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Kaiser Permanente Dual Complete South P1 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Complete South P1 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Dual Complete South P1 (HMO D-SNP) in 2025, please refer to our full plan details page.
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. The overall rating for this plan is not yet available for 2025.
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.
Important:
Kaiser Permanente Dual Complete South P1 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
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.
For Kaiser Permanente Dual Complete South P1 (HMO D-SNP), 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 Dual Complete South P1 (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. During the initial coverage phase, you will pay coinsurance for your prescriptions, which varies based on the drug tier and pharmacy type. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your prescriptions. If you qualify for the low-income subsidy, you will pay no premium for Part D.
Additional Benefits
The Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient and outpatient hospital care, primary care, preventive services, emergency services, and home health services. The plan also includes vision and dental benefits, with a combined maximum benefit of $350.00 per year for eyewear and no copay for Medicare Dental Services. Additional benefits include coverage for ambulance services with a $50 copay, as well as medical equipment, home infusion services, and diagnostic services with no copays. Hearing exams are covered with no copay, but routine hearing exams and hearing aids are not included. Dialysis services have a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-90, there is no copay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for both are covered with no copay. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, or outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan. Ground and Air Ambulance Services have a $50 copay with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have no copay and no coinsurance. Worldwide Emergency Transportation has a $50 copay and no coinsurance.
Primary Care See details
The Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational therapy services, individual and group sessions for mental health and psychiatric services, other healthcare professional services, and psychiatric services have a copay of $0. Chiropractic services do not cover routine care, and podiatry services are not covered.
Preventive Services See details
The Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including health education, nutritional/dietary benefits, fitness benefits, and remote access technologies, are also covered with no copay. Other services such as in-home safety assessments, personal emergency response systems, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include routine eye exams with no copay and a doctor referral, as well as coverage for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. The plan offers a combined maximum benefit of $350.00 per year for eyewear, but upgrades are not covered.
Dental Services See details
Dental services are covered, with no copay for Medicare Dental Services, but prior authorization and a doctor referral are required. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for any of these services.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with no coinsurance, and Medical Supplies with no coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with no copay. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are covered with no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Dual Complete South P1 (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-100, there is no copay, and there is no coinsurance.
Other Services See details
Other Services includes acupuncture with no copay, and over-the-counter items with a maximum benefit of $200 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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