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Kaiser Permanente Dual Complete North P25 (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 P25 (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 P25 (HMO D-SNP) in 2026, please refer to our full plan details page.
Kaiser Permanente Dual Complete North P25 (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 25. 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 P25 (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 P25 (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 P25 (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 P25 (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:
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Drug Coverage
The Kaiser Permanente Dual Complete North P25 (HMO D-SNP) offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. If you qualify for the low-income subsidy (LIS), your Part D cost-sharing is reduced to $0.00. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generics, Tier 2 standard generics, and Tier 5 specialty drugs at standard pharmacies. For other tiers, you will pay a 24% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D medications.
Additional Benefits
The Kaiser Permanente Dual Complete North P25 (HMO D-SNP) plan offers robust coverage for essential medical needs, featuring no copays or coinsurance for primary care visits, preventive services, routine vision exams, and home health care. Vision benefits also include a $350 annual allowance for eyewear, while Medicare-covered dental services are fully covered with no copay. However, some specialized services like routine hearing exams and cardiac rehabilitation are not covered by this plan. For more intensive care, members will face predictable copays, such as daily copays up to $475 for the first five days of inpatient hospital stays and a $115 copay for emergency room visits. Outpatient diagnostic tests and x-rays feature no copay, though diagnostic radiological services can range from no copay up to a $500 copay. Additionally, services like dialysis, durable medical equipment, and specific Part B drugs may require up to a 20% coinsurance.
Inpatient Hospital See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) covers inpatient acute hospital stays with a $475 daily copay for days 1 through 5 and psychiatric stays with a $405 daily copay for days 1 through 5, with no copay for subsequent days and no coinsurance. Non-Medicare-covered stays are not covered, and referrals or prior authorizations are required for these services.
Outpatient Services See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) covers outpatient services with no coinsurance, including outpatient hospital visits with a $0 to $455 copay and observation stays with a $0 to $115 copay. Ambulatory surgical center services require a $455 copay, while outpatient blood services and substance abuse sessions are covered with no copay.
Partial Hospitalization See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP), 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 P25 (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 and worldwide urgent coverage are offered with no copay and no coinsurance, while worldwide emergency transportation is covered with a $400 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP), offering no copay and no coinsurance for covered services like doctor visits, therapy, and mental health sessions. 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 P25 (HMO D-SNP) with no copay or coinsurance for covered benefits like annual physical exams, health education, and fitness benefits. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, bathroom safety modifications, and counseling services.
Hearing Services See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) does not cover hearing services in practice, as routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are all not covered. Consequently, there is no plan coverage, copay, or coinsurance available for any of these hearing services.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP), offering routine eye exams and eyewear with no copays and no coinsurance. While eyeglasses and contact lenses are covered up to a $350 annual allowance with a doctor referral, eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) partially covers dental services, providing Medicare-covered dental services with no copay and no coinsurance, though prior authorization and a doctor referral are required. Other major dental sub-services are not covered, including restorative, endodontic, periodontic, orthodontic, prosthodontic, implant, oral surgery, adjunctive general, and maxillofacial services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP) with no copay for all Medicare Part B drugs, including insulin, chemotherapy, and radiation. There is no coinsurance for Part B insulin, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Dual Complete North P25 (HMO D-SNP) plan with a 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP) with prior authorization required, offering durable medical equipment, prosthetics, and medical supplies for no copay and coinsurance ranging from no coinsurance to 20%. Diabetic supplies are available with no copay and no coinsurance, while diabetic shoes and inserts require 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) covers diagnostic and radiological services with a required doctor referral and no coinsurance. There is no copay for lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services carry a copay of $0 to $500.
Home Health Services See details
Kaiser Permanente Dual Complete North P25 (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 P25 (HMO D-SNP) plan, meaning there are no copay or coinsurance benefits available. This non-coverage applies to all related sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Kaiser Permanente Dual Complete North P25 (HMO D-SNP), with additional days beyond the Medicare-covered limit not covered. Patients pay no copay and no coinsurance for days 1 through 20, and a $214 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) partially covers other services, excluding the meal benefit and dual eligible SNPs with highly integrated services. Covered options include acupuncture and over-the-counter items with no copay and no coinsurance, residential substance use treatment with a $100 copay and no coinsurance, and non-Medicare medical supplies with no copay and up to 20% coinsurance.
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