2027 Medicare Advantage plan

Kaiser Permanente Dual Essential (HMO D-SNP): 2027 benefits and costs

Kaiser Permanente HMO D-SNP Special Needs Plan

CMS plan ID: H0630-014-0 · Plan year: 2027

Kaiser Permanente Dual Essential (HMO D-SNP) is a 2027 Medicare Advantage plan offered by Kaiser Permanente. It is listed in Colorado.

2027 plan costs at a glance

Monthly plan premium$0.00
Drug deductible$700.00
In-network medical out-of-pocket maximum$5,900.00

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
None
In-network medical maximum
$5,900.00

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

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Telehealth

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Emergency care

$130.00 copay

Urgent care

$15.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
Yes
Part B chemotherapy and radiation drugs

$0.00 to $47.00 copay; 0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

$0.00 to $47.00 copay; 0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered foot care

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Other health professionals

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–6: $225.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–6: $225.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$200.00 copay

Service-specific deductible
No
Hospital observation services

$0.00 copay

Service-specific deductible
No
Ambulatory surgical center

$150.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Laboratory services

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Diagnostic radiology (CT, MRI)

$25.00 to $250.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Therapeutic radiology

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
X-rays

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$45.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Intensive outpatient program

$45.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Substance use treatment, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Substance use treatment, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Opioid treatment program

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Mental health, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Mental health, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Psychiatry, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Psychiatry, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Physical and speech therapy

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Cardiac rehabilitation

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Intensive cardiac rehabilitation

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Pulmonary rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Supervised exercise for peripheral artery disease

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

$0.00 copay

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$10.00 copay

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

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$0

Service-specific deductible
No
Approval required
No
Referral required
Yes

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

Benefits for qualifying members

Advanced Care at Home

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Other 1
Qualifying conditions
Meets clinical criteria, hospital care in home based on health status
Covered package services cost $0 until the package limit is reached
No
Benefits that apply to reduced cost sharing
Supplemental benefits; Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing
Emergency Services; Urgently Needed Services; Diagnostic Radiological Services; Ambulatory surgical center; Ground Ambulance Services; Durable Medical Equipment (DME); Medical Supplies
Non-Medicare benefits that apply to reduced cost sharing
Other 1
Some package benefits are exempt from the deductible
No
Do you offer reduced Coinsurance?
Yes
Types of benefits that apply to the coinsurance cost sharing
Supplemental benefits; Medicare-covered benefits
Medicare-covered benefits that will receive reduced coinsurance
Ground Ambulance Services; Durable Medical Equipment (DME); Medical Supplies
Supplemental benefits that will receive reduced coinsurance
Other 1
Minimum Coinsurance Percentage for Ground Ambulance Services
0%
Maximum Coinsurance Percentage for Ground Ambulance Services
0%
Minimum Coinsurance Percentage for Durable Medical Equipment (DME)
0%
Maximum Coinsurance Percentage for Durable Medical Equipment (DME)
0%
Minimum Coinsurance Percentage for Medical Supplies
0%
Maximum Coinsurance Percentage for Medical Supplies
0%
Minimum Coinsurance Percentage for OTHER 1
0%
Maximum Coinsurance Percentage for OTHER 1
0%
Service-specific deductible
No
Reduced Copayment?
Yes
Types of benefits that apply to the copayment cost sharing
Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment
Emergency Services; Urgently Needed Services; Diagnostic Radiological Services; Ambulatory surgical center
Minimum Copayment for Emergency Services
$0.00
Maximum Copayment for Emergency Services
$0.00
Minimum Copayment for Urgently Needed Services
$0.00
Maximum Copayment for Urgently Needed Services
$0.00
Minimum Copayment for Diagnostic Radiological Services
$0.00
Maximum Copayment for Diagnostic Radiological Services
$0.00
Minimum Copayment for Ambulatory Surgical Center (ASC) Services
$0.00
Maximum Copayment for Ambulatory Surgical Center (ASC) Services
$0.00

Full package terms are not summarized here.

Advanced Care at Home

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Other 1
Qualifying conditions
Meets clinical criteria, hospital care in home based on health status.
Included services
Other 2
Some package benefits are exempt from the deductible
No

Full package terms are not summarized here.

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.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 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 listedNot 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.

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days100 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

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 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

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 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.

View all locations 11 county listings across 1 state or territory

Colorado