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Kaiser Permanente Dual Complete South P5 (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 P5 (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 P5 (HMO D-SNP) in 2025, please refer to our full plan details page.
Kaiser Permanente Dual Complete South P5 (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 5. The overall rating for this plan is not yet available for 2025.
It's important to know that Kaiser Permanente Dual Complete South P5 (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 P5 (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 P5 (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 P5 (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:
Sign up for Kaiser Permanente Dual Complete South P5 (HMO D-SNP)
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Drug Coverage
The Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you pay coinsurance for your prescriptions. For preferred generic drugs at a standard pharmacy, you pay 3% coinsurance, while you pay 0% coinsurance through standard mail. For specialty tier drugs at a standard pharmacy, there is no copay.
Additional Benefits
The Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays for the first 90 days, outpatient services, primary care, preventive services, and vision exams. This plan also includes coverage for emergency services, ambulance, home health, and medical equipment with no copays, but with some coinsurance requirements for certain services like dialysis. Additional benefits of the plan include coverage for hearing exams with no copay, and up to $350 annually for eyewear. Dental services are covered with no copay for Medicare dental services. The plan also provides coverage for home infusion, and diagnostic and radiological services with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay for days 1-90 and additional days 91-999. Non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered with no copay. Outpatient blood services include an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay, and a doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan. Ground and Air Ambulance Services have a $50 copay, and there is no coinsurance. 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 P5 (HMO D-SNP) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, additional telehealth benefits, physical therapy, and speech-language pathology services with no copay. Occupational therapy services, other health care professional services, psychiatric services, and opioid treatment program services are covered, but may have copays. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while other preventive services like health education, nutritional/dietary benefits, fitness benefits, and remote access technologies have a $0 copay. This plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, or telemonitoring services.
Hearing Services See details
Hearing services are covered, with no copay for hearing exams, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types), prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a doctor referral required. Eye exams have no copay, and eyewear has a combined maximum benefit of $350 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, while upgrades are not covered.
Dental Services See details
Dental services are covered by the Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan with no copay for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered. Prior authorization and a doctor referral are required for Medicare Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan. Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs have no copay.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan. You will pay 20% coinsurance for these services, and a doctor referral is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay and 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, including diagnostic procedures, tests, and lab services, are covered with no copay, while diagnostic radiological, therapeutic radiological, and outpatient X-ray services have a copay of $0.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Dual Complete South P5 (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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-100, there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Kaiser Permanente Dual Complete South P5 (HMO D-SNP) plan covers acupuncture with no copay, and covers Over-the-Counter (OTC) items up to $200 every three months. Other services such as Meal Benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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