Kaiser Permanente Dual Complete South P5 (D-SNP) Plan Details for Ventura County, CA
This page provides coverage and cost details for Kaiser Permanente’s H8794-005-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*This plan is new and has not yet been rated by CMS.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Dual-Eligible SNP qualification requirements to join this D-SNP plan.
Kaiser Permanente Dual Complete South P5 Basic Plan Details
- Plan ID
- H8794-005-0
- Plan Type
- HMO D-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 3,400.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$590.00 deductible - Supplemental Benefits
- Vision
- Availability
- Ventura County, CA
- Insured By
- Kaiser Permanente
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
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
- Primary
- $0 Copay
- Specialist
- $0 Copay
Referral Required
Emergency, Urgent, and Inpatient Hospital Coverage
- 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
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
Referral Required - Routine Foot Care
- $0 Copay
Referral Required
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
- Routine chiropractic
- $0 Copay
Mental Health Services
- 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
- Physical therapy and speech and language therapy
- $0 Copay
Referral Required - Occupational therapy
- $0 Copay
Referral Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
Prior Authorization Required - Durable medical equipment
- $0 Copay
Prior Authorization Required - Prosthetics
- $0 Copay
Diagnostics, Lab Services, and Imaging
- 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
- Chemotherapy
- $0 Copay
- Other Part B drugs (Medicare-covered)
- $0 Copay
Dental Services
- 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
- Fitting/evaluation
- Not Covered
- Hearing aids
- Not Covered
- Hearing exam
- Not Covered
Vision Services
- Medicare-covered eye exam
- $0 Copay
- Routine eye exam
- $0 Copay
- Eyewear benefits
- None
Prescription Drug Costs & Benefits
Kaiser Permanente Dual Complete South P5 includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
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 premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| 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 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 Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Kaiser Permanente Dual Complete South P5 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* | 3.00% | 0.00% |
| Preferred Brand | 24.00% | 22.00% |
| 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. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Kaiser Permanente plan.
| 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 |
How to Qualify to Enroll in
Kaiser Permanente Dual Complete South P5
To qualify for enrollment in Kaiser Permanente Dual Complete South P5 in Ventura County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below California's state thresholds.
Before enrolling in Kaiser Permanente Dual Complete South P5, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Kaiser Permanente
| Website: | Kaiser Permanente Plan Page (opens in new tab) |
|---|---|
| Providers: | Kaiser Permanente Providers Page (opens in new tab) |
| Formulary: | Kaiser Permanente Formulary Page (opens in new tab) |
| Pharmacy: | Kaiser Permanente Pharmacy Page (opens in new tab) |
| 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
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold a Medigap Insurance policy at the same time.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their 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
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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