Choose flexible, quality care from the region's leading health system

Kaiser Permanente Medicare Advantage Care Plus Virginia (HMO-POS) health plan​

Switch to the region’s leading health system1​ for flexible coverage with highly skilled doctors and 24/7 access. You’ll experience convenient access to care with both in-person visits and a variety of telehealth options like video visits,2 24/7 phone advice, and Mail Order Pharmacy3 that keeps you on top of your care from anywhere.

You’ll also have an annual $1,500 allowance4 to see a licensed physician of your choosing outside of our network.

For the best experience, see any provider that accepts Medicare. To find a provider that accepts Medicare, visit medicare.gov. The Care Plus allowance can only be used inside the United States and its territories.

FLEXIBILITY

Freedom of choice to go out of network. Copays for out-of-network services:

  • $25 out-of-network primary care per office visit

  • $50 out-of-network specialty care per office visit

  • $0-$50 out-of-network labs

  • $50 out-of-network X-ray

  • $50 out-of-network physical, speech, and occupational therapy per visit

  • Individual behavioral health: $25 per visit

  • Group behavioral health: $15 per visit

QUALITY

  • 4.5 out of 5 rated Medicare health plan by NCQA5

  • Award-winning doctors6

  • Integrated health system for personalized care

  • Care by video,2 email, online, or in-person

BENEFITS

  • Comprehensive dental plan with $0 copays for preventive care and a $2,000 annual allowance7 on more extensive services such as dentures.

  • $250 vision allowance every 2 years

  • Over-the-counter wellness benefit for vitamins, first aid, and more8

  • $1,000 hearing aid allowance per ear, every 36 months9

  • 24 rides to or from nonurgent medical appointments at our medical centers10

  • One Pass® gym membership at no cost to you11

In-Network Premiums and Benefits

Monthly premium

$26

Annual deductible

None

Doctor office visits

$5 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 services12

No charge

Inpatient hospitalization

$280​ per day for days 1 through 6

No charge for the remainder of your stay

Outpatient surgery

$225

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

$15 X-ray

MRI, CT, and PET

$180

Durable Medical Equipment

20%

Ambulance service

Per one-way trip

$225

Transportation

$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®11

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

Over-the-counter (OTC) wellness credit8

$50 quarterly allowance

Annual maximum out-of-pocket

$5,500

Comprehensive dental plan13

  • 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

The comprehensive dental plan also includes a $2,000 annual allowance7 for more extensive care, such as fillings, crowns, dentures, root canals, and more.

$0 copay per visit

Hearing aids9

$1,000 allowance per ear every 36 months to use at Kaiser Permanente audiology centers

Part D Prescription Drug Coverage

Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS)

DESCRIPTION

YOU PAY

Initial Coverage Stage

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

  • $3 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)

Catastropic Coverage Stage

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

Our Mail-Order Pharmacy*

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

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

Ready to learn more?

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.

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.