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Kaiser Permanente Dual Essential 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 Essential 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 Essential Plan 1 MD (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Essential 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 Essential 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 Essential 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 Essential 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 Essential 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 $200.00 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 Essential Plan 1 MD (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) features a $200 annual drug deductible. For Tier 1 preferred generic and Tier 2 generic medications, members pay no coinsurance when using a preferred pharmacy or standard mail order, while standard pharmacies require a 25% coinsurance. Vaccines in Tier 6 are covered with no copay for a one-month supply 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 25% coinsurance at standard pharmacies. Both Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a flat 25% coinsurance across preferred pharmacies, standard pharmacies, and standard mail-order services.
Additional Benefits
The Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) offers comprehensive healthcare coverage with no copay for primary care visits, preventive services, home health, and diagnostic lab tests. Specialist visits and physical therapy require a $30 copay, while emergency services carry a $115 copay which is waived upon hospital admission. For inpatient hospital stays, members pay a $375 daily copay for the first five days and no copay for days six through ninety, with no coinsurance required. This plan also features essential secondary benefits, including up to twenty-four one-way transportation trips per year to approved locations at no copay. Dental care is covered with no coinsurance and copays up to $30, while routine eye exams range from no copay to a $30 copay. Additionally, over-the-counter items are available with no copay, and durable medical equipment is covered with no copay and a coinsurance ranging from zero to twenty percent.
Inpatient Hospital See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute hospital days are covered at no copay, additional psychiatric days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) with no coinsurance across all covered services. Copays range from no copay for blood services and group substance abuse sessions, to $15 for individual substance abuse sessions, and up to $350 for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) with a $15.00 copay and no coinsurance. This benefit requires prior authorization and a referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP), featuring a $290 copay and no coinsurance for ground and air ambulance services under prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) are covered with a $115 copay (waived if admitted to the hospital) and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance and copays of $115 and $30 respectively, alongside worldwide emergency transportation for a $290 copay.
Primary Care See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech therapy require a $30 copay and no coinsurance. Mental health and psychiatric individual sessions have a $15 copay and no coinsurance, while group sessions have no copay and no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are partially covered, as the plan does not cover in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP), offering Medicare-covered exams for a $30 copay and no coinsurance, and fitting evaluations for no copay and no coinsurance. While some prescription hearing aid services are covered up to $1,000 per ear every three years with no copay and no coinsurance, routine hearing exams, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services under the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) are partially covered, offering routine eye exams with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear features no copay and a 20% coinsurance for contact lenses up to a $250 combined maximum benefit every two years, while eyewear upgrades are excluded.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP), offering no coinsurance and copays ranging from no copay up to $30, with a $1,000 annual maximum for preventive benefits. While preventive, restorative, endodontic, and oral surgery services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin has no copay and no coinsurance, while other covered Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) 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 Dual Essential Plan 1 MD (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment has a coinsurance of 0% to 20%, diabetic supplies have no coinsurance, and prosthetic devices, medical supplies, and diabetic shoes or inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) with no coinsurance, but require prior authorization and referrals. There is no copay for diagnostic tests and lab services, while outpatient X-rays and diagnostic radiological services have a $25 copay, and therapeutic radiological services have a $30 copay.
Home Health Services See details
The Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) covers home health services with no copay and no coinsurance. Access to these covered services requires both a referral and prior authorization.
Cardiac Rehabilitation Services See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as none of the associated sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20, but a $218 daily copay applies for days 21 through 100, and additional days beyond the Medicare limit are not covered.
Other Services See details
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) partially covers other services, excluding acupuncture, meal benefits, and highly integrated services. Covered benefits include over-the-counter items with no copay and no coinsurance, non-Medicare durable medical equipment with no copay and no coinsurance to 20% coinsurance, and non-Medicare ambulatory surgical center procedures with a $350 copay and no coinsurance.
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