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Kaiser Permanente Medicare Advantage Key (HMO)

H5050 - 022 - 0

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Kaiser Permanente Medicare Advantage Key (HMO) is a Medicare Advantage Plan by Kaiser Permanente.

This page features plan details for 2025 Kaiser Permanente Medicare Advantage Key (HMO) H5050 – 022 – 0 available in Island,King,Pierce,Snohomish and Thurston counties.

Locations

Kaiser Permanente Medicare Advantage Key (HMO) is offered in the following locations.

Island County, Washington

King County, Washington

Kitsap County, Washington

Click to see more locations

Plan Overview

Kaiser Permanente Medicare Advantage Key (HMO) offers the following coverage and cost-sharing.

Insurer:	Kaiser Permanente
Health Plan Deductible:	$0
MOOP:	$6,600 In-network
Drugs Covered:	Yes

Ready to sign up for Kaiser Permanente Medicare Advantage Key (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Kaiser Permanente Medicare Advantage Key (HMO) qualifies for a monthly Medicare Give Back Benefit of $10.00.

Premium Reduction:

$10.00

Premium Breakdown

Kaiser Permanente Medicare Advantage Key (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.

Part B	Part C	Part D	Part B Give Back	Total
$185.00	$0.00	$0.00	$10.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.
You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Kaiser Permanente Medicare Advantage Key (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$0.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$15.00 Copay
2) Generic	$7.00 Copay	$20.00 Copay	$7.00 Copay
3) Preferred Brand	$40.00 Copay	$40.00 Copay	$40.00 Copay
4) Non-Preferred Drug	$99.00 Copay	$99.00 Copay	$99.00 Copay
5) Specialty Tier	31.00% Coinsurance	31.00% Coinsurance
6) Vaccines

60 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$30.00 Copay
2) Generic	$14.00 Copay	$40.00 Copay
3) Preferred Brand	$80.00 Copay	$80.00 Copay	$80.00 Copay
4) Non-Preferred Drug	$198.00 Copay	$198.00 Copay	$198.00 Copay
5) Specialty Tier	31.00% Coinsurance	31.00% Coinsurance
6) Vaccines

90 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$45.00 Copay
2) Generic	$21.00 Copay	$60.00 Copay
3) Preferred Brand	$120.00 Copay	$120.00 Copay	$100.00 Copay
4) Non-Preferred Drug	$297.00 Copay	$297.00 Copay	$247.50 Copay
5) Specialty Tier	31.00% Coinsurance	31.00% Coinsurance
6) Vaccines

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Kaiser Permanente Medicare Advantage Key (HMO) also provides the following benefits.

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

- In-Network: Yes, contact plan for further details

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – 0.00 Copay
Fluoride Treatment
- In-Network: No Coins – 0.00 Copay
Oral Exams
- In-Network: No Coins – 0.00 Copay
Other Diagnostic Dental Services
- In-Network: No Coins – 0.00 Copay
Other Preventive Dental Services
- In-Network: No Coins – 0.00 Copay
Prophylaxis (cleaning)
- In-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI)
- $325 copay (Authorization Required, Referral Required)
Outpatient x-rays
- $20 copay (Authorization Required, Referral Required)
Diagnostic tests and procedures
- $20 copay (Authorization Required, Referral Required)
Lab services
- $0 copay (Authorization Required, Referral Required)

Doctor visits

Primary
- $0 copay
Specialist
- $35 copay per visit (Authorization Required, Referral Required)

Emergency care/Urgent care

Emergency
- $125 copay per visit (always covered)
Urgent care
- $40 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- $40 copay (Authorization Required, Referral Required)
Routine foot care
- Not covered

Ground ambulance

- $275 copay

Health plan deductible

- $0

Hearing

Hearing aids – inner ear
- Not covered
Hearing aids – over the ear
- Not covered
Hearing aids – outer ear
- Not covered
Medicare-Covered Hearing Exam
- $0-35 copay (Authorization Required, Referral Required)
Fitting/evaluation
- $0 copay (Limits Apply, Authorization Required, Referral Required)
Hearing aids OTC
- Not covered

Inpatient hospital coverage

- $400 per day for days 1 through 5
  $0 per day for days 6 through 90
  $0 per day for days 91 and beyond (Authorization Required, Referral Required)

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

- $6,600 In-network

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)
- 25% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- 25% coinsurance per item (Authorization Required)
Diabetes supplies
- $0 copay (Authorization Required)

Medicare Part B drugs

Chemotherapy
- 0-20% coinsurance (Authorization Required)
Other Part B drugs
- 0-20% coinsurance (Authorization Required)

Mental health services

Inpatient hospital – psychiatric
- $400 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required, Referral Required)
Outpatient group therapy visit with a psychiatrist
- $30 copay (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- $50 copay (Authorization Required)
Outpatient group therapy visit
- $30 copay (Authorization Required)
Outpatient individual therapy visit
- $50 copay (Authorization Required)

Optional supplemental benefits

- Yes

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- $0-350 copay per visit (Authorization Required, Referral Required)

Preventive care

- $0 copay (Authorization Required, Referral Required)

Rehabilitation services

Physical therapy and speech and language therapy visit
- $0-40 copay (Authorization Required, Referral Required)
Occupational therapy visit
- $0-40 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

- $0 per day for days 1 through 20
  $214 per day for days 21 through 100 (Authorization Required, Referral Required)

Transportation

- Not covered

Vision

Eyeglasses (frames and lenses)
- $0 copay (Limits Apply)
Other
- Not covered
Contact lenses
- $0 copay (Limits Apply)
Eyeglass frames
- $0 copay (Limits Apply)
Eyeglass lenses
- $0 copay (Limits Apply)
Routine eye exam
- $0-35 copay (Limits Apply)
Upgrades
- Not covered

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

- Covered

Advantage Plus 2

Hearing Aids

Prescription Hearing Aids (all types)
- Monthly Premium: $18.00

Transportation Services

Transportation Services – Plan Approved Health-related Location
- Monthly Premium: $18.00