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Kaiser Permanente Dual Complete North P21 (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 P21 (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 P21 (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete North P21 (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 21. 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 P21 (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 P21 (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 P21 (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 P21 (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 P21 (HMO D-SNP) offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for preferred generic, standard generic, and specialty tier drugs at standard pharmacies. For preferred brand and non-preferred drugs, standard pharmacy and mail-order services require an 18% and 25% coinsurance respectively. 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 drugs. Additionally, members who qualify for the low-income subsidy can see their Part D premium reduced to zero dollars. This plan provides clear and affordable pathways for managing your prescription medication expenses.
Additional Benefits
The Kaiser Permanente Dual Complete North P21 (HMO D-SNP) plan offers many essential healthcare benefits with no copay and no coinsurance, including primary care visits, preventive services, outpatient hospital care, and diagnostic tests. Members also benefit from no copay for home health services, home infusions, and vision exams, which includes up to a $350 annual allowance for eyewear. However, some specialty areas like routine hearing care and cardiac rehabilitation are not covered under this plan. For more intensive services, members will face specific copays, such as $450 per day for the first five days of an acute inpatient hospital stay and $400 for ambulance services. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgently needed care has no copay. Additionally, medical equipment and dialysis services may require up to a 20% coinsurance, though diabetic supplies are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) partially covers inpatient hospital services, as non-Medicare-covered stays for both acute and psychiatric care are not covered. Covered acute stays require a $450 copay for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $405 copay for days 1 to 5 and no copay for subsequent days, both with no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with no coinsurance and no copay for outpatient hospital, ambulatory surgical center, blood, and substance abuse services. Outpatient observation services are also covered with no coinsurance and a copay ranging from $0 to $115 per stay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with no copay and no coinsurance. A doctor referral is required to receive these services.
Ambulance and Transportation Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) provides partial coverage for ambulance and transportation services, requiring a $400 copay and no coinsurance for ground and air ambulance services. Transportation services to plan-approved health-related locations and any other health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide coverage features a $115 copay for emergency services, no copay for urgent care, and a $400 copay for emergency transportation, all with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with no copay and no coinsurance for covered services like doctor visits, therapy, and telehealth. Under this plan, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, health education, and fitness benefits. Sub-services that are not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (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.
Hearing Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) does not cover hearing services, as routine hearing exams, fitting and evaluations, prescription hearing aids, and over-the-counter hearing aids are all not covered in practice.
Vision Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) partially covers vision services, offering eye exams and eyewear with no copay and no coinsurance, though eyewear upgrades are not covered. Members receive up to a $350 annual maximum for covered contacts, lenses, and frames, with doctor referrals required for all services.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP), which covers Medicare dental services with no copay and no coinsurance, requiring prior authorization and a doctor referral. However, several sub-services are not covered, including restorative, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Kaiser Permanente Dual Complete North P21 (HMO D-SNP) covers home infusion bundled services, including Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs. These covered services are available to members with no copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with a 20% coinsurance and no copay.
Medical Equipment See details
Medical Equipment benefits are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with prior authorization required. Durable medical equipment, prosthetics, and medical supplies feature no copay and coinsurance ranging from no coinsurance to 20%, while diabetic supplies have no copay or coinsurance, and diabetic shoes require 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with no copay and no coinsurance. These covered benefits require a doctor referral and include diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with no copay and no coinsurance, although a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Dual Complete North P21 (HMO D-SNP) plan, as all sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD)—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kaiser Permanente Dual Complete North P21 (HMO D-SNP) with a doctor referral and no prior three-day hospital stay requirement. Covered stays feature no copay for days 1 to 20, a $214 daily copay for days 21 to 100, and no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Kaiser Permanente Dual Complete North P21 (HMO D-SNP) plan, though meal benefits and highly integrated dual-eligible services are not covered. Acupuncture and over-the-counter items (up to $75 every three months) are available with no copay and no coinsurance, while residential substance use treatment requires a $100 copay and no coinsurance, and non-Medicare medical supplies carry no copay and 0% to 20% coinsurance.
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* 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.
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