A non-government entity
Kaiser Permanente Medicare Advantage Centennial (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Centennial (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 Centennial (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Centennial (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 Centennial (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 Centennial (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 Centennial (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $10.00. You must continue to pay paying your reduced 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 $4950.00 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 Centennial (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $7 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Medicare Advantage Centennial (HMO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay for the first few days, but no copay for the majority of the stay. Outpatient services have copays that vary from $0 to $325, and emergency services have a $125 copay. This plan includes coverage for primary care, preventive services, hearing, vision, and dental services, with a range of copays for different services. Additionally, the plan covers home health services, skilled nursing facilities, and dialysis services. Medical equipment, including DME, prosthetics, and diabetic supplies, are covered with either no copay or 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered, but require prior authorization and a doctor referral. For days 1-4, the copay is $385, and there is no copay for days 5-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan, including outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, ambulatory surgical center services with a $250 copay, individual substance abuse sessions with a $40 copay, group substance abuse sessions with a $30 copay, and outpatient blood services with no copay. Prior authorization and a doctor referral may be required.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring prior authorization and a doctor referral. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan. Ground and air ambulance services have a $175 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $20 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $20 copay, and Worldwide Emergency Transportation has a $175 copay.
Primary Care See details
Primary Care, including Primary Care Physician Services, is covered with no copay. Chiropractic Services are covered with a $20 copay for routine care. Occupational Therapy, Physician Specialist Services, and Other Health Care Professional services are covered with copays ranging from $0 to $40, $25, and $0 to $25, respectively. Mental Health and Psychiatric Services, including individual and group sessions, are covered with copays ranging from $30 to $40. Physical Therapy and Speech-Language Pathology Services are covered with a copay between $0 and $40. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services are covered with a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Annual physical exams have no copay, while additional preventive services may have a copay. The plan also covers additional sessions of smoking and tobacco cessation counseling, as well as fitness benefits and remote access technologies, all with no copay. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits are also covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with no copay, and routine hearing exams are covered with a copay between $0 and $25. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$25, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $350 per year. Upgrades are not covered.
Dental Services See details
The Kaiser Permanente Medicare Advantage Centennial (HMO) plan covers Medicare Dental Services with a $25 copay and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventative dental services with no copay, but the number of visits is limited to 2 per year. Orthodontic, restorative, adjunctive general, endodontic, periodontic, prosthodontics, maxillofacial prosthetics, implant, oral and maxillofacial surgery, and orthodontics services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Centennial (HMO) plan, with prior authorization and a doctor referral required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance, and does not have a copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $20 copay, and lab services with no copay. Diagnostic radiological services have a copay of at least $225, while therapeutic radiological services have at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Medicare Advantage Centennial (HMO) plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor referral. You will have no copay for days 1-20, and a $160 copay for days 21-100.
Other Services See details
The Kaiser Permanente Medicare Advantage Centennial (HMO) plan covers acupuncture with a $10 copay per visit, up to 30 treatments per year. Other services like over-the-counter items, meal benefits, and various other services are not covered.
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