A non-government entity
Senior Care Plus Enriched 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 Enriched 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 Enriched Duals Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Care Plus Enriched 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 Clark County 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 Enriched 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 Enriched 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 Enriched 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 Enriched 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:
Sign up for Senior Care Plus Enriched Duals Plan (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Senior Care Plus Enriched Duals Plan (HMO D-SNP) features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before the plan begins to cover your prescription costs. Specific drug coverage tier details, including individual copayments and coinsurance rates, are not available for this plan. For the most accurate estimate of your medication costs, you should verify how your specific prescriptions are covered under the plan's formulary.
Additional Benefits
The Senior Care Plus Enriched Duals Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most primary care, specialist visits, outpatient services, and emergency care, though these services generally require a 17% coinsurance. Inpatient hospital stays also feature no copay, requiring an 8% coinsurance for acute stays and 10% for psychiatric stays during the first six days. Additionally, home health services are fully covered with no copay and no coinsurance, while skilled nursing facility stays require no coinsurance for the first 20 days. This plan provides valuable supplemental benefits, including up to 36 one-way medical transport trips and a $200 quarterly over-the-counter allowance with no copay and no coinsurance. Dental services are covered with no copay and no coinsurance up to a $2,000 annual limit, while vision care features no copays with a 17% coinsurance for exams and eyewear. Hearing services require no deductible, offering routine exams with no copay and prescription hearing aids with copays ranging from $495 to $1,970.
Inpatient Hospital See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) partially covers inpatient hospital services with no copay, requiring an 8% coinsurance for days 1 through 6 of acute stays and a 10% coinsurance for days 1 through 6 of psychiatric stays, with no coinsurance thereafter. Prior authorization and referrals are required, and the plan does not cover upgrades or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services under the Senior Care Plus Enriched Duals Plan (HMO D-SNP) are covered with no copay and a 17% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Some of these covered services may require a prior authorization or referral.
Partial Hospitalization See details
Partial hospitalization is covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay and a 17% coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP), with ground and air ambulance services requiring a 17% coinsurance and no copay. Transportation services are partially covered, offering up to 36 one-way medical transport 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
Emergency services are covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with a 17% coinsurance and no copay for emergency and urgent care, with the coinsurance waived if you are admitted to the hospital. Worldwide emergency and urgent care are partially covered up to a $10,000 limit with a 17% coinsurance and no copay, though worldwide emergency transportation is not covered.
Primary Care See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, and therapy services with no copay and a 17% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services under the Senior Care Plus Enriched Duals Plan (HMO D-SNP) are covered with no copay and no coinsurance for annual physicals, kidney disease education, and select supplemental benefits like counseling and fitness. A 17% coinsurance and no copay apply to glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs. Additional preventive benefits are only partially covered, as health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, and home safety devices are not covered.
Hearing Services See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) covers hearing services with no deductible, including an annual routine exam with no copay and 17% coinsurance, and a fitting exam with a copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $495 to $1,970 copay for up to two devices per year, while OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered under the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copays, but a 17% coinsurance applies to routine eye exams and contact lenses. Routine eye exams are covered up to $150 annually, though other eye exam services are not covered, and eyewear is covered up to a $400 annual combined maximum.
Dental Services See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) covers Medicare dental services with no copay and 17% coinsurance, and provides other dental services with no copay and no coinsurance up to a $2,000 yearly maximum. This benefit is partially covered, as fluoride treatments, other diagnostic or preventive services, adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs require 0% to 17% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay and a 17% coinsurance. A referral is required to receive these covered services.
Medical Equipment See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 17% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and there are no manufacturer limitations on diabetic supplies.
Diagnostic and Radiological Services See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays, with a referral. There is no copay for these services, and they are subject to a 17% minimum coinsurance.
Home Health Services See details
Home health services are covered under the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay and no coinsurance, although a referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay and a referral, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 17% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Care Plus Enriched Duals Plan (HMO D-SNP) with no copay, requiring prior authorization, a referral, and a three-day inpatient hospital stay before admission. There is no coinsurance for days 1 through 20, followed by a 19% coinsurance for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Senior Care Plus Enriched Duals Plan (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illnesses and a $200 quarterly over-the-counter item allowance with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under these benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved