radiology has a minimum $40 copay.
Home Health Services See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under the Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) plan, where some services are covered but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Covered services require a referral and prior authorization, and copayments will apply.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS), featuring no copay or coinsurance for over-the-counter items up to $40 quarterly and no copay with 0% to 20% coinsurance for non-Medicare covered medical supplies. Additionally, non-Medicare covered surgical procedures in an ambulatory surgical center require a $300 copay and no coinsurance, while acupuncture and meal benefits are not covered.
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