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Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Standard 2 VA (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 2 VA (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Northern Virginia. 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 2 VA (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 2 VA (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 2 VA (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $5900.00 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 2 VA (HMO-POS) plan features prescription drug coverage with a $0 drug deductible, meaning you have no annual deductible to meet. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or standard mail order. Tier 2 generic drugs cost $10 for a one-month supply at preferred pharmacies, but you can get a two-month or three-month supply for no copay through standard mail order. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at preferred pharmacies and standard mail order. Tier 4 non-preferred drugs have a $100 copay for a one-month supply, while Tier 5 specialty drugs require a 29% coinsurance across all pharmacy options. Finally, Tier 6 vaccines are highly accessible with no copay for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) plan offers comprehensive medical coverage with predictable, low out-of-pocket costs. Members benefit from no copay for primary care visits, telehealth services, and home health care, as well as no coinsurance for inpatient hospital stays, which carry a $325 daily copay for the first six days. Specialist visits, urgent care, and physical therapy are available with a $35 copay, while emergency room visits require a $130 copay. The plan also features partial coverage for dental, vision, and hearing services, featuring no copay for routine preventive dental care and up to $1,000 per ear for prescription hearing aids every three years. Prescription eyewear is covered with a 20% coinsurance up to $250 every two years, and skilled nursing facility stays require no copay for the first 20 days. Additionally, members receive an over-the-counter allowance of up to $35 every three months with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because non-Medicare-covered stays, hospital upgrades, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $325 for outpatient hospital and observation services, and a $325 copay for ambulatory surgical center services. Outpatient substance abuse sessions carry a $5 to $10 copay with no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance, requiring prior authorization. Transportation benefits are partially covered with no copay or coinsurance, offering up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services are covered with a $35 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $35 for urgent care, and $225 for emergency transportation.
Primary Care See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) offers primary care physician visits and telehealth services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, and opioid treatment require a $35 copay with no coinsurance, while mental health and psychiatric sessions range from a $5 to $10 copay with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. The plan's additional preventive services are only partially covered; excluded 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 benefits, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) partially covers hearing services, featuring a $35 copay and no coinsurance for Medicare-covered exams, though routine hearing exams and OTC hearing aids are not covered. Prescription hearing aids and fitting evaluations are covered with no copay and no coinsurance up to $1,000 per ear every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS), with routine eye exams requiring a $0 to $35 copay and no coinsurance, while other eye exam services and eyewear upgrades are not covered. Eyewear is covered with no copay and a 20% coinsurance up to a $250 combined maximum limit every two years.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS), with preventive and diagnostic care costing no copay to a $35 copay and no coinsurance. Most covered comprehensive services require a 50% coinsurance with either no copay or a $35 copay, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers home infusion bundled services with prior authorization, requiring a copay of $10.00 to $47.00 and 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs. Covered Part B insulin has a copay of $10.00 to $35.00 and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers medical equipment with no copays, requiring prior authorization for all categories. Durable medical equipment carries 0% to 20% coinsurance, diabetic supplies have no coinsurance, and prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers diagnostic and radiological services 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 $20 copay, and therapeutic radiology requires a $35 copay.
Home Health Services See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) with no copay and no coinsurance; however, while some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation (each with a $35 copay) along with supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) 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, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS) plan are partially covered, excluding acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance up to $35 every three months, non-Medicare medical supplies and equipment with no copay and 0% to 20% coinsurance, and non-Medicare ASC surgical procedures for a $325 copay and no coinsurance.
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