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Kaiser Permanente Medicare Advantage Essential Thu (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Essential Thu (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 Thu (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Essential Thu (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Thurston. 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 Thu (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 Thu (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 Thu (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 Thu (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, you will pay a $2 copay for a 1-month supply at preferred pharmacies, or no copay through standard mail order. Tier 2 generics cost a $10 copay for a 1-month supply at preferred pharmacies, and standard mail order options offer no copay for 2-month and 3-month supplies. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 1-month copay of $47 and $99 respectively at both preferred and standard pharmacies. Tier 5 specialty drugs require a 31% coinsurance, which applies across all pharmacy and mail order options. Additionally, Tier 6 vaccines are covered with no copay for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Kaiser Permanente Medicare Advantage Essential Thu (HMO) plan offers robust coverage with no coinsurance for many core services, including primary care visits, preventive care, and home health services, all of which feature no copay. For inpatient hospital stays, members pay a $350 daily copay for days 1 to 5 and no copay for days 6 to 90, while outpatient hospital services require copays up to $340. Emergency care is covered with a $130 copay, which is waived if admitted, and urgent care visits require a $30 copay. Routine dental cleanings and exams feature no copay, while routine vision and hearing exams range from no copay up to a $35 copay. The plan also includes a $300 annual eyewear allowance, though hearing aids and transportation services are not covered. For durable medical equipment and dialysis, members generally pay a 20% coinsurance with no copay, whereas diabetic supplies are available with no copay and no coinsurance.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for days 6 to 90. While additional acute stay days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the Kaiser Permanente Medicare Advantage Essential Thu (HMO) feature no coinsurance, with copays ranging from no copay for blood services up to $340 for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require no coinsurance and a copay of $25 for group sessions or $35 for individual sessions.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by the Kaiser Permanente Medicare Advantage Essential Thu (HMO) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay with no coinsurance, and worldwide emergency benefits are covered with no coinsurance and copays of $130 for emergency care, $30 for urgent care, and $290 for emergency transportation.
Primary Care See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) offers primary care and telehealth visits with no copay and no coinsurance, while specialists, occupational therapy, and physical therapy range from a $0 to $35 copay with no coinsurance. Mental health, psychiatric, and opioid treatment services carry a $25 to $35 copay with no coinsurance, whereas chiropractic services are partially covered with a $15 copay for routine care (other chiropractic services are not covered), and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Kaiser Permanente Medicare Advantage Essential Thu (HMO), offering annual physicals, fitness benefits, and select screenings with no copay and no coinsurance. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, adult day health, and home-based support.
Hearing Services See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers Medicare-covered hearing exams and hearing aid fitting evaluations with no copay, and one routine hearing exam per year with a copay ranging from $0 to $35, all with no coinsurance or deductibles. 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 Essential Thu (HMO), offering one routine annual eye exam with a $0 to $35 copay and no coinsurance, alongside a $300 annual eyewear allowance with no copay or coinsurance. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) partially covers dental services, providing preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental services for a $35 copay and no coinsurance. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Essential Thu (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization is required for all medical equipment.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Essential Thu (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic tests, procedures, and lab services have no copay and no coinsurance, while outpatient x-rays require a $10 copay, diagnostic radiological services carry a minimum $325 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Medicare Advantage Essential Thu (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Medicare Advantage Essential Thu (HMO) with no copay and no coinsurance, although only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and a referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Kaiser Permanente Medicare Advantage Essential Thu (HMO) with no coinsurance, though prior authorization and referrals are required. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Kaiser Permanente Medicare Advantage Essential Thu (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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