Kaiser Permanente Dual Complete South P1 (D-SNP) Plan Details for Orange County, CA
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*This plan is new and has not yet been rated by CMS.
Kaiser Permanente Dual Complete South P1 (D-SNP) is a Dual-Eligible Medicare SNP option with tailored benefits. Eligibility and enrollment periods apply. Enroll online.
The delivery of healthcare services and costs by Kaiser Permanente is different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all Dual-Eligible SNP qualification requirements are eligible to join this D-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H8794-001-0 |
| Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 3,400.00 /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced $590.00 deductible |
| Supplemental Benefits: | Vision |
| Availability: | Orange County, CA |
| Insured By: | Kaiser Permanente |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Kaiser Permanente plan:
Doctor's Office Visits
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Referral Required |
Emergency, Urgent, and Inpatient Hospital Coverage
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $0 Copay |
| Inpatient hospital care: | $0.00 per day for days 1 through 90 |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 100 |
Foot Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Referral Required |
| Routine Foot Care: | $0 Copay Referral Required |
Chiropractic Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay |
| Routine chiropractic: | $0 Copay |
Mental Health Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $0.00 per day for days 1 through 90 |
Rehabilitation Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Referral Required |
| Occupational therapy: | $0 Copay Referral Required |
Medical Equipment and Supplies
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | $0 Copay |
Diagnostics, Lab Services, and Imaging
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $0 Copay Referral Required |
| Lab services: | $0 Copay Referral Required |
| Outpatient x-rays: | $0 Copay Referral Required |
| Diagnostic tests and procedures: | $0 Copay Referral Required |
Medicare Part B Drugs
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | $0 Copay |
| Other Part B drugs (Medicare-covered): | $0 Copay |
Dental Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $0 Copay Prior Authorization Required |
| Oral exam | Not Covered |
| Dental x-rays | Not Covered |
| Cleaning | Not Covered |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
Hearing Aids and Services
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Not Covered |
| Hearing aids | Not Covered |
| Hearing exam | Not Covered |
Vision Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 Copay |
| Routine eye exam (in-network) | $0 Copay |
| Eyewear benefits | None |
Feel free to download our Kaiser Permanente Dual Complete South P1 Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Kaiser Permanente Dual Complete South P1 includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the premium details of this prescription drug plan.
| Basic Part D Premium: | $(25.20) |
| Supplemental Part D Premium: | $25.20 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $29.66 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Kaiser Permanente begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Kaiser Permanente Dual Complete South P1 has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic* | $0.00 | $0.00 | |
| Generic* | 23.00% | 0.00% | |
| Preferred Brand | 24.00% | 24.00% | |
| Non-Preferred Drug | 25.00% | 25.00% | |
| Specialty Tier | 25.00% | 25.00% | |
| Vaccines* | $0.00 | $0.00 | |
| *The Part D deductible does not apply. | |||
CMS 5-Star Rating Marks
Each year Medicare rates D-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Kaiser Permanente Dual Complete South P1 .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Kaiser Permanente Dual Complete South P1
- Kaiser Permanente Dual Complete North P2
- Kaiser Permanente Dual Complete North P4
- Kaiser Permanente Dual Complete South P5
Contact Kaiser Permanente
| Website: | Kaiser Permanente Plan Page |
|---|---|
| Providers: | Kaiser Permanente Providers Page |
| Formulary: | Kaiser Permanente Formulary Page |
| Pharmacy: | Kaiser Permanente Pharmacy Page |
| New Member Health Plan Help: | (800)777-1238 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)777-1238 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- Kaiser Permanente, http://kp.org/medicare, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.