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Kaiser Permanente Medicare Advantage Essential Kng (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Essential Kng (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 Essential Kng (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Essential Kng (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in King. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Medicare Advantage Essential Kng (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 Essential Kng (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 Essential Kng (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $69.00. 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 $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 Essential Kng (HMO) prescription drug coverage features a $0 deductible, meaning your benefits start immediately. For Tier 1 preferred generic drugs, you pay as little as a $2 copay for a one-month supply at preferred pharmacies, and no copay for standard mail order. Tier 2 generic drugs carry a $10 copay for a one-month supply at preferred pharmacies, while Tier 6 vaccines are available with no copay. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay and Tier 4 non-preferred drugs require a $99 copay for a one-month supply. Specialty medications in Tier 5 are subject to a 30% coinsurance across all pharmacy options. Ordering a three-month supply of Tier 3 or Tier 4 drugs through standard mail order can also help lower your overall out-of-pocket costs with reduced copays.
Additional Benefits
The Kaiser Permanente Medicare Advantage Essential Kng (HMO) plan offers affordable coverage with no copays or coinsurance for primary care, home health, and preventive services. Inpatient hospital stays require a $350 daily copay for days 1 through 5 and no copay for subsequent days, while emergency room visits carry a $130 copay. Outpatient services are also covered with no coinsurance and copays ranging from no copay to $340. Specialty benefits include routine dental, hearing, and vision exams with no copay or low copays up to $35, alongside a $300 annual eyewear allowance. While diagnostic lab tests and diabetic supplies have no copay, durable medical equipment and dialysis services require a 20% coinsurance. Note that some services, such as transportation, over-the-counter items, and meal benefits, are not covered under this plan.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 and beyond. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers outpatient services with no coinsurance, featuring a $0 to $340 copay for outpatient hospital services, a $340 copay for ambulatory surgical center and observation services, and no copay for outpatient blood services. Outpatient substance abuse services are also covered with no coinsurance, requiring a $25 copay for group sessions and a $35 copay for individual sessions.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required for this covered benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers ground and air ambulance services with a $290 copay and no coinsurance, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $30, and $290 respectively.
Primary Care See details
Primary care benefits under the Kaiser Permanente Medicare Advantage Essential Kng (HMO) include primary care and telehealth visits with no copay and no coinsurance. Most other outpatient services, including specialists, mental health, and physical therapy, feature copays ranging from $0 to $35 and no coinsurance, though podiatry is not covered and chiropractic care is only partially covered with routine visits requiring a $15 copay and no coinsurance.
Preventive Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and kidney disease education. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Medicare Advantage Essential Kng (HMO), featuring no coinsurance and no copay for Medicare-covered exams and hearing aid fittings, and a $0 to $35 copay with no coinsurance for annual routine exams. While some services are covered, prescription hearing aids (including inner ear, outer ear, and over-the-ear types) and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Kaiser Permanente Medicare Advantage Essential Kng (HMO), which offers one routine eye exam per year with a $0 to $35 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 annual limit, though other eye exams and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) partially covers dental services, offering Medicare-covered dental care with a $35 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance. However, 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 Essential Kng (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Medicare Advantage Essential Kng (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment coverage through Kaiser Permanente Medicare Advantage Essential Kng (HMO) includes durable medical equipment (DME) and prosthetics with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization and vendor limitations apply.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic tests and lab services have no copay and no coinsurance, while outpatient X-rays require a $10 copay, diagnostic radiological services have a minimum $325 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Essential Kng (HMO) with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered. These services require prior authorization and referrals, with copays ranging from $15 to $35.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Essential Kng (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required for this benefit, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Kaiser Permanente Medicare Advantage Essential Kng (HMO) plan.
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