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Kaiser Permanente Medicare Advantage Vital Sound (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Vital Sound (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 Vital Sound (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Vital Sound (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in Grays Harbor, Kitsap Lewis, Mason. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Medicare Advantage Vital Sound (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 Vital Sound (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 Vital Sound (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. 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 $6500.00 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 Vital Sound (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, you will pay no copay for standard mail order deliveries, while preferred retail pharmacies offer copays starting at just $3 for a 1-month supply. Tier 2 generic medications also offer excellent savings, featuring no copay for 2-month and 3-month standard mail order refills and a low $10 copay for a 1-month supply at preferred pharmacies. Tier 3 preferred brand and Tier 4 non-preferred drugs carry a 1-month copay of $47 and $99 respectively at both preferred and standard retail pharmacies. Specialty medications under Tier 5 require a 30% coinsurance for all supply durations, whereas Tier 6 vaccines are covered with no copay for a 1-month supply at retail pharmacies. This structured prescription drug coverage helps Medicare beneficiaries easily manage their healthcare costs through affordable mail order and retail options.
Additional Benefits
The Kaiser Permanente Medicare Advantage Vital Sound (HMO) plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care, telehealth, and preventive services. For specialized medical care, members pay no coinsurance and low copays, including a $0 to $50 copay for specialists and a $130 copay for emergency room visits. Inpatient hospital stays require a $450 daily copay for days 1 through 5 followed by no copay for days 6 through 90, while outpatient hospital services range from no copay up to a $450 copay. This plan also includes key supplemental benefits, providing preventive dental care and home health services with no copay and no coinsurance. Routine eye and hearing exams are covered with no coinsurance and copays ranging from no copay up to $50, alongside a $150 annual allowance for eyewear. Additionally, durable medical equipment and dialysis require no copay and a 20% coinsurance, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by Kaiser Permanente Medicare Advantage Vital Sound (HMO) with no coinsurance, requiring a $450 daily copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered under Kaiser Permanente Medicare Advantage Vital Sound (HMO) with no coinsurance for all services, though copays apply depending on the care received. Patients will pay a $0 to $450 copay for outpatient hospital services, a $450 copay for ambulatory surgical center and observation services, a $25 to $35 copay for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Medicare Advantage Vital Sound (HMO) with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Medicare Advantage Vital Sound (HMO) with a $290 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) covers emergency services for a $130 copay (waived if admitted within 24 hours) and urgently needed services for a $40 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring copays of $130 for emergency care, $40 for urgent care, and $290 for emergency transportation.
Primary Care See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) covers primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $0 to $50 and no coinsurance. Chiropractic benefits are partially covered with a $15 copay and no coinsurance for routine care (other chiropractic services are not covered), but podiatry services are not covered.
Preventive Services See details
Preventive Services under the Kaiser Permanente Medicare Advantage Vital Sound (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, though benefits such as health education, weight management programs, nutritional/dietary benefits, and in-home safety assessments are not covered.
Hearing Services See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) covers diagnostic and routine hearing exams with no deductible, no coinsurance, and copays ranging from no copay up to $50. While some prescription hearing aid services are covered, specific types—including inner ear, outer ear, and over-the-ear prescription aids—are not covered in practice, and over-the-counter (OTC) hearing aids are also excluded.
Vision Services See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) provides partially covered vision services with no deductibles, though other eye exam services and eyewear upgrades are not covered. Routine eye exams are covered once annually with a $0 to $50 copay and no coinsurance, while eyewear is covered with no copay and no coinsurance up to a $150 yearly limit.
Dental Services See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) offers partially covered dental services, featuring Medicare-covered dental care for a $50.00 copay and no coinsurance, and preventive care with no copay and no coinsurance. While most restorative, periodontic, and surgical services are covered with no copay and no coinsurance, 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 Vital Sound (HMO) with no copay, though prior authorization is required. Under this benefit, Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Kaiser Permanente Medicare Advantage Vital Sound (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required and brand limitations may apply.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Vital Sound (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for care. Diagnostic procedures and tests have a $20 copay with no coinsurance, lab services have no copay and no coinsurance, and outpatient x-rays require a $20 copay. Diagnostic radiological services require a minimum copay of $375, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Medicare Advantage Vital Sound (HMO) plan with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by Kaiser Permanente Medicare Advantage Vital Sound (HMO) with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered. Covered services require a referral and prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Kaiser Permanente Medicare Advantage Vital Sound (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are not covered under the Kaiser Permanente Medicare Advantage Vital Sound (HMO) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, or meal benefits.
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