Kaiser Permanente Medicare Advantage Basic (HMO)
H5050 - 001 - 0
(3.5 / 5)
Kaiser Permanente Medicare Advantage Basic (HMO) is a Medicare Advantage (Part C) Plan by Kaiser Permanente.
This page features plan details for 2024 Kaiser Permanente Medicare Advantage Basic (HMO) H5050 – 001 – 0 available in Puget Sound Area and Counties: GY, TH, LE, SP.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Kaiser Permanente Medicare Advantage Basic (HMO) is offered in the following locations.
Plan Overview
Kaiser Permanente Medicare Advantage Basic (HMO) offers the following coverage and cost-sharing.
| Insurer: | Kaiser Permanente |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,200 In-network |
| Drugs Covered: | No |
Ready to sign up for Kaiser Permanente Medicare Advantage Basic (HMO) ?
Premium Breakdown
Kaiser Permanente Medicare Advantage Basic (HMO) has a monthly premium of $76.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $76.00 | $0.00 | $250.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Kaiser Permanente Medicare Advantage Basic (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $4,200 In-network |
| Yes |
| In-network | No |
| $0-200 copay per visit (Authorization is required.) (Referral is required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $30 copay per visit (Authorization is required.) (Referral is required.) |
| $0 copay (Authorization is required.) (Referral is required.) |
| Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $25 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is required.) |
| Lab services | $0 copay (Authorization is required.) (Referral is required.) |
| Diagnostic radiology services (e.g., MRI) | $200 copay (Authorization is required.) (Referral is required.) |
| Outpatient x-rays | $0 copay (Authorization is required.) (Referral is required.) |
| Hearing exam | $0-30 copay (Authorization is required.) (Referral is required.) |
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Routine eye exam | $0-30 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $0-30 copay (Authorization is required.) (Referral is required.) |
| Physical therapy and speech and language therapy visit | $0-30 copay (Authorization is required.) (Referral is required.) |
| $200 copay (Not applicable.) (Not applicable.) |
| $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Foot exams and treatment | $30 copay (Authorization is required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| $200 per day for days 1 through 3 $0 per day for days 4 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is required.) |
| Inpatient hospital – psychiatric | $200 per day for days 1 through 3 $0 per day for days 4 through 90 (Authorization is required.) (Referral is required.) |
| Outpatient group therapy visit with a psychiatrist | $20 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $50 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
| Monthly Premium | $58.00 |
| Deductible | nan |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $52.00 |
| Preventive dental: | Deductible: | N/A |
| Comprehensive dental: | Monthly Premium: | $52.00 |
| Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Kaiser Permanente Medicare Advantage Basic (HMO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
HealthCompare Insurance Services does not offer every plan available in your area. Currently we represent 18 organizations, which offers 52,101 products in your area.
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Medicare has neither approved nor endorsed any information on this site.