A non-government entity
Kaiser Permanente Medicare Advantage Columbia (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Columbia (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 Columbia (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Columbia (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Spokane. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Medicare Advantage Columbia (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 Columbia (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 Columbia (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. 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 $3950.00 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 Columbia (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies based on the drug tier and pharmacy type. For example, preferred generic drugs have a $7.00 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Columbia (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $300 per day for the first four days, but no copay for days 5-90. Outpatient services have copays that vary depending on the service, such as $0-$225 for Outpatient Hospital Services. Preventive services, hearing exams, and eye exams have no copay, while dental services have a $20 copay for Medicare dental services and no copay for other services. Ambulance services have a $150 copay, while emergency services have a $140 copay. This plan also covers home health services with no copay, and skilled nursing facility services with a copay after 20 days.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 4 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, the copay is $300 per day, and there is no copay for days 5-90; additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, with varying copays depending on the service. Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $225 copay, and Ambulatory Surgical Center (ASC) Services have a $150 copay. Individual and Group Sessions for Outpatient Substance Abuse have copays between $25 and $35, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Medicare Advantage Columbia (HMO) plan. Ground and air ambulance services have a $150 copay, and there is no coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $140 copay, Urgently Needed Services have a $20 copay, Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $20 copay, and Worldwide Emergency Transportation has a $150 copay; all have no coinsurance.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $0-$35 copay for Physical Therapy and Speech-Language Pathology Services. Mental Health Specialty Services and Psychiatric Services have a copay of $35 for individual sessions and $25 for group sessions. Other covered services include Occupational Therapy, Physician Specialist Services, Other Health Care Professional, Additional Telehealth Benefits, and Opioid Treatment Program Services. Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered by the Kaiser Permanente Medicare Advantage Columbia (HMO) plan, including an annual physical exam with no copay. Additional preventive services, including smoking cessation counseling, fitness benefits, and remote access technologies, are also covered, but some services require a copay. Other services like health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids, each with a maximum copay of $20. Prescription hearing aids and OTC hearing aids are not covered by this plan.
Vision Services See details
Vision services include eye exams with a copay of $0-$20, and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental services include Medicare dental services with a $20 copay, and other dental services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Columbia (HMO) plan and require prior authorization and a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic radiological services have a copay of at most $150, while therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Medicare Advantage Columbia (HMO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Medicare Advantage Columbia (HMO) plan. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Medicare Advantage Columbia (HMO) plan. You will have no copay for days 1-20, and a $160 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes acupuncture, with a $10 copay, and is limited to 30 treatments per year. Over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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