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Senior Care Plus Extensive Duals Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care Plus Extensive Duals Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Care Plus Extensive Duals Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Care Plus Extensive Duals Plan (HMO D-SNP) is a HMO D-SNP plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Washoe, Carson City Counties, NV. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Senior Care Plus Extensive Duals Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Senior Care Plus Extensive Duals Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Care Plus Extensive Duals Plan (HMO D-SNP).
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 Senior Care Plus Extensive Duals Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.50. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8300.00 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 Senior Care Plus Extensive Duals Plan (HMO D-SNP) features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before the plan begins to cover its share of your drug costs. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication tiers, are currently unavailable for this plan. To fully understand your potential out-of-pocket expenses, it is recommended to check the plan's formulary to see how your specific prescription drugs are categorized.
Additional Benefits
The Senior Care Plus Extensive Duals Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most medical services, including primary care, outpatient hospital visits, emergency care, and diagnostic testing. In place of copays, members generally pay a standard 17% coinsurance for these outpatient services, while inpatient hospital stays require an 8% to 10% coinsurance for the first six days before transitioning to no coinsurance. Skilled nursing facility stays and home health services are also highly accessible, requiring no copays and low or no coinsurance. This plan also includes valuable supplemental benefits such as dental coverage with no copays and a $2,500 annual limit for preventive and comprehensive care. Vision and hearing services feature no copays for routine exams, and members receive allowances for eyewear, hearing aids, and up to 36 free one-way medical transportation trips per year. Additionally, the plan provides a quarterly $205 allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) partially covers inpatient hospital services, excluding upgrades and non-Medicare-covered stays. There is no copay for covered stays, but patients pay an 8% coinsurance for acute stays and a 10% coinsurance for psychiatric stays during days 1 through 6, with no coinsurance for days 7 through 90 and unlimited additional days.
Outpatient Services See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 17% coinsurance. Referrals or prior authorizations are required for several of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay and a 17% coinsurance. This service requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers ground and air ambulance services with a 17% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way medical trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with a 17% coinsurance and no copay for emergency and urgent care visits. Worldwide emergency services are partially covered with a 17% coinsurance and no copay up to a $10,000 limit, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, therapy, and opioid treatment services with no copay and a 17% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay and no coinsurance for annual physical exams and kidney disease education. Additional preventive services are partially covered, excluding options like health education, in-home safety assessments, and medical nutrition therapy, while specific screenings and diabetes self-management training require a $0 copay and 17% to 20% coinsurance.
Hearing Services See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers hearing services, offering annual routine hearing exams with no copay and 17% coinsurance, and fitting evaluations with a copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495.00 to $1,970.00, while OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no deductibles and no copays, featuring a 17% coinsurance only for routine eye exams and contact lenses. Benefits include one routine eye exam per year up to $150 (other eye exam services are not covered) and a $400 annual combined maximum for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 17% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance up to a $2,500 annual limit. Sub-services that are not covered include other diagnostic, fluoride, other preventive, adjunctive general, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance between 0% and 17%.
Dialysis Services See details
Dialysis services are covered under the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay and a 17% coinsurance, though a referral is required.
Medical Equipment See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 17% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay and a 17% minimum coinsurance, subject to a required referral. This coverage includes diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Senior Care Plus Extensive Duals Plan (HMO D-SNP) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Senior Care Plus Extensive Duals Plan (HMO D-SNP), as all related sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy—are not covered in practice.
Skilled Nursing Facility (SNF) See details
Senior Care Plus Extensive Duals Plan (HMO D-SNP) covers skilled nursing facility (SNF) services with no copay, though prior authorization and a referral are required. There is no coinsurance for days 1 through 20 and a 16% coinsurance for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Senior Care Plus Extensive Duals Plan (HMO D-SNP), which offers over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Covered OTC items are limited to $205 every three months, and the meal benefit requires prior authorization.
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