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Kaiser Permanente Medicare Advantage Key Thurston (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Key Thurston (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 Thurston (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Key Thurston (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 Key Thurston (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 Thurston (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 Thurston (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:
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Drug Coverage
The Kaiser Permanente Medicare Advantage Key Thurston (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using standard mail order, or as low as a $3 copay for a one-month supply at a preferred pharmacy. Tier 2 generic medications cost $10 at preferred pharmacies for a one-month supply, but you can save significantly with no copay for two- and three-month supplies filled through standard mail order. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs carry copays starting at $47 and $99 respectively for a one-month supply at both preferred and standard pharmacies. Specialty drugs in Tier 5 require a 31% coinsurance across all pharmacy options, while Tier 6 vaccines are highly accessible with no copay for a one-month supply at both preferred and standard pharmacies. This structured plan offers multiple ways to save on prescription costs, particularly when utilizing preferred pharmacies and mail-order services.
Additional Benefits
The Kaiser Permanente Medicare Advantage Key Thurston (HMO) plan offers comprehensive medical coverage with no coinsurance for most primary care, specialist, and hospital services. Beneficiaries enjoy no copay for primary care visits, preventive care, and home health services, while specialist visits require a copay of up to $50. Inpatient hospital stays have a $435 daily copay for the first five days, and outpatient hospital services range from no copay up to $400. For extra benefits, the plan includes routine vision and hearing exams with copays ranging from no copay up to $50, alongside a $150 annual eyewear allowance. While routine dental care is not covered, Medicare-covered dental services are available with a $50 copay. Durable medical equipment and dialysis services require a 20% coinsurance, whereas diabetic supplies are covered with no copay.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers inpatient hospital services with no coinsurance, requiring a $435 daily copay for days 1 through 5 and no copay for days 6 through 90, with unlimited additional acute stay days also covered at no copay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay up to $400 for outpatient hospital services, and a $400 copay for ambulatory surgical center and observation services. Outpatient substance abuse services require a copay of $35 for group sessions or $45 for individual sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Key Thurston (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 Key Thurston (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance, requiring copays of $130, $50, and $300 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits and therapy services require copays of $0 to $50 and no coinsurance. Chiropractic benefits are partially covered, with routine care requiring a $15 copay and no coinsurance while other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness benefits and smoking cessation with no copay, while services such as health education, weight management, alternative therapies, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services covered by Kaiser Permanente Medicare Advantage Key Thurston (HMO) require no coinsurance or deductible, featuring no copay for fitting evaluations and a $0 to $50 copay for yearly routine exams. Although some hearing aid services are covered, prescription hearing aids (including all types, inner ear, outer ear, and over the ear) and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) offers partially covered vision services, including one routine annual eye exam with a $0 to $50 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $150 yearly limit, but other eye exam services and upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) partially covers dental services, offering coverage only for Medicare-covered dental care with a $50 copay and no coinsurance, which requires prior authorization and a referral. Routine preventive and comprehensive dental services, such as cleanings, exams, x-rays, and orthodontics, are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Medicare Advantage Key Thurston (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 chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies, equipment, and therapeutic shoes are also covered with no copay and no coinsurance, though manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Medicare Advantage Key Thurston (HMO) with no coinsurance for diagnostic services, featuring no copay for lab services and a $20 copay for diagnostic procedures. Outpatient X-rays require a $15 copay, diagnostic radiological services carry a $375 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, though cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($30 copay), and SET for PAD services ($20 copay) are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization and a referral but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Key Thurston (HMO) does not cover Other Services, as acupuncture, over-the-counter items, and meal benefits are all excluded from coverage.
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