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Kaiser Permanente Dual Essential Plan 2 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 2 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 2 MD (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Essential Plan 2 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 AA, Baltimore City/Co, Carroll, Harford, Howard. 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 2 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 2 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 2 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 2 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 2 MD (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) features an annual prescription drug deductible of $200. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no coinsurance when using a preferred pharmacy or standard mail order. Additionally, Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. For Tier 3 preferred brand drugs, the plan offers a low 5% coinsurance at preferred pharmacies and through standard mail order, which increases to 25% at standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a flat 25% coinsurance across all pharmacy options. This plan provides the most significant savings on prescription drug costs when utilizing preferred network pharmacies.
Additional Benefits
The Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) offers comprehensive medical coverage featuring no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits and urgent care require a $30 copay, while inpatient hospital stays have a $375 copay for the first five days and no copay thereafter. Emergency services are available with a $115 copay, which is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,000 yearly limit with copays ranging from no copay to $30 and no coinsurance. Members receive up to 24 one-way transportation trips per year with no copay, a $30 monthly allowance for over-the-counter items, and a $1,000 allowance per ear for prescription hearing aids every three years. Vision care features routine eye exams with copays up to $30 and a $250 eyewear benefit every two years.
Inpatient Hospital See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $375 copay for days 1 to 5 and no copay for days 6 and beyond. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) covers outpatient hospital and observation services with no coinsurance and a copay of $0 to $350, and ambulatory surgical center services with no coinsurance and a $350 copay. Outpatient substance abuse services feature no coinsurance with a $15 copay for individual sessions (no copay for group sessions), while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) with a $15.00 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP), with a $290 copay and no coinsurance for both ground and air ambulance services. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) with a $115 copay (waived if admitted) and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and respective copays of $115, $30, and $290.
Primary Care See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) covers primary care physician visits and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $30 copay and no coinsurance. Individual mental health and psychiatric sessions have a $15 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) with no copay and no coinsurance, though select services require prior authorization or referrals. Not covered sub-services 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/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 Dual Essential Plan 2 MD (HMO D-SNP) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, alongside hearing aid fittings with no copay. While prescription hearing aids 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 2 MD (HMO D-SNP) are partially covered, excluding other eye exam services and eyewear upgrades. Routine eye exams require a $0 to $30 copay with no coinsurance, while covered eyewear features no copay, a 20% coinsurance for contact lenses, and a combined maximum benefit of $250 every two years.
Dental Services See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) partially covers dental services, featuring copays ranging from no copay to $30.00 and no coinsurance, up to a $1,000 yearly maximum. Covered services include preventive care and various comprehensive treatments, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, insulin is available with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Essential Plan 2 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
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) covers medical equipment with no copay, although prior authorization is required. Durable medical equipment incurs a coinsurance ranging from no coinsurance to 20%, diabetic supplies carry no coinsurance, and prosthetic devices, medical supplies, and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services and diagnostic procedures, while outpatient x-rays and diagnostic radiology require a minimum $25 copay, and therapeutic radiology requires a minimum $30 copay.
Home Health Services See details
Home health services are covered by Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP), but in practice, only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Kaiser Permanente Dual Essential Plan 2 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 100-day Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) partially covers other services, offering over-the-counter items with no copay or coinsurance up to $30 monthly, non-Medicare medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare ASC surgical procedures for a $350 copay and no coinsurance. Acupuncture and meal benefits are not covered.
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