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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 2025, 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 2025.
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 $27.00. 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 has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $15 copay for a preferred generic drug at a preferred pharmacy, and 31% coinsurance for a non-preferred drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services with a copay. Emergency services are covered with copays for different situations. This plan includes coverage for primary care with a $10 copay, hearing exams with a $45 copay, and vision services with copays for eye exams and coinsurance for eyewear. Dental services are covered, and the plan also provides benefits for home infusion, dialysis, medical equipment, and diagnostic services with various cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $335 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, may have a copay of $0 to $325. Ambulatory Surgical Center (ASC) Services have a $325 copay. Outpatient Substance Abuse Services have a $20 copay for individual sessions and a $10 copay for group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $10 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan. All ambulance services require prior authorization, with no coinsurance, and a $350 copay for both ground and air ambulance services. 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 under the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $350 copay, while Worldwide Urgent Coverage has a $45 copay; all have no coinsurance.
Primary Care See details
The Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan covers primary care physician services and chiropractic services with a $10 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services and physical therapy with a $45 copay, and mental health specialty services with a copay of $10-$20 depending on the service. Additional telehealth benefits have no copay, and opioid treatment program services have a $45 copay. Podiatry services are not covered.
Preventive Services See details
The Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like Health Education, Home-Based Palliative Care, and Fitness Benefit* are covered, but may have a copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), and more are not covered.
Hearing Services See details
Hearing exams have a $45 copay, while fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) are covered for 2 visits every three years, and the plan covers up to $1000 per ear every three years for prescription hearing aids. Routine hearing exams, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45 and eyewear with 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. However, upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $45 copay, and other dental services with a copay between $0 and $45. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 50% coinsurance. Orthodontic Services are covered up to a maximum of $1500 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan, including Medicare Part B Insulin Drugs with a copay between $15 and $35, and Medicare Part B Chemotherapy/Radiation Drugs with a copay between $15 and $47 and a coinsurance between 0% and 20%. Other Medicare Part B Drugs are covered with a copay between $15 and $47 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under the Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $50, up to $200, Therapeutic Radiological Services have a copay of $45, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Care Plus MD (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, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $203 per day.
Other Services See details
The Other Services benefit covers over-the-counter items with a maximum of $100 every three months, and other services including DME and medical supplies not covered by Medicare with 0% to 20% coinsurance, and surgical procedures performed in an ASC not covered by Medicare with a $325 copay. Acupuncture, meal benefits, 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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