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Kaiser Permanente Medicare Advantage Value 2 MD (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Value 2 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 2 MD (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Carroll, Harford, Howard. 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 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 2 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 2 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 $8900.00 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 MD (HMO) plan features a $0 prescription drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or standard mail order. Tier 2 generic drugs cost as low as a $13 copay for a one-month supply at preferred pharmacies, while Tier 6 vaccines are available with no copay. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs require a $100 copay. Specialty drugs in Tier 5 require a 28% coinsurance regardless of the pharmacy type or supply duration. You can also save on multi-month prescriptions by utilizing standard mail order, which offers reduced copays for generic and brand-name drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan offers affordable access to core healthcare services with no coinsurance for many key benefits. Primary care visits require a low $5 copay, telehealth services are available with no copay, and specialist visits range from $35 to $45. Inpatient hospital stays feature a $360 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $115 copay that is waived upon admission. Preventive care, annual physicals, and fitness benefits are covered with no copay or coinsurance, though many specialized wellness and alternative therapy programs are excluded. Routine dental cleanings and vision exams feature low copays ranging up to $45, and prescription hearing aids are covered up to $1,000 per ear every three years with no copay. Additionally, home health services are provided with no copay, and durable medical equipment requires no copay with coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $360 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) covers outpatient services with no coinsurance, featuring copays from $0 to $350 for outpatient hospital and observation services. Ambulatory surgical center services require a $350 copay, outpatient substance abuse sessions carry a $10 to $20 copay, and outpatient blood services are provided with no copay.
Partial Hospitalization See details
The Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan covers partial hospitalization services with a $5.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services through the Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan cover emergency ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Although transportation benefits are technically listed, they are not covered in practice as transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Medicare Advantage Value 2 MD (HMO) with a $115 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed care requires a $40 copay and no coinsurance, while 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 MD (HMO) covers primary care physician services for a $5 copay and telehealth services with no copay, both featuring no coinsurance. Specialist visits, physical therapy, and occupational therapy require copays ranging from $35 to $45 with no coinsurance, while mental health sessions have a $10 to $20 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Kaiser Permanente Medicare Advantage Value 2 MD (HMO) with no copay and no coinsurance for received services like annual physicals, fitness benefits, and health education. However, sub-services such as 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/dietary benefits, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) partially covers hearing services, offering Medicare-covered hearing exams for a $45 copay and no coinsurance, and hearing aid fittings and prescription hearing aids with no copay or coinsurance. While prescription hearing aids are covered up to $1,000 per ear every three years, routine hearing exams, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Medicare Advantage Value 2 MD (HMO), excluding other eye exam services and eyewear upgrades. Eye exams feature a $0 to $45 copay with no coinsurance, and covered eyewear has no copay and a 20% coinsurance for contact lenses up to a $200 maximum limit every two years.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan, featuring no coinsurance and copays ranging from no copay to $45 for Medicare-covered and preventive care like cleanings, exams, and X-rays. Comprehensive treatments, including restorative, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) covers home infusion bundled services, requiring prior authorization. Covered Medicare Part B insulin has a $13.00 to $35.00 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a $13.00 to $47.00 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive coverage for these services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Value 2 MD (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries between no coinsurance and 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
Diagnostic and radiological services are covered by Kaiser Permanente Medicare Advantage Value 2 MD (HMO) with no coinsurance, although prior authorization and referrals are required. There is no copay for diagnostic tests, procedures, and lab services, while outpatient x-rays and diagnostic radiological services require a $40 copay, and therapeutic radiological services require a $45 copay.
Home Health Services See details
The Kaiser Permanente Medicare Advantage Value 2 MD (HMO) plan 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 by Kaiser Permanente Medicare Advantage Value 2 MD (HMO) with no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Kaiser Permanente Medicare Advantage Value 2 MD (HMO) with no coinsurance, offering no copay for days 1 to 20 and a daily copay of $218 for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the 100-day Medicare-covered benefit are not covered.
Other Services See details
Other Services under the Kaiser Permanente Medicare Advantage Value 2 MD (HMO) are partially covered, with acupuncture, over-the-counter items, and meal benefits excluded from coverage. Covered benefits include non-Medicare durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance, and non-Medicare ambulatory surgical center procedures for a $350 copay and no coinsurance.
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