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 2025, 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 2025.
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. 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 a $200.00 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 has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, the copay is $9 at preferred pharmacies and $14 at standard pharmacies. For specialty drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, but many services such as outpatient blood services, preventive services, hearing exams, eyewear, and home health services have no copay. The plan covers a range of services, including outpatient services with copays, emergency services, primary care, vision, dental, and medical equipment. Services like ambulance, dialysis, and diagnostic radiology come with copays or coinsurance.
Inpatient Hospital See details
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan covers inpatient hospital stays, including acute and psychiatric services. For days 1-4, there is a $390 copay, and for days 5-90, there is no copay; additional days for inpatient hospital-acute have no copay.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0-$325, observation services have a $325 copay, ambulatory surgical center services have a $250 copay, individual outpatient substance abuse sessions have a copay of $40, group outpatient substance abuse sessions have a $30 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance.
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 Anchor (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $35 copay. Worldwide Emergency Transportation has a $275 copay and 20% coinsurance, and Worldwide Emergency Coverage has a $125 copay, while Worldwide Urgent Coverage has a $35 copay.
Primary Care See details
Primary Care services include coverage for primary care physician services with a copay between $0 and $35, chiropractic services with a $15 copay, occupational therapy services with a copay between $0 and $40, and physician specialist services with a copay between $0 and $50. Mental health services include individual sessions with a $40 copay and group sessions with a $30 copay, while physical therapy and speech-language pathology services have a copay between $0 and $40. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $50 copay. Podiatry services are not covered.
Preventive Services See details
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like smoking cessation counseling and fitness benefits are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all with no copay, but prescription hearing aids and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year.
Vision Services See details
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan covers vision services, including eye exams with a copay of $0-$50. Eyewear is covered with no copay, and contact lenses are covered. There is a combined maximum benefit of $250 every year for eyewear.
Dental Services See details
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan covers Medicare dental services for a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, but with a limit of 2 visits per year. 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Medicare Advantage Anchor (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has no copay and a 20% coinsurance, while the plan does not cover DME for use outside the home. Prosthetics and Medical Supplies have no copay and 20% coinsurance, and Diabetic Supplies and Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $20 copay, Lab Services with no copay, Diagnostic Radiological Services with a $250 copay, and Therapeutic Radiological Services with 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Anchor (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 Anchor (HMO) plan. Prior authorization and a doctor referral are required to receive the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Medicare Advantage Anchor (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $160. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Kaiser Permanente Medicare Advantage Anchor (HMO) plan covers acupuncture with a $10 copay per visit, up to 30 treatments every year. However, over-the-counter items, meal benefits, and other listed services are not covered.
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