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Kaiser Permanente Maryland Medicare health plans and rates for 2025

Premiums and benefits

Premiums and benefits

Kaiser Permanente Medicare Advantage Value MD and Value Balt (HMO-POS)

Kaiser Permanente Medicare Advantage Standard MD (HMO-POS)

Kaiser Permanente Medicare Advantage High MD (HMO-POS)

DESCRIPTION

YOU PAY

YOU PAY

YOU PAY

Monthly premium

$0

$21

$104

Annual deductible

None

None

None

Doctor office visits

$10 Primary

$40 Specialist

$5 Primary

$25 Specialist

$10 Primary

$35 Specialist

Emergency care

We cover emergency care anywhere in the world

$110 per emergency department visit

$110 per emergency department visit

$125 per emergency department visit

Urgently needed services

We cover urgent care anywhere in the world

$40 per office visit

$25 per office visit

$35 per office visit

Preventive services1

No charge

No charge

No charge

Inpatient hospitalization

$300 per day for days 1 through 5

No charge for the remainder of your stay

$270 per day for days 1 through 5

No charge for the remainder of your stay

$270 per day for days 1 through 6

No charge for the remainder of your stay

Outpatient surgery

$300

$125

$125

Skilled nursing facility

Up to 100 days per benefit period

$0 per day for days 1 through 20

$214 per day for days 21 through 100

$0 per day for days 1 through 20

$190 per day for days 21 through 100

$0 per day for days 1 through 20

$160 per day for days 21 through 100

Lab, X-ray

$0 Lab
$20 X-ray Value MD
$40 X-Ray Value Balt

$0 Lab

$15 X-ray

$0 Lab

$10 X-ray

MRI, CT, PET

$150 Value MD
$190Value Balt

$100

$100

Durable medical equipment

20%

20%

20%

Ambulance service

Per one-way trip

$275

$225

$225

Transportation

Not covered

$0 for 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only.

$0 for 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only.

Fitness program One Pass®2

Not covered

No cost for membership to any participating gym, on-demand workouts, digital fitness programs, and one fitness kit annually for strength, yoga, or dance.

No cost for membership to any participating gym, on-demand workouts, digital fitness programs, and one fitness kit annually for strength, yoga, or dance.

Annual maximum out-of-pocket

$7,200 Value MD
$8,200 Value Balt

$6,900

$5,700

Comprehensive dental plan

  • Oral exams, up to two per year
  • Cleanings, up to two per year
  • Bitewing X-rays, one set per year
  • Topical fluoride, one per year
  • Full mouth series X-rays, one every
    three years

$0 copay per visit
The comprehensive dental plan also includes a $1,500 annual allowance3 for Value MD and a $500 annual allowance for Value Balt for more extensive care, such as fillings, crowns, dentures, root canals, and more

$0 copay per visit
The comprehensive dental plan also includes a $3,000 annual allowance3 for more extensive care, such as fillings, crowns, dentures, root canals, and more

$0 copay per visit
The comprehensive dental plan also includes a $1,000 annual allowance3 for more extensive care, such as fillings, crowns, dentures, root canals, and more

Over the counter (OTC) wellness credit4

$50 quarterly allowance for Value MD
$30 quarterly allowance for Value Balt

$110​ quarterly allowance

$65​ quarterly allowance

Hearing aids5

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers

Medicare Explorer by Kaiser Permanente6

Not covered

If you travel outside any Kaiser Permanente service area, but inside the United States or its territories, we cover preventive, routine, follow-up, or continuing care office visits obtained from out-of-network Medicare providers not to exceed a benefit maximum of $1,200 in covered plan charges per calendar year. See Evidence of Coverage for details.

If you travel outside any Kaiser Permanente service area, but inside the United States or its territories, we cover preventive, routine, follow-up, or continuing care office visits obtained from out-of-network Medicare providers not to exceed a benefit maximum of $1,200 in covered plan charges per calendar year. See Evidence of Coverage for details.

Part D prescription drug coverage

Kaiser Permanente Medicare Advantage Value MD and Value Balt (HMO-POS) Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) Kaiser Permanente Medicare Advantage High MD (HMO-POS)
DESCRIPTION YOU PAY YOU PAY YOU PAY

Initial coverage stage

Up to a 30-day supply from a Kaiser Permanente pharmacy

$0 Preferred generic (Tier 1) for Value MD

$3​ Preferred generic (Tier 1) for Value Balt

$14​​ Generic (Tier 2)

$45​​ Preferred brand-name (Tier 3)

$100​​ Nonpreferred brand-name (Tier 4)

33%​​ Specialty (Tier 5)

$0​​ Injectable Part D vaccines ​ (Tier 6)

$0​ Preferred generic (Tier 1)

$12​​ Generic (Tier 2)

$45​​ Preferred brand-name (Tier 3)

$100​​ Nonpreferred brand-name (Tier 4)

33%​​ Specialty (Tier 5)

$0​​ Injectable Part D vaccines ​ (Tier 6)

$0​ Preferred generic (Tier 1)

$12​​ Generic (Tier 2)

$42​​ Preferred brand-name (Tier 3)

$100​​ Nonpreferred brand-name (Tier 4)

33%​​ Specialty (Tier 5)

$0​​ Injectable Part D vaccines ​ (Tier 6)

Catastrophic coverage stage

After your yearly out-of-pocket drug costs reach $2,000, you pay $0

Our Mail-Order Pharmacy5

$0​ copay for up to a 90-day supply for preferred generic and generic (Tiers 1 and 2)

Enhance your health coverage — get extra benefits for an affordable monthly premium with Advantage Plus

Enhance your health and well-being by combining the affordable benefits of Advantage Plus with your Kaiser Permanente Medicare Advantage (HMO) plan. Choose Option 1, Option 2, or both options for maximum coverage. 

Concerned about affording coverage? We may be able to help.

Ready to learn more?

Set up a personal appointment

Connect with a licensed Kaiser Permanente Medicare specialist in your area, on your schedule. Simply complete the form (click or tap to open)​ and we’ll contact you to set up an appointment.

Attend a seminar

Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.

Call to learn more

Call 1-855-357-5101, (TTY 711) to speak with a Kaiser Permanente Medicare specialist 7 days a week, 8 a.m. – 8 p.m. They will walk you through your options over the phone.