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Kaiser Permanente Dual Complete North P16 (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 P16 (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 P16 (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) is a HMO D-SNP plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 to people living in North Plan 16. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Dual Complete North P16 (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 P16 (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 P16 (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 P16 (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 $9250.00 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 P16 (HMO D-SNP) offers an Enhanced Alternative drug benefit with a $0 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. For other tiers, standard pharmacy costs include an 18% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, can have their Part D premium reduced to $0.
Additional Benefits
The Kaiser Permanente Dual Complete North P16 (HMO D-SNP) plan offers comprehensive medical coverage with no copays or coinsurance for primary care, specialist visits, outpatient surgeries, and diagnostic services. For inpatient hospital stays, members pay a daily copay of $425 for acute care or $405 for psychiatric care during the first five days, with no copays thereafter. Emergency room visits require a $115 copay, which is waived if admitted, while ambulance services carry a $400 copay. This plan includes valuable extra benefits such as routine vision exams and eyewear with a $350 annual allowance, along with a $75 quarterly over-the-counter item allowance, all with no copays. Medicare-covered dental, home health, and home infusion services also feature no copays or coinsurance, though dialysis and prosthetic devices require a 20% coinsurance. While routine hearing aids and cardiac rehabilitation are not covered, members benefit from no-copay preventive services, fitness benefits, and acupuncture.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with no coinsurance, though non-Medicare-covered stays are not covered. Acute stays require a $425 daily copay for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $405 daily copay for days 1 to 5 and no copay for days 6 and beyond.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with no coinsurance and no copays for most services, including outpatient surgery, blood services, and substance abuse treatment. The only exception is outpatient observation services, which require a copay of $0 to $115 per stay, with no deductibles applied.
Partial Hospitalization See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to access these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) partially covers ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground and air ambulance services require a $400 copay and no coinsurance.
Emergency Services See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent coverage are available with no copay and no coinsurance, while worldwide emergency coverage has a $115 copay and worldwide emergency transportation has a $400 copay.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with no copay and no coinsurance for most services, including primary care, specialist, therapy, and telehealth visits. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with no copay or coinsurance for covered options like annual physical exams, fitness benefits, and health education. However, the plan does not cover sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, caregiver support, in-home support, smoking cessation, disease management, telemonitoring, bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with no copay and no coinsurance, though only some services are covered in practice. Routine hearing exams, fitting and evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP), as eyewear upgrades are not covered. Routine eye exams and eyewear, including contacts and eyeglasses, are available with no copay or coinsurance, with a combined eyewear allowance of $350 every year.
Dental Services See details
Dental Services are partially covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP), offering Medicare-covered dental services with no copay and no coinsurance, subject to prior authorization and a doctor referral. Orthodontic, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, maxillofacial, and adjunctive general services are not covered under this plan.
Home Infusion bundled Services See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers Home Infusion bundled Services, including Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs. These services are fully covered with no copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Dual Complete North P16 (HMO D-SNP) with a 20% coinsurance and no copay. This ensures you have access to necessary dialysis treatments with clear and predictable out-of-pocket costs.
Medical Equipment See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and medical supplies feature no copay and coinsurance ranging from no coinsurance to 20%, while prosthetic devices and diabetic shoes require 20% coinsurance with no copay, and diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers diagnostic and radiological services with no copay and no coinsurance, though a doctor referral is required. These covered services include diagnostic tests, lab services, therapeutic and diagnostic radiological treatments, and outpatient X-rays.
Home Health Services See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) covers home health services with no copay and no coinsurance, though a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Dual Complete North P16 (HMO D-SNP) plan, as none of the sub-services—including cardiac, pulmonary, and SET for PAD rehabilitation—are covered. Because these services are not covered by the plan, members will have no copayments or coinsurance costs.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Dual Complete North P16 (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) care with a required doctor referral, featuring no copay for days 1 to 20, a $214 daily copay for days 21 to 100, and no coinsurance. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under Kaiser Permanente Dual Complete North P16 (HMO D-SNP) are partially covered, as meal benefits and highly integrated services for dual eligible SNPs are not covered. Covered benefits include acupuncture and OTC items (up to $75 every three months) with no copay or coinsurance, residential substance use treatment with a $100 copay and no coinsurance, and non-Medicare durable medical equipment and medical supplies with 0% to 20% coinsurance and no copay.
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