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Kaiser Permanente Medicare Advantage Care Plus MD (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 MD (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 MD (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Howard and Montgomery counties. 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 MD (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 MD (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 MD (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7500.00 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 MD (HMO-POS) plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, members pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs cost a $12 copay for a one-month supply at preferred pharmacies and standard mail order, with the copay dropping to no copay for two- and three-month mail order supplies. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs carry a one-month copay of $47 and $100 respectively at both preferred and standard pharmacies. Specialty drugs in Tier 5 require a 28% coinsurance across all pharmacy options, while Tier 6 vaccines are covered with no copay for a one-month supply. Utilizing standard mail order can also offer cost savings, capping three-month copays at $94 for Tier 3 and $200 for Tier 4 drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no copay for preventive care, telehealth visits, and home health services. Primary care visits require a low $5 copay, while specialist visits and outpatient hospital services have copays of up to $45 and $375 respectively, with no coinsurance. Emergency care is covered with a $115 copay, which is waived if admitted, while inpatient hospital stays require a copay of $385 per day for the first six days of acute care. Supplemental benefits include preventive dental care starting at no copay, comprehensive dental services with a 50% coinsurance, and vision benefits featuring no deductible and a $250 eyewear allowance. Hearing aid services are covered with no copay up to $1,000 per ear every three years, and members receive a quarterly $65 allowance for over-the-counter items. Additionally, skilled nursing facility stays require no copay for the first 20 days, and diagnostic lab tests are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) with no coinsurance, requiring a $385 copay for days 1 to 6 of acute care and a $345 copay for days 1 to 6 of psychiatric care, followed by no copay for additional covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) covers outpatient hospital and observation services with a copay of up to $375 and no coinsurance, and ambulatory surgical center services with a $375 copay and no coinsurance. Outpatient substance abuse sessions require a $10 to $20 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) covers partial hospitalization services with a $5.00 copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services through Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) include ground and air ambulance transportation with a $350 copay per service and no coinsurance, subject to prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $115 for emergency care, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) provides partially covered primary care benefits, which exclude podiatry and chiropractic services. Covered care features no coinsurance, with copays ranging from $5 for primary care visits up to $45 for specialists and physical therapy, while telehealth services are available with no copay.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan with no copay and no coinsurance for covered benefits like annual physicals, fitness benefits, and health education. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) partially covers hearing exams with a $45 copay and no coinsurance for Medicare-covered exams and no copay for fitting evaluations, though routine hearing exams are not covered. Some prescription hearing aid services are covered with no copay and no coinsurance up to $1,000 per ear every three years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) with no deductibles, featuring routine eye exams with a $5 to $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is partially covered with no copays, a 20% coinsurance for contact lenses, and a combined maximum benefit of $250 every two years, though upgrades are excluded.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS), excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare and preventive dental services range from no copay to a $45 copay with no coinsurance, while covered comprehensive services require a 50% coinsurance and either no copay or a $45 copay up to a $1,500 annual limit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) with prior authorization required. Covered Medicare Part B insulin drugs have a $12.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs feature a $12.00 to $47.00 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Medicare Advantage Care Plus MD (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
Medical equipment is covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) with no copays, although prior authorization is required. Durable medical equipment ranges from no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic shoes require 20% coinsurance, and diabetic supplies are available with no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) covers diagnostic procedures, tests, and lab services with no copay and no coinsurance. Radiological services also feature no coinsurance, but require a $50 copay for outpatient x-rays, a minimum $50 copay for diagnostic radiological services, and a minimum $45 copay for therapeutic radiological services.
Home Health Services See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) with no coinsurance, but some services are covered while standard cardiac ($30 copay), intensive cardiac ($40 copay), pulmonary ($25 copay), and SET for PAD services ($20 copay) are not covered. Prior authorization and referrals are required for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other services are partially covered by Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS), featuring over-the-counter (OTC) items with no copay and no coinsurance up to a $65 quarterly limit, alongside select non-Medicare covered DME with no copay and 0% to 20% coinsurance. Non-Medicare covered surgical procedures in an ambulatory surgical center require a $375 copay and no coinsurance, while acupuncture and meal benefits are not covered.
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