A non-government entity
Kaiser Permanente Dual Complete North P19 (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 P19 (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 P19 (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete North P19 (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 19. 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 P19 (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 P19 (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 P19 (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 P19 (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 $615.00 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 $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:
Sign up for Kaiser Permanente Dual Complete North P19 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Dual Complete North P19 (HMO D-SNP) offers an enhanced alternative drug benefit with a prescription drug deductible of $615.00. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs at standard pharmacies. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance at standard pharmacies and through standard mail. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Furthermore, if you qualify for the low-income subsidy, also known as Extra Help, your Part D premium cost is reduced to $0.00.
Additional Benefits
The Kaiser Permanente Dual Complete North P19 (HMO D-SNP) offers comprehensive primary and specialist care with no copays or coinsurance, alongside preventive services like annual physicals and fitness programs at no copay. For more intensive care, inpatient hospital acute stays require a $450 daily copay for the first five days, while outpatient hospital services can range up to a $465 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, while urgent care visits have no copay. The plan provides partial coverage for vision and dental care, featuring a $350 annual eyewear allowance and no copays for routine eye exams and Medicare-covered dental services, though routine hearing care and cardiac rehabilitation are not covered. Additional perks include a $75 quarterly over-the-counter allowance and home health services with no copay. Medical equipment and dialysis services are available with no copay and coinsurance ranging up to 20 percent.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP), with non-Medicare-covered stays for both acute and psychiatric care excluded from coverage. Acute stays require a $450 copay per day for days 1 to 5 and no copay for days 6 to 999, while psychiatric stays require a $405 copay per day for days 1 to 5 and no copay for days 6 to 999, with no coinsurance required for either service.
Outpatient Services See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) covers outpatient services with no coinsurance, including no copay for outpatient blood and substance abuse services. Copayments for other outpatient services range from no copay to $115 per stay for observation services, and up to $465 for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Kaiser Permanente Dual Complete North P19 (HMO D-SNP) plan, which offers ground and air ambulance services with a $400 copay and no coinsurance. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) covers emergency services and worldwide emergency coverage with a $115 copay and no coinsurance, with the emergency service copay waived if admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are provided with no copay and no coinsurance, while worldwide emergency transportation requires a $400 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP) with no copay and no coinsurance for primary care, specialist, telehealth, and therapy services. However, 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 P19 (HMO D-SNP) with no copays or coinsurance for covered benefits like annual physicals, fitness programs, and health education. However, the plan does not cover sub-services including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are not covered in practice under the Kaiser Permanente Dual Complete North P19 (HMO D-SNP) plan. While the plan technically lists no copay and no coinsurance for exams, all key sub-services—including routine hearing exams, fitting evaluations, prescription hearing aids, and over-the-counter hearing aids—are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP), which offers routine eye exams and eyewear with no copay, no coinsurance, and no deductible. The plan provides a $350 annual allowance for contacts and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) provides partial coverage for dental services, offering Medicare-covered dental benefits with no copay and no coinsurance. However, orthodontic, restorative, endodontic, periodontic, prosthodontic, implant, oral and maxillofacial surgery, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP) with no copay for all covered drugs, including insulin, chemotherapy, and radiation. Patients will pay a coinsurance of 0% to 20% for Medicare Part B chemotherapy, radiation, and other Part B drugs.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) covers medical equipment with no copay, and coinsurance ranges from no coinsurance up to 20% depending on the item. Covered services include durable medical equipment, prosthetics, and diabetic supplies, with prior authorization required for many benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP) with no coinsurance and a required doctor referral. There is no copay for lab services, outpatient X-rays, therapeutic radiology, and diagnostic tests, while diagnostic radiological services have a copay ranging from $0 to $500.
Home Health Services See details
Kaiser Permanente Dual Complete North P19 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. A doctor referral is required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Dual Complete North P19 (HMO D-SNP) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are all not covered. Since these services are not covered by the plan, there are no copay or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP) because additional days beyond the Medicare-covered limit are not covered. There is no copay and no coinsurance for days 1 to 20, followed by a $214 daily copay and no coinsurance for days 21 to 100, with a doctor referral required.
Other Services See details
Other Services are partially covered by Kaiser Permanente Dual Complete North P19 (HMO D-SNP), with meal benefits and highly integrated SNP services not covered. Covered acupuncture and quarterly OTC items (up to $75) feature no copay and no coinsurance, while residential substance use treatment requires a $100 copay with no coinsurance, and non-Medicare DME and medical supplies require 0% to 20% coinsurance with no copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved