Health Education
No copayMandatory · referral required
IncludedKaiser Permanente Dual Complete North P2 (HMO D-SNP)
Kaiser Permanente
HMO D-SNPDual-EligibleSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premium
$9,250most you pay in-network per year
4overall CMS star rating
26,096members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$9,250
Plan premium, per month$0
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient hospital stay
Days 1–5$475 per day
Days 6–90$0 per day
Inpatient psychiatric stay
Days 1–5$405 per day
Days 6–90$0 per day
Skilled nursing facility stay
Days 1–20$0 per day
Days 21–100$214 per day
Doctor visits
Primary care visit
$0
You pay nothing
Specialist visit
$0
You pay nothing
Telehealth visit
$0
You pay nothing
Other health care professional
$0
You pay nothing
Chiropractic care (Medicare-covered)
$0
You pay nothing
Podiatry (Medicare-covered)
$0
You pay nothing
Emergency and urgent care
Emergency room visit
$115
Copay
Urgent care visit
$0
You pay nothing
Emergency care outside the U.S.
$115
Copay
Urgent care outside the U.S.
$0
You pay nothing
Emergency transportation outside the U.S.
$400
Copay
Mental health and substance use
Individual therapy session
$0
You pay nothing
Group therapy session
$0
You pay nothing
Opioid treatment program
$0
You pay nothing
Partial hospitalization program
$0
You pay nothing
Referral required
Therapy and rehabilitation
Occupational therapy
$0
You pay nothing
Physical and speech therapy
$0
You pay nothing
Cardiac rehabilitation
$0
You pay nothing
Intensive cardiac rehabilitation
$0
You pay nothing
Pulmonary rehabilitation
$0
You pay nothing
Supervised exercise therapy for peripheral artery disease
$0
You pay nothing
Tests, labs and imaging
Lab services
$0
You pay nothing
Diagnostic tests
$0
You pay nothing
Diagnostic procedures
$0
You pay nothing
Diagnostic radiology (MRI, CT, PET)
$0–$500
Copay, depends on the service
Therapeutic radiology
$0
You pay nothing
Outpatient hospital and surgery
Outpatient hospital services
$0
You pay nothing
Ambulatory surgical center
$0
You pay nothing
Observation services
$0–$115
Copay, depends on the service
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
Ambulance
Ground ambulance
$325
Copay
Air ambulance
$325
Copay
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
0–20%
Coinsurance, depends on the service
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
$0
You pay nothing
Chemotherapy drugs
$0
You pay nothing
Part B insulin
$0
You pay nothing
Preventive and wellness
Barium enema
$0
You pay nothing
Diabetes screening
$0
You pay nothing
Digital rectal exam
$0
You pay nothing
Electrocardiogram (EKG)
$0
You pay nothing
Fitness (health club membership)
$0
You pay nothing
Glaucoma screening
$0
You pay nothing
Health education
$0
You pay nothing
Nursing hotline
$0
You pay nothing
Nutritional / dietary benefit
$0
You pay nothing
Web / phone access
$0
You pay nothing
Vision
Eye exam (Medicare-covered)
$0
You pay nothing
Routine eye exam
$0
You pay nothing
Eyewear allowance
Up to $350 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
$0
You pay nothing
Extra benefits
Over-the-counter items
$0
You pay nothing
Up to $50 every three months
Acupuncture
$0
You pay nothing
Residential Substance Use Disorder and MH Treatment
$100
Copay
DME and Prosthetic/Medical Supplies not covered by Medicare
0–20%
Coinsurance, depends on the service
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
Nutritional/Dietary Benefit
No copayMandatory · referral required
IncludedFitness Benefit
Physical Fitness; Memory Fitness
No copayMandatory · referral required
IncludedRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Nursing Hotline; Web/Phone-based technologies
No copayMandatory · referral required
IncludedNot offered by this plan
In-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesHome and Bathroom Safety Devices and ModificationsCounseling Services
Prescription drugs (Part D)
$0 annual drug deductible · 6 formulary tiers · mail order available. Costs shown for a 30-day supply.
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | No copay | — | — | Waived |
| 3. Preferred Brand | — | No copay | — | — | Waived |
| 4. Non-Preferred Drug | — | 18% coinsurance | — | — | Waived |
| 5. Specialty Tier specialty | — | 25% coinsurance | — | — | Waived |
| 6. Vaccines | — | No copay | — | — | Waived |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | — | Waived |
| 4. Non-Preferred Drug | No copay | No copay | No copay | — | Waived |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Waived |
| 6. Vaccines | No copay | No copay | No copay | — | Waived |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
4 out of 5Overall rating
4.5 out of 5Health services (Part C)
4 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
- Breast cancer screening4
- Colorectal cancer screening5
Managing chronic (long-term) conditions
4- Readmissions2
- Kidney health5
- Blood pressure4
- Statin therapy5
- Pain assessment3
- Medication review4
- Diabetes eye exam5
- Transitions of care5
- Diabetes blood sugar3
- Osteoporosis management5
- Followup after emergency department visit5
- Medication reconciliation5
- Special needs plan SNP care management4
Member complaints and changes in the plan's performance
5- Complaints4
- Members leaving5
Health plan customer service
4- Call center4
- Timely decisions4
- Appeals decisions4
Drug plan customer service
4- Call center foreign language interpreter and TTY availability4
Drug plan complaints and changes
5- Complaints4
- Members leaving5
Drug safety and accuracy of drug pricing
4- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications4
- Medication adherence for hypertension RAS antagonists s3
- Medication adherence for cholesterol statins3
Service area and network
Sold in 6 California counties.
FresnoKingsMaderaSacramentoSan MateoSanta Clara
Doctor directory
1,413 providers are named in Kaiser Permanente’s directory for this plan, dated Sep 1, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Contract with Medicare sinceJan 1, 2024
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.