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Kaiser Permanente Medicare Advantage High MD (HMO-POS)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$136.30
Monthly Premium
Kaiser Permanente Medicare Advantage High MD (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc.
Plan ID: H2172-002
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Kaiser Permanente Medicare Advantage High MD (HMO-POS) - H2172-002 by Kaiser Foundation Health Plan, Inc. as well as other Medicare Advantage plans available in your area.
$136.30
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $5700 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $5 |
| Specialty Doctor Visit | Out-of-Network: Doctor Specialty Visit Services: Copayment for Physician Specialist Office Visit $0 to $65 |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: $300 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services Referral Required for Acute Hospital Services Members admitted and discharged on the same day pay a copayment for one day. |
| Urgent Care | Urgent Care: Copayment for Urgent Care $30 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $30 |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $130 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 0 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $130 Copayment for Worldwide Emergency Transportation $225 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $225 Air Ambulance: Copayment for Air Ambulance Services $225 Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
Kaiser Permanente Medicare Advantage High MD (HMO-POS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $0 to $65 In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $5 Prior Authorization Required for Chiropractic Services Referral Required for Chiropractic Services |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20% |
| Durable Medical Equipment (DME) | In-Network: Durable Medical Equipment: Coinsurance for Medicare-covered Durable Medical Equipment 0% to 20% Prior Authorization Required for Durable Medical Equipment The minimum coinsurance applies to ultraviolet light therapy equipment for psoriasis treatment. The maximum coinsurance applies to all other DME. |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Referral Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $10 to $200 Copayment for Medicare-covered Therapeutic Radiological Services $30 Copayment for Medicare-covered X-Ray Services $10 |
| Home Health Care | In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Referral Required for Home Health Services |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $300 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services Referral Required for Psychiatric Hospital Services Members admitted and discharged on the same day pay a copayment for one day. |
| Mental Health Outpatient Care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $10 Copayment for Medicare-covered Group Sessions $5 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $225 Prior Authorization Required for Outpatient Hospital Services Referral Required for Outpatient Hospital Services The minimum copayment applies to surgical procedures performed during a screening colonoscopy and diagnostic colonoscopies in response to a positive gFOBT, FIT, or sigmoidoscopy. The maximum copayment applies to all other services. Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 to $225 Prior Authorization Required for Outpatient Observation Services The minimum copayment applies to observation stays incident to other outpatient hospital services such as an ER visit or outpatient surgery. The maximum copayment applies when admitted directly to the hospital for observation. Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $225 Prior Authorization Required for Ambulatory Surgical Center Services Referral Required for Ambulatory Surgical Center Services |
| Outpatient Substance Abuse Care | Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $15 to $25 Copayment for Medicare Covered Group Sessions $15 to $25 In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $10 Copayment for Medicare-covered Group Sessions $5 Prior Authorization Required for Outpatient Substance Abuse Services Referral Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0
|
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $30 Prior Authorization Required for Podiatry Services Referral Required for Podiatry Services Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 to $65 |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $218 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Referral Required for Skilled Nursing Facility Services |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network:
Copayment for Dental x-rays $0
Copayment for Other diagnostic services $0
Copayment for Fluoride treatment $0
Copayment for Other preventive services $0 Coinsurance for Endodontics 50% Coinsurance for Periodontics 50% Coinsurance for Prothodontics, removable 50% Coinsurance for Prothodontics, fixed 50% Copayment for Maxillofacial surgery $30 Coinsurance for Adjunctive general services 50% Maximum Plan Benefit of $1,000 every year |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $30 Copayment for Routine Eye Exams $5 to $30 Prior Authorization Required for Eye Exams Referral Required for Eye Exams The minimum copayment applies to diabetic retinopathy services. The maximum copayment applies to services rendered by an ophthalmologist. Eyewear: Coinsurance for Medicare-Covered Benefits 20% Copayment for Contact Lenses $0 Copayment for Eyeglasses (lenses and frames) $0 Copayment for Eyeglass Lenses $0 Copayment for Eyeglass Frames $0 Maximum Plan Benefit of $225 every two years Referral Required for Eyewear |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | Out-of-Network: Medicare Covered Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $0 to $65 |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 to $25 |