0 2020 Kaiser Permanente Medicare Advantage w/o Part D (HMO) H2172-005 By Kaiser Permanente.
2020 Kaiser Permanente Medicare Advantage w/o Part D (HMO) H2172-005 By Kaiser Permanente.

2020 Medicare Advantage Plan Services for
Kaiser Permanente Medicare Advantage w/o Part D (HMO)


Kaiser Permanente Medicare Advantage w/o Part D (HMO) H2172-005 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Kaiser Permanente available to residents in Virginia Maryland Washington D.C.. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Kaiser Permanente Medicare Advantage w/o Part D (HMO) has a monthly premium of $30.00 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

Kaiser Permanente Medicare Advantage w/o Part D (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Kaiser Permanente works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Kaiser Permanente Medicare Advantage w/o Part D (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Kaiser Permanente and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Kaiser Permanente except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.





2020 Kaiser Permanente Medicare Advantage Plan Details

Name:
Kaiser Permanente Medicare Advantage w/o Part D (HMO)
ID:
H2172-005
Provider:Kaiser Permanente
Year:2020
Type: Local HMO *
Monthly Premium C+D: $30.00
Part C Premium:
MOOP: $6,700






2019 Plan Services

(*2020 Plan services will be added when available)




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $40 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $0 copay
Lab services $0 copay
Diagnostic radiology services (e.g., MRI) $150
Outpatient x-rays $10



Hearing


Hearing exam $40
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Office visit $30.00
Oral exam Covered under office visit
Cleaning Covered under office visit
Fluoride treatment Covered under office visit
Dental x-ray(s) Covered under office visit



Comprehensive dental


Non-routine services $0-55
Diagnostic services $11-69
Restorative services $40-755
Endodontics $47-1,047
Periodontics $33-836
Extractions $72-429
Prosthodontics, other oral/maxillofacial surgery, other services $30-3,658



Vision


Routine eye exam $10-40
Other Not covered
Contact lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric $225 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist $10
Outpatient individual therapy visit with a psychiatrist $20
Outpatient group therapy visit $10
Outpatient individual therapy visit $20



Skilled Nursing Facility


$0 per day for days 1 through 20
$150 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit $40
Physical therapy and speech and language therapy visit $40



Ground ambulance


$250



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment $40
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) 20% per item
Prosthetics (e.g., braces, artificial limbs) 20% per item
Diabetes supplies $0 copay



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy $0-47
Other Part B drugs $0-47



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$6,700 In-network



Optional supplemental benefits


Yes



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


$225 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient hospital coverage


$200 per visit



Doctor visits


Primary $10 per visit
Specialist $40 per visit



Preventive care


$0 copay


Ratings for Kaiser Permanente Medicare Advantage w/o Part D (HMO) H2172

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Kaiser Permanente Medicare Advantage w/o Part D (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Kaiser Permanente Medicare Advantage w/o Part D (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Kaiser Permanente Medicare Advantage w/o Part D (HMO) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for Kaiser Permanente Medicare Advantage w/o Part D (HMO)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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