Medicare Advantage · HMOPOS · 2027
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)
At a glance: $38 monthly premium and $0 primary care visits.
- Monthly premium
- $38
- Part B premium separate
- Yearly limit
- $7,400
- Most you’d pay for in-network care
- Dental
- $1,000/yr
- Comprehensive dental allowance
- Doctor visits
- $0
- Primary care · specialists $40
Check this plan for you
Referral needed to see a specialist
Add your doctors and prescriptions to see how they work with this plan.
- DentalComprehensive dental allowance
- $1,000/yr
- HearingHearing aid allowance per 3 years
- $1,000
- VisionEyewear allowance ($40 exam copay)Routine eye exam: $40 copay
- $250/yr
- OTC allowance
- $50/quarter
- Fitness$0 fitness benefit
- Included
- TransportationNon-emergency transportation benefit
- Included
This is a supplemental benefit with plan-specific limits. See plan documents for details.
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Costs and copays
Deductibles, yearly limit, visits, hospital stays and drug tiers
- DeductiblesMedical · $0 for drugs
- $0
- Yearly limitIn-network care, not counting drugs
- $7,400
- Primary doctorPer visit
- $0
- SpecialistPer visit · referral needed
- $40
- Hospital stayNo limit on covered hospital days
- Days 1-6: $375/day, Days 7-90: $0/day, then $0/day
- Inpatient mental healthHospital stay
- Days 1-6: $345/day, Days 7-90: $0/day
- Outpatient surgeryPer procedure
- $330
- Emergency roomPer visit
- $115
- Urgent carePer visit
- $40
- Tier 1 · Preferred Generic30-day supply at a retail pharmacy
- $0
- Tier 2 · Generic30-day supply at a retail pharmacy
- $6
- Tier 3 · Preferred Brand30-day supply at a retail pharmacy
- $45
- Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
- $100
- Tier 5 · Specialty30-day supply at a retail pharmacy
- 29%
- Tier 6 · Drugs30-day supply at a retail pharmacy
- $0
Our take
Where this plan shines, and what to know
Where this plan shines
- See your primary doctor for $0.
- No separate drug deductible.
- No separate medical deductible.
- Highly rated by CMS (4.5 stars).
- Some out-of-network care is covered (HMO-POS).
Things to know before you enroll
- This plan’s out-of-pocket maximum is above the national median.
- Limited coverage while traveling outside the plan’s service area.
Similar plans
Other Medicare Advantage plans offered in District of Columbia
Browse the full 2027 Medicare Advantage with drug coverage directory. This plan is offered in District of Columbia. Plan availability can vary by county.
More Medicare Advantage with drug coverage options
These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.
- Kaiser Permanente Medicare Advantage High DC (HMO-POS)Kaiser Permanente · H2172-001Offered in District of Columbia
- Kaiser Permanente Medicare Advantage Value DC (HMO-POS)Kaiser Permanente · H2172-027Offered in District of Columbia
- AARP Medicare Advantage from UHC DC-0002 (PPO)UnitedHealthcare · H2406-082Offered in District of Columbia
- Aetna Medicare Enhanced Plus (HMO-POS)Aetna Medicare · H3931-095Offered in District of Columbia
- Aetna Medicare Premier (PPO)Aetna Medicare · H5521-015Offered in District of Columbia
- CareFirst BlueCross BlueShield Advantage Signature (PPO)CareFirst BlueCross BlueShield Medicare Advantage · H7379-004Offered in District of Columbia
Common questions
6 answers about this plan
What does Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) cover?
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental ($1,000/yr comprehensive dental allowance), vision ($250/yr eyewear allowance ($40 exam copay)), hearing ($1,000 hearing aid allowance per 3 years), and over-the-counter (OTC) ($50/quarter OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) cost in 2027?
The published 2027 monthly plan premium for Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) is $38. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $7,400; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $40. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS)?
CMS lists Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) as a HMOPOS plan. The plan record says specialist referrals are required. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.
Check your doctorsDoes Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) cover my prescriptions?
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) has 6 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $0, Tier 2 at $6, Tier 3 at $45, Tier 4 at $100, and Tier 5 at 29%. The listed Part D deductible is $0. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.
Check your prescriptionsWhat dental, vision, and hearing benefits does Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) include?
The current plan record for Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) lists dental ($1,000/yr comprehensive dental allowance), vision ($250/yr eyewear allowance ($40 exam copay)), and hearing ($1,000 hearing aid allowance per 3 years). It also lists over-the-counter (OTC) ($50/quarter OTC allowance). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.
When can I enroll in Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS)?
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.
Review Medicare enrollment periodsPlan documents
Summary of Benefits and Evidence of Coverage
- Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
- Evidence of Coverage (PDF)Complete plan details and rules
- Check Your DoctorsSee if your doctors accept this plan
- Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español
Enter your ZIP code to see how you can enroll
Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.
