A non-government entity
Kaiser Permanente Medicare Advantage Harbor (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Harbor (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 Harbor (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Harbor (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Counties: IS, SK, WM. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Medicare Advantage Harbor (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 Harbor (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 Harbor (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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 $100.00 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 $5800.00 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 Harbor (HMO) plan features a $100 annual drug deductible and offers competitive pricing on generic prescriptions. For Tier 1 preferred generics, you pay no copay through standard mail order, or as low as a $2 copay for a one-month supply at a preferred pharmacy. Tier 2 generic drugs are also highly affordable, with no copay for two- or three-month supplies filled via standard mail order. For brand-name and specialty medications, Tier 3 preferred brands and Tier 4 non-preferred drugs start at a $47 and $99 one-month copay, respectively, at both preferred and standard pharmacies. Tier 5 specialty drugs require a 29% coinsurance across all pharmacy and mail-order options. Additionally, Tier 6 vaccines are fully covered with no copay for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Harbor (HMO) plan offers comprehensive coverage for core medical services, featuring a $10 copay for primary care visits, a $35 copay for specialists, and no copay for preventive care or telehealth. Inpatient hospital stays require a $325 copay per day for the first five days with no copay thereafter, while outpatient hospital services range from no copay up to a $300 copay. Emergency care is covered with a $130 copay, which is waived if you are admitted within 24 hours. This plan also covers essential wellness benefits, providing preventive dental cleanings and home health services with no copay, alongside a $150 annual eyewear allowance. Diagnostic lab services and x-rays are available with no copay, while durable medical equipment and dialysis require a 20% coinsurance. Skilled nursing facility stays are also covered, featuring no copay for the first 20 days.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Harbor (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $325 copayment for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $300 for outpatient hospital services and $300 per stay for observation services. Ambulatory surgical center services require a $250 copay, outpatient substance abuse sessions carry a $30 to $40 copay, and outpatient blood services are covered with no copay and no deductible.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent care are covered with these same copays and no coinsurance, while worldwide emergency transportation requires a $260 copay and 20% coinsurance.
Primary Care See details
Primary Care benefits under the Kaiser Permanente Medicare Advantage Harbor (HMO) are partially covered, with no coinsurance for all services and copays ranging from no copay for telehealth up to $40 for therapy and mental health. Primary care visits require a $10 copay and specialist visits require a $35 copay, but podiatry and non-routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Kaiser Permanente Medicare Advantage Harbor (HMO) with no copay and no coinsurance for covered options such as annual physicals, smoking cessation, and fitness benefits. However, the plan does not cover health education, 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 benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers hearing exams with no deductible, no coinsurance, and a $10 copay, which includes one annual routine exam (with a $10 to $35 copay) and one annual fitting evaluation with no copay. Although some prescription hearing aid services are covered, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and over-the-counter hearing aids are also not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) offers partially covered vision services, which include one routine eye exam per year for a $10 to $35 copay and no coinsurance, and a $150 annual allowance for eyewear with no copay or coinsurance. Other eye exam services and eyewear upgrades are not covered under these benefits.
Dental Services See details
Dental services are partially covered by the Kaiser Permanente Medicare Advantage Harbor (HMO) plan, which offers Medicare-covered dental care for a $35 copay and no coinsurance. Other covered services, including preventive cleanings, exams, x-rays, and periodontics, are available with no copay and no coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no copay and a coinsurance of 0% to 20%, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Medicare Advantage Harbor (HMO) 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 by Kaiser Permanente Medicare Advantage Harbor (HMO), with durable medical equipment, prosthetics, and medical supplies requiring prior authorization, a 20% coinsurance, and no copay. Diabetic equipment, supplies, and therapeutic shoes are also fully covered with no copay, no coinsurance, and prior authorization, though brand restrictions apply.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers diagnostic and radiological services, with prior authorization and referrals required for these benefits. Diagnostic tests require a $20 copay with no coinsurance, lab services and outpatient X-rays have no copay, diagnostic radiological services require a $250 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered by Kaiser Permanente Medicare Advantage Harbor (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Kaiser Permanente Medicare Advantage Harbor (HMO) with no coinsurance, though prior authorization and a referral are required. While some services are covered, standard cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Harbor (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a referral and prior authorization. There is no copay for days 1 through 20 and a $150 copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
For the Kaiser Permanente Medicare Advantage Harbor (HMO), some services are covered under the Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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