A non-government entity
Kaiser Permanente Medicare Advantage Anchor (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Anchor (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 Anchor (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Anchor (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Counties: Skagit, Whatcom. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Medicare Advantage Anchor (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 Anchor (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 Anchor (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.
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 $110.00 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 $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 Anchor (HMO) plan features a low $110 prescription drug deductible. For preferred generic drugs (Tier 1), you will pay as little as a $2 copay for a 1-month supply at preferred pharmacies, or enjoy no copay when using standard mail order services. Generic drugs (Tier 2) cost a $10 copay for a 1-month supply at preferred pharmacies, with standard mail order options offering no copay for 2-month and 3-month supplies. Preferred brand drugs (Tier 3) and non-preferred drugs (Tier 4) carry a 1-month copay of $47 and $99 respectively at both preferred and standard pharmacies, with savings available on 3-month mail orders. Specialty drugs (Tier 5) require a 29% coinsurance across all pharmacy options, while Tier 6 vaccines are available with no copay for a 1-month supply.
Additional Benefits
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan offers robust coverage for essential medical services with predictable copays and no coinsurance for many benefits. For inpatient hospital stays, members pay a $415 copay for days 1 through 5 and no copay for days 6 through 90, while doctor visits feature copays ranging from no copay up to $50. Emergency care is covered with a $130 copay, and home health services are provided with no copay or coinsurance. Preventive dental care and routine eye exams are highly accessible with no copay, and the plan includes a $100 annual eyewear allowance. However, some services like durable medical equipment and dialysis require a 20% coinsurance instead of a copay. It is also important to note that this plan does not cover hearing aids, over-the-counter items, acupuncture, or transportation services.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers inpatient hospital services with no coinsurance, requiring a $415 copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $325 for outpatient hospital and observation services. Ambulatory surgical center services require a $250 copay, outpatient substance abuse sessions cost a $30 to $40 copay, and outpatient blood services are provided with no copay or deductible.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Anchor (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 Anchor (HMO) covers ambulance services with prior authorization, requiring a $275 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport, with neither fee waived upon hospital admission. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Medicare Advantage Anchor (HMO) with a $130 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed care requires a $35 copay and no coinsurance. Worldwide emergency and urgent care are covered at these same copay rates with no coinsurance, though worldwide emergency transportation requires a $275 copay and 20% coinsurance.
Primary Care See details
Kaiser Permanente Medicare Advantage Anchor (HMO) offers primary care, specialist, therapy, and psychiatric services with no coinsurance and copays ranging from no copay up to $50. Chiropractic services are partially covered, featuring a $15 copay and no coinsurance for routine care while other chiropractic services are not covered, whereas podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Medicare Advantage Anchor (HMO) plan, featuring no copay and no coinsurance for covered options like annual physicals, glaucoma screenings, and diabetes self-management training. 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, or counseling.
Hearing Services See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers hearing exams with no deductible and no coinsurance, featuring no copay for Medicare-covered exams and fitting evaluations, and a copay ranging from $0 to $50 for one routine annual exam. Prescription and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Medicare Advantage Anchor (HMO), featuring routine eye exams with a $0 to $50 copay, no coinsurance, and no deductible. Eyewear is also partially covered with no copay or coinsurance up to a $100 annual limit for contacts and eyeglasses, though upgrades and other eye exam services are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers Medicare dental services for a $50 copay and no coinsurance, while preventive and other covered dental services are offered with no copay and no coinsurance. Dental benefits are partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Medicare Advantage Anchor (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Anchor (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes or inserts, is also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers diagnostic and radiological services, requiring referrals and prior authorization for most procedures. Patients pay a $20 copay and no coinsurance for diagnostic tests, no copay for lab services and outpatient X-rays, a $280 copay for diagnostic radiological services, and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Medicare Advantage Anchor (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Anchor (HMO) with no coinsurance, requiring referrals and prior authorization. While some services are covered, standard cardiac rehab ($30 copay), intensive cardiac rehab ($30 copay), pulmonary rehab ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Anchor (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Kaiser Permanente Medicare Advantage Anchor (HMO) plan. This means there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, or meal benefits.
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