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Kaiser Permanente Medicare Advantage Value 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 Value 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 Value 2 VA (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Value 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 Fred�burg, Loudoun, Manassas, PW, SP, Stafford. 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 Value 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 Value 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 Value 2 VA (HMO-POS), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7500.00 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 Value 2 VA (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or standard mail order. Tier 2 generic drugs carry a $12 copay for a one-month supply at preferred pharmacies, while standard mail order offers these medications with no copay for two- and three-month fills. Tier 3 preferred brand drugs require a $45 copay at preferred pharmacies, whereas Tier 4 non-preferred drugs have a $100 copay for a one-month supply. Tier 5 specialty drugs require a 29% coinsurance regardless of whether you use a preferred, standard, or mail-order pharmacy. Additionally, Tier 6 vaccines are fully covered with no copay at both preferred and standard retail pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs. You will pay no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For inpatient hospital stays, there is a $360 daily copay for the first five days and no copay for days six through 90, while specialist visits require a $35 copay. This plan also includes essential dental, vision, and hearing benefits to support your overall well-being. Preventive dental care features no copay to a $35 copay with no coinsurance, while prescription hearing aids are covered with no copay up to a $1,000 maximum per ear every three years. Additionally, routine eye exams carry no copay to a $35 copay, and home health services are available with no copay and no coinsurance.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $360 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered as room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital and observation services, and a $350 copay for ambulatory surgical center services. Outpatient substance abuse services require a $5 copay for group sessions and a $10 copay for individual sessions, while outpatient blood services are fully covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Medicare Advantage Value 2 VA (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 Value 2 VA (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $40 to $275.
Primary Care See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Mental health and psychiatric services have a $5 to $10 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and health education. Specific sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services under the Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) plan include Medicare-covered hearing exams for a $35 copay and no coinsurance, with no deductible. Prescription hearing aids are covered with no copay or coinsurance up to a $1,000 maximum per ear every three years, although routine hearing exams, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) with no deductibles, offering routine eye exams with a $0 to $35 copay and no coinsurance, and eyewear with no copay and a 20% coinsurance for contact lenses up to a $200 limit every two years. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) provides partially covered dental services, featuring a $0 to $35 copay and no coinsurance for preventive care and a $35 copay with no coinsurance for Medicare-covered dental. Most comprehensive services require no copay and 50% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers Home Infusion bundled Services with prior authorization, offering Medicare Part B insulin for a $12.00 to $35.00 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation drugs, require a copay of $12.00 to $47.00 and coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Value 2 VA (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 require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for diagnostic procedures, tests, and lab services, while outpatient X-rays and diagnostic radiological services have a minimum $20 copay, and therapeutic radiological services require a minimum $35 copay.
Home Health Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) plan with no coinsurance, although referrals and prior authorization are required. While some services are covered, several sub-services are not covered in practice, including standard cardiac rehabilitation with a $30 copay, intensive cardiac rehabilitation with a $40 copay, pulmonary rehabilitation with a $25 copay, and supervised exercise therapy for peripheral artery disease with a $20 copay.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) partially covers other services, as acupuncture and meal benefits are not covered. Covered services include over-the-counter items with no copay and no coinsurance, non-Medicare covered medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare covered ASC surgical procedures with a $350 copay and no coinsurance.
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