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 2026, 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 2026.
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 $67.00. 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:
Sign up for Kaiser Permanente Medicare Advantage Columbia (HMO)
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Drug Coverage
The Kaiser Permanente Medicare Advantage Columbia (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront deductible costs. For Tier 1 preferred generic drugs, you will pay no copay when using standard mail order, or as little as a $2 copay for a one-month supply at preferred pharmacies. Tier 2 generic drugs also offer excellent savings, including no copay for two- and three-month supplies filled through standard mail order. For Tier 3 preferred brands and Tier 4 non-preferred drugs, one-month copays start at $47 and $99 respectively at both preferred and standard pharmacies. Tier 5 specialty medications require a 31% coinsurance across all pharmacy and mail order options, while Tier 6 vaccines are available with no copay for a one-month supply.
Additional Benefits
The Kaiser Permanente Medicare Advantage Columbia (HMO) plan offers comprehensive medical coverage with affordable out-of-pocket costs, featuring no copay for primary care, telehealth, and home health services. Specialist visits require a low copay of up to $20, while emergency room care has a $140 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $295 daily copay for days one through four and no copay for days five through 90, with no coinsurance required. Additionally, members benefit from no copays on preventive dental care, routine hearing exams, and annual eye exams, plus a $150 annual allowance for contacts and eyeglasses. Diagnostic lab tests and diabetic equipment are also covered with no copay, though durable medical equipment, dialysis, and therapeutic radiology require a 20% coinsurance. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers inpatient acute and psychiatric hospital care with no coinsurance, requiring a $295 daily copay for days 1 through 4 and no copay for days 5 through 90. Unlimited additional acute days are covered at no copay, but additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $225 for outpatient hospital services and $150 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $25 to $35 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Columbia (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 Columbia (HMO) covers ground and air ambulance services with a $175 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers emergency services with a $140 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $20 to $175 and no coinsurance.
Primary Care See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $20 copay and no coinsurance. Therapy and psychiatric services feature copays up to $35 with no coinsurance, whereas podiatry is not covered and chiropractic services are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) offers partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney disease education. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, weight management programs, and personal emergency response systems.
Hearing Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers routine hearing exams and hearing aid fittings with no coinsurance and copays ranging from $0 to $20. While prescription hearing aids are technically covered, no specific models (including inner ear, outer ear, and over-the-ear) are covered in practice, and over-the-counter hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers vision services with no deductibles, including one routine eye exam per year for a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual limit for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) partially covers dental services, offering preventive and various comprehensive services with no copay and no coinsurance, while Medicare-covered dental services require a $20 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers home infusion bundled services with no copay or coinsurance, 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 require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Medicare Advantage Columbia (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required for this coverage.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers medical equipment, featuring no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Diabetic equipment and supplies are also covered with no copay and no coinsurance, subject to prior authorization and manufacturer limitations.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Diagnostic tests and lab services are covered with no copay and no coinsurance, outpatient X-rays have no copay, and diagnostic radiological services require a $175 copay, while therapeutic radiological services carry a 20% coinsurance.
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 prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization and a referral are required. While some services are covered, specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered, with listed copays ranging from $15 to $35.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Columbia (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other Services are not covered under the Kaiser Permanente Medicare Advantage Columbia (HMO) plan, with no coverage, copays, or coinsurance provided for acupuncture, over-the-counter (OTC) items, and meal benefits.
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