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Kaiser Permanente Medicare Advantage Value 1 MD (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Value 1 MD (HMO). 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 1 MD (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) is a HMO 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 Value 1 MD (HMO) 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 1 MD (HMO).
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 1 MD (HMO), 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 $8200.00 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 1 MD (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or standard mail order. Tier 2 generic prescriptions carry a $13 copay at preferred pharmacies, though standard mail order offers no copay on two- and three-month supplies. Tier 3 preferred brands and Tier 4 non-preferred drugs require a $45 and $90 copay respectively for a one-month supply at preferred pharmacies. Specialty drugs in Tier 5 incur a 28% coinsurance across all pharmacy options, while Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Standard pharmacies are also available but generally come with higher copays for most drug tiers.
Additional Benefits
The Kaiser Permanente Medicare Advantage Value 1 MD (HMO) plan offers affordable coverage with no copay for primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a $360 copay for days one through five and no copay for days six through 90, with no coinsurance. Emergency room visits carry a $115 copay, which is waived upon admission, while specialist visits and outpatient diagnostic tests require low copays or no copays. This plan also features essential dental, vision, and hearing benefits to help lower your out-of-pocket costs. Preventive dental and routine vision exams feature low to no copays, while prescription hearing aids are covered with no copay and no coinsurance up to $1,000 per ear every three years. Additionally, members benefit from no copays on over-the-counter items and diagnostic lab tests, with durable medical equipment requiring 0% to 20% coinsurance and no copay.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) partially covers inpatient hospital services with no coinsurance and a $360 copay for days 1 through 5, followed by no copay for days 6 through 90. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers outpatient services with no coinsurance, although copays and prior authorization or referral requirements apply to most benefits. Outpatient hospital and observation stays carry a copay of $0 to $350, ambulatory surgical center services require a $350 copay, substance abuse therapy ranges from a $10 to $20 copay, and outpatient blood services are covered with no copay and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Medicare Advantage Value 1 MD (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Medicare Advantage Value 1 MD (HMO) with a $115 copay (waived if admitted) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $275 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and opioid treatment services require copays of $35 to $40 with no coinsurance. Mental health, psychiatric, and other professional services feature copays ranging from $0 to $40 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Medicare Advantage Value 1 MD (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding sub-services like weight management, alternative therapies, therapeutic massage, in-home safety assessments, nutritional benefits, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by the Kaiser Permanente Medicare Advantage Value 1 MD (HMO) plan, which offers Medicare-covered exams for a $40 copay and no coinsurance, and hearing aid fittings with no copay and no coinsurance. For prescription hearing aids, there is no copay and no coinsurance up to $1,000 per ear every three years, but only some services are covered as inner ear, outer ear, and over-the-ear prescription devices are not covered. Routine hearing exams and OTC hearing aids are also not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers vision services, offering routine eye exams with a $0 to $40 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear benefits have no copay, a 20% coinsurance for contact lenses, and no deductible, providing up to a $200 combined maximum benefit every two years, excluding upgrades.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Medicare Advantage Value 1 MD (HMO), which excludes coverage for maxillofacial prosthetics, implant services, and orthodontics. Covered preventive services feature no coinsurance and a copay ranging from $0 to $40, while covered comprehensive services require 50% coinsurance with either no copay, or a $40 copay for oral surgery.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers home infusion bundled services with prior authorization, offering Part B insulin for a $13.00 to $35.00 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and additional drugs require a copay of $13.00 to $47.00 and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Medicare Advantage Value 1 MD (HMO) with no copays, though prior authorization is required. Members pay no coinsurance for diabetic supplies, 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes, and between 0% and 20% coinsurance for durable medical equipment (DME).
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Kaiser Permanente Medicare Advantage Value 1 MD (HMO) plan with no coinsurance, though prior authorization and referrals are required. Outpatient lab services and diagnostic tests have no copay, while outpatient X-rays, therapeutic, and diagnostic radiological services require a copay starting at $40.
Home Health Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) covers home health services 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 Value 1 MD (HMO) with no coinsurance; however, while some services are covered, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for PAD ($20 copay) are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Kaiser Permanente Medicare Advantage Value 1 MD (HMO) 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 for these services, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) partially covers other services, excluding acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance, non-Medicare durable medical equipment with no copay and 0% to 20% coinsurance, and non-Medicare surgical procedures in an ambulatory surgical center for a $350 copay and no coinsurance.
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