Kaiser Permanente Medicare Advantage Standard MD (HMO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by Kaiser Permanente
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
5.0out of 5 stars
State: Maryland
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
Medical Benefits
Doctor Services
$10 copay per visit
$40 copay per visit
Tests, labs, & imaging
$0 copay
$0 copay
$100 copay
$15 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)
Hospital Services
$250 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 6 through 90
$0-250 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$160 per day for days 21 through 100
$160 per day for days 21 through 100
Preventive services
$0 copay
Ambulance
$275 copay
Therapy services
$40 copay
$40 copay
Mental health services
$10 copay
$20 copay
$10 copay
$20 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $10.00 copay | 5% | |
| Generic | $20.00 copay | 5% | |
| Preferred Brand | $47.00 copay | 5% | |
| Non-Preferred Drug | |||
| Specialty Tier | 33% | 5% | |
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
$0-47 copay
$0-47 copay
Extra Benefits
Hearing
$40 copay
Not covered
Not covered
Not covered
Not covered
Preventive Dental
Covered under office visit
Covered under office visit
Covered under office visit
Covered under office visit
Comprehensive dental
$0-55 copay
$11-69 copay
$40-755 copay
$47-1,047 copay
$76-836 copay
$72-429 copay
$30-3,658 copay
Vision
$10-40 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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