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Kaiser Permanente Medicare Advantage Essential Sno (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Essential Sno (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 Sno (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Essential Sno (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Snohomish. 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 Sno (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 Sno (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 Sno (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 Sno (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay as little as a $2 copay for a 1-month supply at a preferred pharmacy, or no copay at all when using standard mail order. Tier 2 generic drugs are also highly affordable, starting at a $10 copay for a 1-month supply at preferred pharmacies or standard mail order. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs carry a $47 and $99 copay respectively for a 1-month supply at both preferred and standard pharmacies. Specialty drugs in Tier 5 require a 31% coinsurance, while Tier 6 vaccines are available with no copay at both preferred and standard pharmacies. This prescription drug plan offers a well-structured cost-sharing model that provides significant savings for members utilizing mail-order services and preferred pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Essential Sno (HMO) plan offers affordable medical coverage with no copay for primary care, telehealth visits, core preventive services, and home health care. For specialized care, members pay no copay to a $35 copay for specialist visits, routine vision exams, and preventive dental care, alongside a $300 annual eyewear allowance. Inpatient hospital stays require a $350 daily copay for the first five days, after which there is no copay, while emergency room visits carry a $130 copay. While diagnostic lab tests and home infusions are available with no copay, other specialized services like dialysis and durable medical equipment require a 20% coinsurance. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Prospective members should note that this plan does not cover acupuncture, over-the-counter items, hearing aids, or routine transportation.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 copay per day 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 days are not covered, while unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital copays from $0 to $340 and ambulatory surgical center copays of $340. Outpatient substance abuse sessions incur a $35 copay for individual visits and a $25 copay for group visits with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Medicare Advantage Essential Sno (HMO) with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Kaiser Permanente Medicare Advantage Essential Sno (HMO) plan, which features a $290 copayment and no coinsurance for ground and air ambulance services, subject to prior authorization. Although transportation is technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers emergency services with a $130 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $30, and $290, respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialists, therapies, and mental health visits require copays from $0 to $35 with no coinsurance. Chiropractic benefits are partially covered with a $15 copay for routine care (other chiropractic services are not covered), whereas podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Medicare Advantage Essential Sno (HMO) with no copay and no coinsurance for core services like annual physical exams, glaucoma screenings, and diabetes self-management training. Although fitness benefits and smoking cessation counseling are included at no cost, the plan only partially covers additional preventive services, excluding options such as health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers Medicare-covered hearing exams with no copay, annual routine hearing exams with a $0 to $35 copay, and annual hearing aid fittings with no copay, all with no coinsurance or deductibles. Prescription and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers vision services with no coinsurance, featuring routine eye exams for a $0 to $35 copay and eyewear with no copay up to a $300 yearly limit. This benefit is partially covered because other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are covered by Kaiser Permanente Medicare Advantage Essential Sno (HMO), with Medicare-covered dental services requiring a $35 copay and no coinsurance, and other covered preventive and comprehensive dental services having no copay and no coinsurance. The benefit is 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 Essential Sno (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 chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Essential Sno (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 Essential Sno (HMO) covers durable medical equipment and prosthetic devices with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies, therapeutic shoes, and inserts are also covered with no copay and no coinsurance, though prior authorization and manufacturer limitations apply.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Essential Sno (HMO) covers diagnostic procedures, tests, and lab services with no copays and no coinsurance. Radiological services are also covered with prior authorization and referral requirements, including a $10 copay for outpatient X-rays, a minimum $325 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Medicare Advantage Essential Sno (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Kaiser Permanente Medicare Advantage Essential Sno (HMO) with no coinsurance, but in practice, sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. These services require prior authorization and referrals, and they carry copays ranging from $15 to $35.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Kaiser Permanente Medicare Advantage Essential Sno (HMO) with no coinsurance and no prior three-day inpatient hospital stay requirement. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, though prior authorization and referrals are required, and additional days beyond day 100 are not covered.
Other Services See details
Other Services are not covered under the Kaiser Permanente Medicare Advantage Essential Sno (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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