Choose flexible, quality care with extra fitness benefits to support a healthy lifestyle

Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) health plan
for residents of Howard and Montgomery counites in MD

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 visits², 24-7 phone advice, and Mail Order Pharmacy³ that keeps you on top of your care from anywhere.

This plan offers a $1,500 allowance⁴ to see a licensed physician of your choosing outside of our network. You’ll also have the One Pass® fitness program that includes membership to any participating gym, on-demand workouts, digital fitness programs, and one fitness kit annually for strength, yoga, or dance. In addition to One Pass, you’ll also receive a $400 annual fitness allowance to support a fun, healthy lifestyle.

Covered items include:
• Personal training fees • Fitness class fees not covered by basic One Pass® membership (e.g., yoga, Pilates) • Additional class fees within the One Pass network that exceed the basic One Pass membership (e.g., power cycling) • Out-of-network fitness center fees (e.g., gyms, fitness studios, climbing gyms) • Racket club memberships (e.g., tennis, pickleball)

For more information, please call 1-800-824-5840 (TTY 711), 9 a.m. to 10 p.m.

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

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

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 $1,500 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
One Pass® gym membership at no cost to you¹⁰

In-Network Premiums and Benefits

Monthly premium	$27
Annual deductible	None
Doctor office visits	$10 Primary $45 Specialist
Emergency care We cover emergency care anywhere in the world.	$110 per emergency department visit
Urgently needed services We cover urgent care anywhere in the world.	$45 per office visit
Preventive services¹¹	No charge
Inpatient hospitalization	$375 per day for days 1 through 6 No charge for the remainder of your stay
Outpatient surgery	$325
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 $50 X-ray
MRI, CT, and PET	$200
Durable Medical Equipment	20%
Ambulance service Per one-way trip	$350
One Pass^®¹⁰	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	$100 quarterly allowance
Annual maximum out-of-pocket	$7,500
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 $1,500 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 MD (HMO-POS)
DESCRIPTION	YOU PAY
Initial Coverage Stage	$5 Preferred Generic (Tier 1) $15 Generic (Tier 2) $47 Preferred Brand-name (Tier 3) $100 Nonpreferred Brand-name (Tier 4) 31% 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 Pharmacy⁵	$0 for up to a 90-day supply for preferred generic and generic (Tiers 1 and 2)

Click or tap to see disclosures and footnotes

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.

Click or tap to see disclosures and footnotes

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 1-855-357-5102, (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.

Medicare health plans

Choose flexible, quality care with extra fitness benefits to support a healthy lifestyle

Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) health planfor residents of Howard and Montgomery counites in MD

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 $1,500 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

One Pass® gym membership at no cost to you10

In-Network Premiums and Benefits

Part D Prescription Drug Coverage

DESCRIPTION

YOU PAY

Initial Coverage Stage

Catastropic Coverage Stage

Our Mail-Order Pharmacy5

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.

Ready to learn more?

Set up a personal appointment

Attend a seminar

Call to learn more

Ready to learn more?

Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) health plan
for residents of Howard and Montgomery counites in MD

4.5 out of 5 rated Medicare health plan by NCQA⁵

Award-winning doctors⁶

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

Comprehensive dental plan with $0 copays for preventive care and a $1,500 allowance⁷ on more extensive services such as dentures.

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

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

One Pass® gym membership at no cost to you¹⁰

Our Mail-Order Pharmacy⁵