2027 Medicare Advantage plan
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP): 2027 benefits and costs
Kaiser Permanente HMO D-SNP Special Needs Plan
CMS plan ID: H0630-024-0 · Plan year: 2027
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) is a 2027 Medicare Advantage plan offered by Kaiser Permanente. It is listed in Colorado.
2027 plan costs at a glance
Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.
- Organization
- Kaiser Permanente
- Plan organization
- KAISER FOUNDATION HP OF CO
- Parent company
- Kaiser Foundation Health Plan, Inc.
- Plan type
- HMO D-SNP
- Part C premium
- $0.00
- Part D premium
- $0.00
- Prescription drug coverage
- Yes
- Special Needs Plan type
- Dual-Eligible
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- $288.00
Applies to certain in-network Medicare-covered services.
- In-network medical maximum
- $9,850.00
Applies to certain in-network supplemental services.
Who can join this Special Needs Plan?
This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.
- Plan eligibility type
- Dual-Eligible
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | What to know |
|---|---|---|
| Primary care doctor | 20% coinsurance
| |
| Specialist visit | 20% coinsurance
|
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| Telehealth | $0.00 copay
|
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| Emergency care | $115.00 copay | |
| Urgent care | $40.00 copay | |
| Home health | $0.00 copay
|
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| Dialysis | 20% coinsurance
|
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| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
|
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| Other Part B drugs | 0% to 20% coinsurance
|
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| Kidney disease education services | 20% coinsurance
|
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| Medicare-covered chiropractic | 20% coinsurance
|
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| Medicare-covered foot care | 20% coinsurance
|
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| Other health professionals | 20% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $2,241.00 copay per stay |
|
| Inpatient mental health care | $2,091.00 copay per stay |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | What to know |
|---|---|---|
| Outpatient hospital care | 20% coinsurance
| |
| Hospital observation services | 20% coinsurance
| |
| Ambulatory surgical center | 20% coinsurance
|
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| Outpatient blood | $0.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | What to know |
|---|---|---|
| Diagnostic procedures and tests | 20% coinsurance
|
|
| Laboratory services | 20% coinsurance
|
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| Diagnostic radiology (CT, MRI) | 20% coinsurance
|
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| Therapeutic radiology | 20% coinsurance
|
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| X-rays | 20% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | What to know |
|---|---|---|
| Partial hospitalization | 20% coinsurance
|
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| Intensive outpatient program | 20% coinsurance
|
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| Substance use treatment, individual sessions | 20% coinsurance
|
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| Substance use treatment, group sessions | 20% coinsurance
|
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| Opioid treatment program | 20% coinsurance
|
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| Mental health, individual sessions | 20% coinsurance
|
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| Mental health, group sessions | 20% coinsurance
|
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| Psychiatry, individual sessions | 20% coinsurance
|
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| Psychiatry, group sessions | 20% coinsurance
|
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Therapy and rehabilitation
| Service | In-network | What to know |
|---|---|---|
| Occupational therapy | 20% coinsurance
|
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| Physical and speech therapy | 20% coinsurance
|
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| Cardiac rehabilitation | 20% coinsurance
|
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| Intensive cardiac rehabilitation | 20% coinsurance
|
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| Pulmonary rehabilitation | 20% coinsurance
|
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| Supervised exercise for peripheral artery disease | 20% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | What to know |
|---|---|---|
| Ground ambulance | 20% coinsurance
|
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| Air ambulance | 20% coinsurance
|
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| Durable medical equipment | 0% to 20% coinsurance
|
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| Prosthetic devices | 20% coinsurance
|
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| Medical supplies | 20% coinsurance
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| Diabetic supplies | $0.00 copay
|
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| Diabetic shoes and inserts | 20% coinsurance
|
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| Diabetic monitors | $0.00 copay
|
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Dental benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered dental | 20% coinsurance | |
| Oral examsAdditional plan benefit | $0.00 copay | |
| Dental X-raysAdditional plan benefit | $0.00 copay | |
| Other diagnostic dentalAdditional plan benefit | $0.00 copay | |
| Dental cleaningAdditional plan benefit | $0.00 copay | |
| FluorideAdditional plan benefit | $0.00 copay | |
| Other preventive dentalAdditional plan benefit | $0.00 copay | |
| Restorative dental careAdditional plan benefit | $0.00 copay | |
| Root canal treatment (endodontics)Additional plan benefit | $0.00 copay | |
| Gum treatment (periodontics)Additional plan benefit | $0.00 copay | |
| Removable dentures (prosthodontics)Additional plan benefit | $0.00 copay | |
| Fixed dental restorations (prosthodontics)Additional plan benefit | $0.00 copay | |
| Oral surgeryAdditional plan benefit | $0.00 copay | |
| Other dental servicesAdditional plan benefit | $0.00 copay |
Vision benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered eye exams | 20% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay |
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| Medicare-covered eyewear | $0.00 copay
|
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| Contact lensesAdditional plan benefit | $0 |
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| Eyeglasses, lenses and framesAdditional plan benefit | $0 |
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| Eyeglass lensesAdditional plan benefit | $0 |
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| Eyeglass framesAdditional plan benefit | $0 |
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Hearing benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered hearing exams | 20% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay |
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay |
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| Prescription hearing aids (all types)Additional plan benefit | $0
|
|
Extra benefits
| Service | In-network | What to know |
|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| |
| Annual physical examAdditional plan benefit | $0.00 copay
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
|
|
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2; Tier 6 are exempt from the deductible.
Standard retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $0.00 | $0.00 | $0.00 |
| Tier 3Preferred Brand | 15% | 15% | 15% |
| Tier 4Non-Preferred Drug | 25% | 25% | 25% |
| Tier 5Specialty Tier | 25% | 25% | 25% |
| Tier 6Vaccines | $0.00 | Not listed | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.
Standard mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $0.00 | $0.00 | $0.00 |
| Tier 3Preferred Brand | 15% | 15% | 15% |
| Tier 4Non-Preferred Drug | 25% | 25% | 25% |
| Tier 5Specialty Tier | 25% | 25% | 25% |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 15% |
| Tier 4Non-Preferred Drug | 25% |
| Tier 5Specialty Tier | 25% |
| Tier 6Vaccines | $0.00 |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 15% |
| Tier 4Non-Preferred Drug | 25% |
| Tier 5Specialty Tier | 25% |
| Tier 6Vaccines | $0.00 |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 6: Vaccines
- Drugs included in this tier
- Part D Drugs Only
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.