A non-government entity
Kaiser Permanente Medicare Advantage Key Pierce (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Key Pierce (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 Pierce (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Key Pierce (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Pierce. 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 Pierce (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 Pierce (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 Pierce (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.
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 $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 Pierce (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 Pierce (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay as low as a $3 copay at preferred pharmacies or enjoy no copay when utilizing standard mail order. Tier 2 generic drugs are also highly affordable, with standard mail order offering no copay on two- and three-month supplies. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, while Tier 4 non-preferred drugs cost $99. Specialty medications in Tier 5 require a 31% coinsurance across all pharmacy options, and Tier 6 vaccines are available with no copay for a one-month supply. This plan provides a well-structured cost-sharing model that helps lower out-of-pocket costs for essential medications.
Additional Benefits
The Kaiser Permanente Medicare Advantage Key Pierce (HMO) offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for primary care visits, telehealth, and preventive services. For hospital stays, members pay no coinsurance and a $435 daily copay for the first five days, with no copay for days six through 90. Emergency care is available with a $130 copay, while outpatient services range from no copay up to a $400 copay with no coinsurance. Specialty benefits include routine vision exams with copays ranging from no copay up to $50 alongside a $150 annual eyewear allowance, though routine dental care and hearing aids are not covered. Essential support services like home health care and diabetic supplies require no copay and no coinsurance, while durable medical equipment and dialysis carry a 20% coinsurance. Skilled nursing facility stays require no coinsurance, with 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 Pierce (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $435 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $400 for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $35 to $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Both prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO) with a $300 copay and no coinsurance for both ground and air transport, though prior authorization is required. Non-emergency transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $50 to $300 and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO) with no coinsurance for all covered services, though podiatry and non-routine chiropractic services are not covered. There is no copay for primary care physician visits and telehealth, while other covered services like specialists, therapy, and mental health have copays ranging from $0 to $50.
Preventive Services See details
Preventive services are partially covered by the Kaiser Permanente Medicare Advantage Key Pierce (HMO) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, or counseling.
Hearing Services See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers hearing exams with no coinsurance or deductible, featuring no copay for hearing aid fittings and a $0 to $50 copay for one routine exam per year. Although prescription hearing aids are technically covered, in practice only some services are covered, and all types of prescription hearing aids (including inner ear, outer ear, and over the ear) as well as OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) partially covers vision services with no deductibles, featuring one routine eye exam per year for a $0 to $50 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $150 annual limit, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are covered by the Kaiser Permanente Medicare Advantage Key Pierce (HMO) only for Medicare-approved dental procedures, which require a $50 copay and no coinsurance, as well as prior authorization and a referral. Routine preventive and comprehensive dental care, including cleanings, exams, x-rays, and restorative or orthodontic services, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO) 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 Key Pierce (HMO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, subject to prior authorization. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though manufacturer limitations and prior authorization apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO), requiring prior authorization and referrals. Lab services have no copay or coinsurance, diagnostic tests require a $20 copay with no coinsurance, X-rays have a $15 copay, diagnostic radiological services have a $375 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Kaiser Permanente Medicare Advantage Key Pierce (HMO) with no coinsurance, requiring prior authorization and referrals. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, with copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Key Pierce (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Other services are not covered in practice under the Kaiser Permanente Medicare Advantage Key Pierce (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. Because these services are excluded, there are no copays or coinsurance, and members must pay all costs out of pocket.
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