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Kaiser Permanente Dual Complete North P4 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Dual Complete North P4 (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 North P4 (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Complete North P4 (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 North Plan 4. The overall rating for this plan is not yet available for 2025.
It's important to know that Kaiser Permanente Dual Complete North P4 (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 North P4 (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 North P4 (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 North P4 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 North P4 (HMO D-SNP) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic drugs at a standard pharmacy or through mail order. For standard generic drugs, you will pay 23% coinsurance, and for preferred brand and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient hospital services, primary care, preventive services, home health services, and home infusion services. The plan also provides coverage for hearing and vision services, dental services, and medical equipment. Emergency services, ambulance services, and dialysis services are covered with copays or coinsurance. The plan also offers additional benefits like acupuncture and an over-the-counter (OTC) allowance. Some services, such as non-Medicare-covered stays, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan, with no copay for days 1-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric 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 services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services, Ambulatory Surgical Center Services, Individual and Group Sessions for Outpatient Substance Abuse, and Outpatient Blood Services have no copay. Observation Services have a copay between $0 and $110.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan with no copay. A doctor referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan. Ground and air ambulance services have a $325 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 Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $325 copay.
Primary Care See details
Primary Care for the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services (Individual and Group Sessions), Psychiatric Services (Individual and Group Sessions), Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services and Other Health Care Professional require a doctor referral and have no copay, but Routine Chiropractic Care is not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services and additional services, with no copay for the annual physical exam, Health Education, Nutritional/Dietary Benefit, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline). Other preventive services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are covered, with hearing exams available with no copay, but routine hearing exams, fitting/evaluation for hearing aids, all types of prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, and the plan covers services not usually covered by Medicare plans, but a doctor referral is required. Eye exams have no copay, while eyewear has a combined maximum benefit of $350 every year, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with no copay for Medicare Dental Services. 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for these services.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20% and requiring authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have no coinsurance, and medical supplies have no coinsurance. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Dual Complete North P4 (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 under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan, but no specific sub-services are covered. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Kaiser Permanente Dual Complete North P4 (HMO D-SNP) plan covers acupuncture with no copay, and also covers Over-the-Counter (OTC) items up to $140 every three months. However, this plan does not cover meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Other 1 is covered with no copay, while Other 2 has a coinsurance of 0% to 20%.
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