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Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Standard DC (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 Standard DC (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in DC. 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 Standard DC (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 Standard DC (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 Standard DC (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7400.00 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 Standard DC (HMO-POS) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order, and Tier 6 vaccines also feature no copay. Tier 2 generic drugs are highly affordable, with copays starting at $12 at preferred pharmacies and no copay for two- or three-month supplies ordered through standard mail. Tier 3 preferred brand drugs cost a $45 copay at preferred pharmacies or standard mail order, while Tier 4 non-preferred drugs carry a $100 copay. Specialty medications in Tier 5 require a 29% coinsurance across all pharmacy options. Standard pharmacies are also available but generally carry higher copays, such as $10 for Tier 1 and $20 for Tier 2 medications.
Additional Benefits
The Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, highlighting no copays for primary care, telehealth, diagnostic labs, and home health services. For acute and specialized care, members pay fixed copays with no coinsurance, including $35 for specialist visits, $115 for emergency care, and $350 per day for the first five days of inpatient hospital stays. This plan also features essential supplemental benefits, such as dental coverage with a $1,000 annual limit, a $250 eyewear allowance, and up to $1,000 per ear for prescription hearing aids. Additionally, members can access a $50 over-the-counter benefit every three months and receive medical equipment with no copays, though some durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a copay of $350 per day for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute care days are covered with no copay, psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) with no coinsurance, featuring a copay of $0 to $330 for outpatient hospital and observation services. Ambulatory surgical center services require a $330 copay and no coinsurance, while outpatient substance abuse services have a $5 to $10 copay and no coinsurance. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. The plan also offers up to 24 one-way transportation 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 for the Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) plan are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $35 copay with no coinsurance, while worldwide emergency services, urgent care, and emergency transportation are covered with no coinsurance and copays of $115, $35, and $275 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies require a $35 copay and no coinsurance. Mental health and psychiatric services have no coinsurance and feature a $10 copay for individual sessions or a $5 copay for group sessions, but chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered care like annual physical exams, fitness benefits, and kidney disease education. Several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services covered under the Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) include Medicare-covered exams for a $35 copay and no coinsurance, while routine hearing exams and OTC hearing aids are not covered. Prescription hearing aids and fittings are covered with no copay or coinsurance up to a $1,000 maximum per ear every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) covers routine eye exams with no coinsurance and a copay ranging from no copay up to $35, though other eye exam services are not covered. Eyewear is also covered with no copay, a 20% coinsurance for contact lenses, and a $250 combined maximum benefit every two years, but eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) partially covers dental services, providing preventive care with a $0 to $35 copay and no coinsurance, and comprehensive treatments with a 50% coinsurance and a $0 to $35 copay. A $1,000 annual limit applies to comprehensive services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) with prior authorization, featuring Part B insulin at a $12.00 to $35.00 copay and no coinsurance. Chemotherapy, radiation, and other Part B drugs are covered with copays ranging from $12.00 to $47.00 and coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) 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 prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) covers diagnostic and radiological services with no coinsurance, though referrals and prior authorizations are required. Members pay no copay for diagnostic procedures, tests, and lab services, while outpatient X-rays and diagnostic radiological services carry a copay starting at $20, and therapeutic radiological services require a minimum copay of $35.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) with no copay and no coinsurance, though only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) with no coinsurance, requiring prior authorization and a referral. There is no copay for days 1 through 20, followed by a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) partially covers other services, excluding acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance up to $50 every three months, non-Medicare covered DME and medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare covered surgical procedures in an ambulatory surgical center for a $330 copay and no coinsurance.
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