Kaiser Permanente Dual Complete South P1 (HMO D-SNP)

Kaiser Permanente Dual Complete South P1 (HMO D-SNP) is a HMO D-SNP plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in South Plan 1. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Kaiser Permanente Dual Complete South P1 (HMO D-SNP) 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 Dual Complete South P1 (HMO D-SNP).

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.

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:

Drug Coverage

The Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, members pay no copay for Tier 1 preferred generic, Tier 2 standard generic, and Tier 5 specialty drugs at standard pharmacies. Additionally, individuals who qualify for the low-income subsidy can see their Part D cost reduced to zero dollars. For Tier 3 preferred brand drugs and Tier 4 non-preferred drugs, members are responsible for an 18% and 25% coinsurance, respectively, through standard pharmacies or standard mail. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. This structure helps keep your essential medication costs affordable and manageable throughout the year.

Additional Benefits

The Kaiser Permanente Dual Complete South P1 (HMO D-SNP) offers robust coverage with no copay and no coinsurance for primary care, preventive services, home health, and partial hospitalization. However, inpatient hospital stays require a daily copay of up to $475 for the first five days, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient services feature no coinsurance, with copays ranging from no copay up to $475 depending on the specific procedure. For supplemental care, this plan provides no copay for routine eye exams alongside a $350 annual eyewear allowance, though dental coverage is limited to Medicare-covered services and hearing care is not covered. Beneficiaries will pay no copay for medical equipment, with coinsurance ranging from 0% to 20% for durable medical equipment and prosthetics. Dialysis services require a 20% coinsurance with no copay, while diagnostic tests and lab services are fully covered with no copay or coinsurance.