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Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) is a HMO D-SNP plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Calvert, Charles, Frederick, Montgomery, PG. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP).
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 Dual Complete Plan 1 MD (HMO D-SNP), 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 a $210.00 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 $9250.00 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:
Sign up for Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) features an annual drug deductible of $210. For Tier 1 preferred generics and Tier 2 generics, you will pay no coinsurance when using a preferred pharmacy or standard mail order, while standard pharmacies charge a 25% coinsurance. Additionally, Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Tier 3 preferred brand drugs require a 5% coinsurance at preferred pharmacies and standard mail order, which increases to a 25% coinsurance at standard pharmacies. For Tier 4 non-preferred drugs and Tier 5 specialty drugs, you will pay a 25% coinsurance regardless of whether you use a preferred pharmacy, standard pharmacy, or standard mail order.
Additional Benefits
The Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) provides robust medical coverage, featuring a $2,080 copay per stay for inpatient hospital services and no copay for unlimited additional acute hospital days. Outpatient services, primary care, and specialist visits feature no copays but generally carry a coinsurance ranging from 0% to 20%. Additionally, emergency room visits require a $115 copay, which is waived upon admission, while urgent care carries a $40 copay. Supplemental care under this plan includes dental coverage with no copay and up to 20% coinsurance, alongside a $300 eyewear allowance every two years with no copay or coinsurance. Members also receive a $1,000 hearing aid allowance per ear every three years, up to 24 one-way transportation trips annually, and a $60 monthly over-the-counter allowance with no copays or coinsurance. Finally, home health services are fully covered with no copay and no coinsurance, and durable medical equipment is available with no copay and 0% to 20% coinsurance.
Inpatient Hospital See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) partially covers inpatient hospital services, requiring a $2,080 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional acute hospital days are covered with no copay, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers outpatient services with no copays, though coinsurance applies to several benefits. Covered outpatient hospital and observation services require a 0% to 20% coinsurance, ambulatory surgical center and substance abuse services require a 20% coinsurance, and outpatient blood services require no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered at these same copay rates with no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and 20% coinsurance, while additional telehealth benefits are offered with no copay and no coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physicals, fitness benefits, and kidney disease education. 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, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services under Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) are partially covered, offering Medicare-covered exams with a copay and no coinsurance or deductible, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear every three years with no copay or coinsurance, but routine exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear hearing aid types are not covered.
Vision Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) offers partially covered vision services with no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses. Eyeglasses, lenses, and frames are covered with no coinsurance up to a $300 combined maximum every two years, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) offers partially covered dental services, with no coverage for maxillofacial prosthetics, implant services, and orthodontics. Covered Medicare-covered, preventive, and oral surgery services have no copay and a 20% coinsurance, while restorative, endodontic, periodontic, and prosthodontic services feature no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers Dialysis Services 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 Dual Complete Plan 1 MD (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 0% to 20% coinsurance, diabetic supplies have no coinsurance, and medical supplies, prosthetic devices, and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. These covered services, which include lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, require prior authorization and referrals.
Home Health Services See details
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) with no copay, though prior authorization and referrals are required. Specific sub-services, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease services, are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) with no coinsurance, featuring 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-covered period are not covered.
Other Services See details
Other Services under the Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) are partially covered, excluding acupuncture, meal benefits, and highly integrated services. Covered benefits include over-the-counter (OTC) items with no copay and no coinsurance up to $60 monthly, select non-Medicare DME with no copay and 0% to 20% coinsurance, and non-Medicare ASC surgical procedures with no copay and 20% coinsurance.
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