2025 DC Medicare Plan Options – Medicare 2025 Special Enrollment Period (SEP)

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Kaiser Permanente DC Medicare health plans and rates for 2025

Premiums and benefits

Premiums and benefits	Kaiser Permanente Medicare Advantage Value DC (HMO-POS)	Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)	Kaiser Permanente Medicare Advantage High DC (HMO-POS)
DESCRIPTION	YOU PAY	YOU PAY	YOU PAY
Monthly premium	$0	$30	$105
Annual deductible	None	None	None
Doctor office visits	$5 Primary $40 Specialist	$5 Primary $35 Specialist	$5 Primary $30 Specialist
Emergency care We cover emergency care anywhere in the world	$110 per emergency department visit	$110 per emergency department visit	$120 per emergency department visit
Urgently needed services We cover urgent care anywhere in the world	$40 per office visit	$35 per office visit	$30 per office visit
Preventive services¹	No charge	No charge	No charge
Inpatient hospitalization	$290 per day for days 1 through 5 No charge for the remainder of your stay	$245 per day for days 1 through 5 No charge for the remainder of your stay	$225 per day for days 1 through 5 No charge for the remainder of your stay
Outpatient surgery	$290	$130	$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 $203 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	$0 Lab $15 X-ray	$0 Lab $10 X-ray
MRI, CT, PET	$170	$100	$00
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	$6,900	$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 more extensive care, such as fillings, crowns, dentures, root canals, and more	$0 copay per visit The comprehensive dental plan also includes a $2,500 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	$70 quarterly allowance	$80 quarterly allowance	$70 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	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.	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.

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Part D Prescription Drug Coverage

	Kaiser Permanente Medicare Advantage Value DC (HMO-POS)	Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)	Kaiser Permanente Medicare Advantage High DC (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) $7 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).

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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.

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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.