A non-government entity
Kaiser Permanente Medicare Advantage Key (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Key (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 Key (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Key (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Island. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Medicare Advantage Key (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 Key (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 Key (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 $6600.00 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 Key (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through standard mail order. Vaccines in Tier 6 also feature no copay at both preferred and standard pharmacies, while Tier 2 generic drugs cost as little as a $7 copay for a one-month supply at preferred pharmacies. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard and preferred pharmacies. Tier 4 non-preferred drugs carry a $99 copay for a one-month supply, while Tier 5 specialty drugs require a 31% coinsurance across all pharmacy options. Standard mail order options are also available for most tiers, offering convenient ways to save on multi-month supplies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Key (HMO) offers comprehensive coverage with highly predictable costs, featuring no copay and no coinsurance for primary care, telehealth, and covered preventive services. Specialist visits, urgent care, and outpatient hospital services require low to moderate copays ranging from $0 to $375 with no coinsurance. For inpatient hospital stays, members pay a $400 daily copay for the first five days and no copay for days six through 90 with no coinsurance. Preventive dental care, home health services, and diagnostic lab tests are covered with no copay and no coinsurance, while routine eye and hearing exams feature copays up to $35. The plan also includes a $150 annual allowance for eyewear with no copay, though durable medical equipment and dialysis services require a 20% coinsurance. Some supplemental benefits, including hearing aids, fitness programs, acupuncture, and transportation services, are not covered under this plan.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Key (HMO) inpatient hospital services are partially covered with no coinsurance, requiring a $400 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Key (HMO) covers outpatient services with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services and a $375 copay for ambulatory surgical center and observation services. Outpatient substance abuse services require a $40 to $50 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Medicare Advantage Key (HMO) with a $55.00 copay and no coinsurance. This benefit requires both prior authorization and a referral from your doctor.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Key (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Medicare Advantage Key (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $40, and $275 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Key (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapy, and mental health services feature copays ranging from $0 to $50 and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, whereas podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Key (HMO) offers partial coverage for preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and diabetes self-management training. However, several supplemental benefits are not covered under this plan, such as the fitness benefit, health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Kaiser Permanente Medicare Advantage Key (HMO) covers hearing exams with no deductibles or coinsurance, offering no copay for Medicare-covered exams and hearing aid evaluations, and a $0 to $35 copay for an annual routine exam. Prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Key (HMO) partially covers vision services with no deductibles, offering one annual routine eye exam for a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 yearly limit for contacts and eyeglasses, but eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Medicare Advantage Key (HMO), which offers Medicare-covered dental with a $35 copay and no coinsurance, and preventive and other covered dental services with no copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Kaiser Permanente Medicare Advantage Key (HMO) plan with no copay, subject to prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs have a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Key (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Key (HMO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment and supplies are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Kaiser Permanente Medicare Advantage Key (HMO), with prior authorization and referrals required for care. Lab services feature no copay or coinsurance, diagnostic tests require a $20 copay with no coinsurance, diagnostic radiological services require a $355 copay, outpatient X-rays require a $20 copay and coinsurance, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Key (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Kaiser Permanente Medicare Advantage Key (HMO) with no coinsurance, though only some services are covered. Under this plan, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require copays ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Key (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required for these services, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are covered by Kaiser Permanente Medicare Advantage Key (HMO), but only some services are covered in practice as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. There are no copays or coinsurance for these excluded services since they are not covered by the plan.
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