Kaiser Permanente Medicare Advantage High DC (HMO-POS) H2172-001-0 Plan Details
Kaiser Permanente Medicare Advantage High DC (HMO-POS) H2172-001-0 Plan Details
Navigating your Medicare Advantage options for 2026 can be overwhelming, but we're here to help. With Kaiser Permanente Medicare Advantage High DC (HMO-POS) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 751 Medicare beneficiaries are enrolled in this plan.
Kaiser Permanente Medicare Advantage High DC Overview
| Plan ID H2172-001-0 Overview | |
|---|---|
| Health Plan ID: | H2172-001-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $105.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5700.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Kaiser Permanente |
Plan Availability
Kaiser Permanente Medicare Advantage High DC (H2172-001-0) is available in the following locations (click to open):
Why Choose Kaiser Permanente Medicare Advantage High DC?
This Medicare Advantage MAPD HMO-POS plan offers both structure and flexibility — including hospital, medical, and prescription drug coverage. With a monthly premium of $105.00, it covers Medicare Part A and Part B benefits, along with built-in drug coverage to help manage ongoing prescriptions. The annual Part D deductible is $0.00. You can get care in or out of network, but you’ll usually pay less when sticking with in-network providers.
Primary care visits have a $0 copay | Out-of-network: $0-$25 copay, specialist visits come with a $0-$30 copay | Out-of-network: $0-$65 copay, urgent care services carry a $30 copay, and ambulance transportation is $225 copay. These costs apply toward the plan’s maximum out-of-pocket (MOOP) limit of $5700.00. Once that limit is reached, your in-network healthcare is covered at 100% for the rest of the year.
You’ll find this plan listed by CMS as H2172-001-0. A cost-sharing summary appears below with details on what you’ll pay for common services. Still have questions? Check the FAQ section for more answers.
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Out-of-Pocket Costs
With Kaiser Permanente Medicare Advantage High DC, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H2172-001-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0-$25 copay |
| Specialist: | In-network: $0-$30 copay | Out-of-network: $0-$65 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $130 copay |
| Wordwide emergency care: | $130 copay |
| Urgent care: | $30 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $225 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 |
| Ground ambulance: | In-network: $225 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $10 copay | Out-of-network: $15-$25 copay |
| Outpatient group therapy: | In-network: $5 copay | Out-of-network: $15-$25 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $225 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $30 copay | Out-of-network: $0-$65 copay |
| Occupational therapy: | In-network: $30 copay | Out-of-network: $0-$65 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: 0% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$250 copay | Out-of-network: $0-$50 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0-$50 copay |
| Outpatient x-rays: | In-network: $10 copay | Out-of-network: $0-$50 copay |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0-$50 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: $12-$47 copay, 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: $12-$47 copay, 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0-$30 copay |
| Dental x-rays: | In-network: $0-$30 copay |
| Cleaning: | In-network: $0-$30 copay |
| Periodontics: | In-network: 50% coinsurance |
| Endodontics: | In-network: 50% coinsurance |
| Restorative services: | In-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $30 copay, 50% coinsurance |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | Not covered |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0-$30 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | In-network: $0 copay |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Kaiser Permanente Medicare Advantage High DC as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Kaiser Permanente Medicare Advantage High DC includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $32.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $32.00 |
| Low-Income Premium Subsidy: | $31.21 |
| Low-Income Premium Subsidy Paid by CMS: | $31.20 |
| Low-Income Subsidy Premium: | $0.80 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Kaiser Permanente starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Kaiser Permanente Medicare Advantage High DC may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $12.00 copay | Coming soon |
| Preferred Brand | $42.00 copay | Coming soon |
| Non-Preferred Drug | $100.00 copay | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| Vaccines | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Kaiser Permanente Medicare Advantage High DC?
To enroll in Kaiser Permanente Medicare Advantage High DC, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in Kaiser Permanente Medicare Advantage High DC and benefit from its comprehensive coverage options.
Enrollment Periods for Kaiser Permanente Medicare Advantage High DC
Knowing when you can enroll in Kaiser Permanente Medicare Advantage High DC is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for Kaiser Permanente Medicare Advantage High DC
Getting started with Kaiser Permanente Medicare Advantage High DC is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Kaiser Permanente Medicare Advantage High DC. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H2172-001-0:
Is there a premium for this plan in 2026?
Members pay their Part B premium and the plan's of $105.00 per month to be in this 2026 plan.
What’s the MOOP for Kaiser Permanente Medicare Advantage High DC in 2026?
Your costs top out at $5700.00 (for in-network services) in 2026; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
You’ll pay the first $0.00 in drug costs before coinsurance kicks in.
How is this plan rated by Medicare?
CMS rates it ★4.5 out of 5 stars for 2026.
How many members does Kaiser Permanente Medicare Advantage High DC have?
CMS reports 751 members in the latest file.
Contact Kaiser Permanente
| Contact Type | Details |
|---|---|
| Website: | Kaiser Permanente Plan Page |
| New Members: | 1-877-408-8607 |
| Existing Members: | 1-888-777-5536 |
| Plan Address: | 3495 Piedmont Rd. NE | Nine Piedmont Center | Atlanta, GA 30305 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Kaiser Permanente, http://kp.org/medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
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