A non-government entity
Kaiser Permanente Medicare Advantage Key King (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Key King (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 Key King (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Key King (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 Key King (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 Key King (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 Key King (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 $8.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 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:
Sign up for Kaiser Permanente Medicare Advantage Key King (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Medicare Advantage Key King (HMO) plan features no drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic drugs, you pay no copay through standard mail order or as little as a three-dollar copay for a one-month supply at preferred pharmacies. Tier 2 generic drugs cost ten dollars for a one-month supply at preferred pharmacies, while Tier 6 vaccines are covered with no copay. Tier 3 preferred brands and Tier 4 non-preferred drugs carry a one-month copay of forty-seven dollars and ninety-nine dollars, respectively, at both preferred and standard pharmacies. Savings are available through standard mail order, which reduces three-month supply costs for these tiers. Specialty drugs in Tier 5 require a twenty-nine percent coinsurance across all pharmacy and mail order options.
Additional Benefits
The Kaiser Permanente Medicare Advantage Key King (HMO) plan offers robust coverage for essential medical services with no coinsurance for many benefits. You will pay no copay for primary care visits, telehealth, and preventive services, while specialist visits range from no copay to a $50 copay. Inpatient hospital stays require a $435 daily copay for the first five days and no copay for days six through ninety, while emergency room visits carry a $130 copay that is waived if you are admitted. For specialized care, the plan features a 20% coinsurance for dialysis, durable medical equipment, and prosthetics, though diabetic supplies have no copay. Routine eye exams and eyewear are covered with low to no copays, but the plan does not cover routine dental services, hearing aids, or transportation. Skilled nursing facility stays are also affordable, requiring no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Key King (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $435 copay per day for days 1 through 5 and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $400 for outpatient hospital visits, $400 for observation and ambulatory surgical center services, and $35 to $45 for substance abuse sessions. Outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers ground and air ambulance services with a $300 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 Kaiser Permanente Medicare Advantage Key King (HMO) with a $130 copay (waived if admitted to the hospital within 24 hours) and no coinsurance. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $300 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers primary care and telehealth with no copay and no coinsurance, while specialist visits and therapy services range from a $0 to $50 copay with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, but other chiropractic services and podiatry services are not covered. Mental health, psychiatric, and opioid treatment services require copays ranging from $35 to $50 with no coinsurance.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Medicare Advantage Key King (HMO) with no copay and no coinsurance for covered options like annual physicals, screenings, and fitness benefits. Several supplemental services are not covered, including health education, weight management programs, nutritional/dietary benefits, and personal emergency response systems.
Hearing Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers hearing exams and fitting evaluations with no coinsurance and copays ranging from no copay to $50. While some services are covered, prescription hearing aids (including all types, inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay and no coinsurance up to a $150 annual maximum, though upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) partially covers dental services, offering Medicare-covered dental care for a $50 copay and no coinsurance, though prior authorization and a referral are required. All other dental services, including routine exams, cleanings, x-rays, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Kaiser Permanente Medicare Advantage Key King (HMO) with no copay and a 20% coinsurance. This benefit requires both prior authorization and a referral.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment and supplies are also covered under this plan with no copay and no coinsurance, though prior authorization is required.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers diagnostic and radiological services, which require prior authorization and referrals. Diagnostic tests have a $20 copay and no coinsurance, lab services have no copay, outpatient X-rays require a $15 copay, diagnostic radiology has a $375 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Medicare Advantage Key King (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 under the Kaiser Permanente Medicare Advantage Key King (HMO) plan are covered with no coinsurance, though prior authorization and referrals are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and carry copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Key King (HMO) covers skilled nursing facility services with no coinsurance, requiring prior authorization and a referral, and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare limit.
Other Services See details
Other services are not covered under the Kaiser Permanente Medicare Advantage Key King (HMO), meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved