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Kern Family Health Care Medicare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kern Family Health Care Medicare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kern Family Health Care Medicare (HMO D-SNP) in 2026, please refer to our full plan details page.
Kern Family Health Care Medicare (HMO D-SNP) is a HMO D-SNP plan offered by Kern Health Systems (KHS) available for enrollment in 2026 to people living in Counties: Kern. The overall rating for this plan is not yet available for 2026.
It's important to know that Kern Family Health Care Medicare (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:
Kern Family Health Care Medicare (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 Kern Family Health Care Medicare (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 Kern Family Health Care Medicare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 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 $9250.00 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 Kern Family Health Care Medicare (HMO D-SNP) offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. After meeting this deductible, you will pay a 25% coinsurance for preferred generic, standard generic, preferred brand, and non-preferred drugs at standard pharmacies, while specialty tier drugs require no copay. Additionally, individuals who qualify for the low-income subsidy can benefit from a reduced Part D premium of $12.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. This plan structure helps manage your healthcare expenses by limiting your maximum out-of-pocket drug costs. Be sure to check the plan's formulary to confirm coverage for your specific prescription medications.
Additional Benefits
Kern Family Health Care Medicare (HMO D-SNP) offers comprehensive medical coverage, with many outpatient, specialist, diagnostic, and emergency services requiring no copay and a standard 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are also covered, following Medicare-defined cost-sharing structures. Standard preventive care is highly accessible, with Medicare-covered preventive services available with no copay or coinsurance. For specialty care, the plan provides routine dental, vision, and hearing benefits with no copay and a 20% coinsurance. This includes generous allowances such as up to $1,500 annually for hearing aids and $300 yearly for contact lenses or frames with no deductible. While these essential benefits are covered, other services like acupuncture, over-the-counter items, and home-delivered meals are not included in this plan.
Inpatient Hospital See details
Kern Family Health Care Medicare (HMO D-SNP) partially covers inpatient hospital acute and psychiatric services, which require prior authorization and follow Original Medicare-defined copay, deductible, and coinsurance structures. Under these benefits, upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Kern Family Health Care Medicare (HMO D-SNP), including outpatient hospital care, observation services, ambulatory surgical center visits, substance abuse treatment, and blood services. Members will pay no copay and a 20% coinsurance for these covered services.
Partial Hospitalization See details
Kern Family Health Care Medicare (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Kern Family Health Care Medicare (HMO D-SNP) provides partial coverage for ambulance and transportation services, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency and urgently needed services are covered by Kern Family Health Care Medicare (HMO D-SNP) with a 20% coinsurance and no copay, with the emergency coinsurance waived if admitted to the hospital within three days. While worldwide emergency services are technically covered, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits are partially covered by Kern Family Health Care Medicare (HMO D-SNP) with no copay and a 20% coinsurance for most services, though podiatry and routine chiropractic care are not covered. Covered services include primary care physician, specialist, and therapy visits, some of which may require prior authorization or a doctor referral.
Preventive Services See details
Kern Family Health Care Medicare (HMO D-SNP) partially covers preventive services, providing Medicare-covered zero-dollar services with no copay or coinsurance, and kidney disease education or select screenings with a 20% coinsurance and no copay. Some services are covered, but annual physical exams and additional benefits like fitness programs, health education, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Kern Family Health Care Medicare (HMO D-SNP) with no copay and a 20% coinsurance for annual routine hearing exams and fitting evaluations. The plan also covers OTC and prescription hearing aids up to $1,500 annually for both ears combined with no copay or coinsurance, although prescription inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Kern Family Health Care Medicare (HMO D-SNP) partially covers vision services with no copay and a 20% coinsurance for routine eye exams and eyewear. This includes one annual routine eye exam and up to $300 yearly for contact lenses or eyeglass frames with no deductible, though eyewear upgrades are not covered.
Dental Services See details
Kern Family Health Care Medicare (HMO D-SNP) partially covers dental services, with Medicare-covered dental requiring a 20% coinsurance and no copay, and other covered dental services having no copay or coinsurance. However, dental X-rays, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kern Family Health Care Medicare (HMO D-SNP) with prior authorization, requiring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Kern Family Health Care Medicare (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. A doctor referral is required to receive these services.
Medical Equipment See details
Kern Family Health Care Medicare (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for these services, and certain items may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kern Family Health Care Medicare (HMO D-SNP) with no copay and a 20% coinsurance. These services, which require prior authorization and a doctor referral, include lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Kern Family Health Care Medicare (HMO D-SNP), requiring a doctor referral and prior authorization to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kern Family Health Care Medicare (HMO D-SNP) with no copay and a coinsurance, though prior authorization is required. Only some services are covered under this benefit, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kern Family Health Care Medicare (HMO D-SNP), requiring prior authorization and a three-day prior inpatient hospital stay. Covered days are subject to Medicare-defined copays and coinsurance, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the Kern Family Health Care Medicare (HMO D-SNP) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated services.
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