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Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Standard 1 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 Standard 1 MD (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) is a HMO-POS 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 Medicare Advantage Standard 1 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 Standard 1 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 Standard 1 MD (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $7900.00 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 1 MD (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, costing a $12 copay for a one-month supply at preferred pharmacies, with no copay for two- and three-month supplies filled via standard mail order. Tier 3 preferred brand drugs require a $45 copay at preferred pharmacies, while Tier 4 non-preferred drugs carry a $100 copay. Specialty drugs in Tier 5 require a 29% coinsurance across all pharmacies, and Tier 6 vaccines are covered with no copay for a one-month supply. This plan offers significant savings opportunities, particularly when utilizing preferred pharmacies and mail-order services for multi-month supplies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care, preventive services, and home health care. For specialized care, members pay a $40 copay for specialist visits, while inpatient hospital stays require a $375 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $115 copay, which is waived upon admission, and urgent care services are available for a $40 copay. This plan also includes valuable supplemental benefits, such as routine dental care with no coinsurance and low copays, and comprehensive dental services generally covered with a 50% coinsurance. Vision coverage features routine eye exams with copays up to $40 alongside a $200 eyewear allowance every two years, while select prescription hearing aids are covered up to $1,000 per ear every three years. Additionally, members can access up to 24 one-way transportation trips annually to approved health locations with no copay, as well as a $40 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $325 for outpatient hospital and observation services. Ambulatory surgical center services require a $325 copay, outpatient substance abuse services have a $10 group or $20 individual session copay, and outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) plan, with ground and air ambulance services requiring prior authorization and a $275 copay with no coinsurance. Transportation is partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) plan with a $115 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are also covered with copays ranging from $40 to $275 and no coinsurance.
Primary Care See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance. Other covered services also feature no coinsurance, with copays of $35 for occupational therapy, $40 for specialists, physical therapy, and opioid treatment, and $10 to $20 for mental health and psychiatric sessions, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness benefits. However, several sub-services are not covered, including medical nutrition therapy, weight management programs, alternative therapies, personal emergency response systems, and in-home safety assessments.
Hearing Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, and hearing aid evaluations with no copay and no coinsurance. Some prescription hearing aid services are covered up to $1,000 per ear every three years with no copay or coinsurance, but routine hearing exams, OTC hearing aids, and inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers routine eye exams with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance up to a $200 combined maximum limit every two years, excluding eyewear upgrades.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) plan, with preventive care requiring no coinsurance and a copay between $0 and $40. Covered comprehensive services generally carry a 50% coinsurance and no copay (except oral surgery, which has a $40 copay and 50% coinsurance), while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers home infusion bundled services, with prior authorization required. Covered Part B insulin has a $12.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs require a $12.00 to $47.00 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Standard 1 MD (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 prosthetic devices, medical supplies, and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Diagnostic procedures, tests, and lab services require no copay, while outpatient x-rays and diagnostic radiological services have a minimum $20 copay, and therapeutic radiological services have a minimum $40 copay.
Home Health Services See details
Home health services are fully covered under the Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) plan with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay or coinsurance up to $40 every three months, non-Medicare medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare ASC surgical procedures for a $325 copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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