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.
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$27 |
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Annual deductible |
None |
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Doctor office visits |
$10 Primary $45 Specialist |
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Emergency care We cover emergency care anywhere in the world. |
$110 per emergency department visit |
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Urgently needed services We cover urgent care anywhere in the world. |
$45 per office visit |
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Preventive services11 |
No charge |
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Inpatient hospitalization |
$375 per day for days 1 through 6 No charge for the remainder of your stay |
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Outpatient surgery |
$325 |
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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 |
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Lab, X-ray |
$0 Lab $50 X-ray |
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MRI, CT, and PET |
$200 |
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Durable Medical Equipment |
20% |
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Ambulance service Per one-way trip |
$350 |
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Fitness program 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. |
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Over-the-counter (OTC) wellness credit8 Quarterly allowance to purchase items such as cold remedies, antacids, pain relievers, etc. |
$100 quarterly allowance |
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Annual maximum out-of-pocket |
$7,500 |
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Comprehensive dental plan13
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 |
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Hearing aids9 |
$1,000 allowance per ear every 36 months to use at Kaiser Permanente audiology centers |
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Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS) |
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|---|---|
DESCRIPTION |
YOU PAY |
Initial Coverage StageFor up to a 30-day supply from an in-network pharmacy with preferred cost sharing. When the total drug costs paid by you and any Part D plan reach $5,030, you move into the Coverage Gap Stage. |
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Catastropic Coverage Stage |
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Our Mail-Order Pharmacy5 |
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*Some medications are not eligible for Mail Order Pharmacy. Mail Order Pharmacy can deliver to addresses in MD, VA, DC, and certain locations outside the service area.
To find out how much you’ll pay for your prescription drugs, you can use Kaiser Permanente’s drug pricing tool. Sign on to your registered account on kp.org and select “Coverage & Costs” from the menu bar and select “Drug cost” to search for drug information, pharmacy pricing, and lower cost options. If you don’t have an account yet, register for a secure account to use the service.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
1 In the survey Best Health Insurance Companies of 2024 by Insure.com, Kaiser Permanente as a national enterprise is rated #1 overall among 70+ competitors—for the fourth year in a row. In the NCQA Medicare Health Plan Ratings 2023, our Medicare plan is rated 4.5 out of 5, the highest rating in the region. The 2022 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group in the Washington, DC, and Baltimore areas exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Arlington Magazine (2024), Northern Virginia Magazine (2024), Baltimore magazine (2023), Bethesda magazine (2023), and Washingtonian magazine (2023). According to NCQA’s Quality Compass® 2023, we’re rated 5 out of 5 in 30 care measures, including: controlling high blood pressure, glucose control and blood pressure control (140/90) for diabetes, breast cancer screening, and colorectal cancer screening. Quality Compass is a registered trademark of the NCQA.
2 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.
3 Some medications are not eligible for Mail Order Pharmacy. Mail Order Pharmacy can deliver to addresses in MD, VA, DC, and certain locations outside the service area.
4 Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,500. Coverage limited to inside the United States and its territories. This benefit covers limited services. See your Evidence of Coverage for details. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
5 NCQA Medicare Health Plan Ratings 2023.
6 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).
7 With a 50% coinsurance.
8 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.
9 Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers.
10 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.
11 $0 copay for all preventive services covered under Original Medicare at zero cost sharing.
12 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.
Concerned about affording coverage? We may be able to help.
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.
Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.
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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