Kaiser Permanente Medicare Advantage Value VA (HMO-POS)

Virginia Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Kaiser Permanente

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Name
Kaiser Permanente Medicare Advantage Value VA (HMO-POS)
Insurance Carrier
Kaiser Permanente
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Virginia and offered by the health insurance company Kaiser Permanente. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,500
Primary doctor visit
$5 copay per visit
Specialist visit
$40 copay per visit
ER visit
$100 copay per visit (always covered)
Ambulance
$275 copay

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,500 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Kaiser Permanente Medicare Advantage Value VA (HMO-POS) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Kaiser Permanente Medicare Advantage Value VA (HMO-POS) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Kaiser Permanente Medicare Advantage Value VA (HMO-POS) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Kaiser Permanente Medicare Advantage Value VA (HMO-POS) received an overall government quality rating of 3.5 stars out of 5 stars.

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) performed worse than Virginia’s State average overall quality score of 3.9 stars.

This Plan’s 5-star Gov’t Quality Score
Virginia State Average Score
Overall Government 5 Star Quality Rating
 3.5
 3.9
Summary rating of health plan quality
 3.5
 3.9
Staying healthy: screenings, tests, & vaccines
 5
 3.6
Managing chronic (long term) conditions
 4
 3.4
Member experience with health plan
 3
 3.7
Member complaints & changes in the health plan's performance
 4
 4.0
Health plan customer service
 3
 4.4
Summary rating of drug plan quality
 4
 3.8
Drug plan customer service
 1
 4.1
Member complaints & changes in the drug plan's performance
 4
 4.3
Member experience with the drug plan
 5
 3.9
Drug safety & accuracy of drug pricing
 5
 3.3

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) received 3.5 stars for its health plan quality score which is worse than the Virginia State average health plan quality score of 3.9 stars.

Kaiser Permanente Medicare Advantage Value VA (HMO-POS) received 4 stars for its drug plan quality score which is better than the Virginia State average drug plan quality score of 3.8 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,500 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
In-network: $5 copay per visit
Out-of-network: $0-25 copay per visit
Specialist visit
In-network: $40 copay per visit
Out-of-network: $0-50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0-25 copay
Lab services
In-network: $0 copay
Out-of-network: $0-25 copay
Diagnostic radiology services (like MRI)
In-network: $20-190 copay
Out-of-network: $0-25 copay
Outpatient x-rays
In-network: $20 copay
Out-of-network: $0-25 copay
Emergency care
$100 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $300 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 90 and beyond
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0-275 copay per visit
Out-of-network: No Data

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0-25 copay

Ambulance

Ground ambulance
In-network: $275 copay
Out-of-network: No Data

Therapy services

Occupational therapy visit
In-network: $40 copay
Out-of-network: $0-50 copay
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $0-50 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $5 copay
Out-of-network: $15-25 copay
Outpatient individual therapy with a psychiatrist
In-network: $10 copay
Out-of-network: $15-25 copay
Outpatient group therapy visit
In-network: $5 copay
Out-of-network: $15-25 copay
Outpatient individual therapy visit
In-network: $10 copay
Out-of-network: $15-25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% coinsurance per item
Out-of-network: No Data
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: No Data
Diabetes supplies
In-network: $0 copay
Out-of-network: No Data

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
In-network: $12-47 copay or 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: $12-47 copay or 0-20% coinsurance
Out-of-network: 20% coinsurance

Hearing

Hearing exam
In-network: $40 copay
Out-of-network: $0-50 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
Covered under office visit
Cleaning
Covered under office visit
Fluoride treatment
Covered under office visit
Dental x-rays
Covered under office visit

Comprehensive dental

Non-routine services
In-network: 50% coinsurance
Out-of-network: No Data
Diagnostic services
In-network: 0% coinsurance
Out-of-network: No Data
Restorative services
In-network: 50% coinsurance
Out-of-network: No Data
Endodontics
In-network: 50% coinsurance
Out-of-network: No Data
Periodontics
In-network: 50% coinsurance
Out-of-network: No Data
Extractions
In-network: $40 copay or 50% coinsurance
Out-of-network: No Data
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: 50% coinsurance
Out-of-network: No Data

Vision

Routine eye exam
In-network: $5-40 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
Not covered

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