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|
Monthly premium |
$0 |
|
Annual deductible |
None |
|
Doctor office visits |
$15 Primary $40 Specialist |
|
Emergency care We cover emergency care anywhere in the world. |
$125 per emergency department visit |
|
Urgently needed services We cover urgent care anywhere in the world. |
$40 per office visit |
|
Preventive services1 |
No charge |
|
Inpatient hospitalization |
$300 per day for days 1 through 5 No charge for the remainder of your stay |
|
Outpatient surgery |
$200 |
|
Skilled nursing facility Up to 100 days per benefit period |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 |
|
Lab, X-ray |
$0 Lab $10 X-ray |
|
MRI, CT, and PET |
$150 |
|
Durable Medical Equipment |
20% per visit |
|
Ambulance Service Per one-way trip |
$250 |
| Transportation | Not covered |
|
One Pass®8 |
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 |
$6,500 |
|
Comprehensive dental plan |
$0 copay per visit
The comprehensive dental plan also includes a $500 annual allowance with a 50% coinsurance for more extensive care, such as fillings, crowns, dentures, root canals, and more. |
|
Over-the-counter (OTC) wellness credit6 Quarterly allowance to purchase items such as cold remedies, antacids, pain relievers, etc. |
$60 quarterly allowance |
|
Hearing aids7 |
$1,000 allowance per ear every 36 months through Kaiser Permanente audiology centers |
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.
1 NCQA Medicare Health Plan Ratings 2023.
2 $0 copay for all preventive services covered under Original Medicare at zero cost sharing.
3 The physicians who practice at Kaiser Permanente are recognized as Top Doctors in Arlington Magazine (2024), Northern Virginia Magazine (2024), Baltimore magazine (2023), Bethesda magazine (2023), and Washingtonian magazine (2023).
4 If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from providing care across state lines. Laws differ by state.
5 With 50% coinsurance.
6 Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1. Each order must be at least $20. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Your order may not exceed your quarterly benefit limit. Limitations and restrictions may apply. Cash, check, credits cards, or money orders are not accepted.
7 Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers.
8 Not available with Kaiser Permanente Medicare Advantage Value Balt (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), or Kaiser Permanente Medicare Advantage Value DC plans. One Pass® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions and is a voluntary program. The One Pass program and amenities vary by plan, area, and location. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. One Pass is not responsible for the services or information provided by third parties. Individuals should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them.
9 Free with no obligation.
10 Dental benefits are underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by LIBERTY Dental Plan. To find an in-network dentist, call 1-888-650-1859 or visit LibertyDentalPlan.com/kaiserdentists.
For more information about benefits, please view the 2025 Summary of Benefits.
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.
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.
Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.
For accommodations of persons with special needs at meetings, call 1-866-975-7803 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.
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© 2024-2025 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Page last updated on October 1, 2024 at 12 a.m. EST
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