Kaiser Permanente Medicare Advantage High MD (HMO-POS) H2172-002-0 Plan Details
Kaiser Permanente Medicare Advantage High MD (HMO-POS) H2172-002-0 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2026. With Kaiser Permanente Medicare Advantage High MD (HMO-POS) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data, there are approximately 4,831 members enrolled in this plan.
Kaiser Permanente Medicare Advantage High MD Overview
| Plan ID H2172-002-0 Overview | |
|---|---|
| Health Plan ID: | H2172-002-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $104.00 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 MD (H2172-002-0) is available in the following locations (click to open):
Why Consider Kaiser Permanente Medicare Advantage High MD?
This Medicare Advantage Prescription Drug (MAPD) HMO-POS plan combines complete coverage with flexible provider access. With a monthly premium of $104.00, Kaiser Permanente Medicare Advantage High MD includes Medicare Part A and Part B benefits, plus prescription drug coverage to manage ongoing medication needs. The annual Part D deductible is $0.00. You can visit providers both in and out of network — but you’ll generally save more when choosing in-network care.
Primary care visits have a $5 copay | Out-of-network: $0-$25 copay, specialist visits come with a $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. After you reach that cap, all in-network services are covered in full through year’s end.
You’ll find this plan listed by CMS as H2172-002-0. A summary of cost sharing appears below. Still have questions? Check the FAQ section for more info.
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Out-of-Pocket Costs
With Kaiser Permanente Medicare Advantage High MD, 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 H2172-002-0.
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: $5 copay | Out-of-network: $0-$25 copay |
| Specialist: | In-network: $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 | $300 per day for days 1-6 | $0 per day for days 7-90 | $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 | $300 per day for days 1-6 | $0 per day for days 7-90 | $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: $10-$200 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: $5-$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 MD as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Kaiser Permanente Medicare Advantage High MD 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: | $32.30 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $32.30 |
| Low-Income Premium Subsidy: | $31.21 |
| Low-Income Premium Subsidy Paid by CMS: | $31.20 |
| Low-Income Subsidy Premium: | $1.10 |
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 MD 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. | ||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| 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.
Eligibility Requirements for Kaiser Permanente Medicare Advantage High MD
To qualify for enrollment in Kaiser Permanente Medicare Advantage High MD, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Kaiser Permanente Medicare Advantage High MD and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Kaiser Permanente Medicare Advantage High MD
Knowing when you can enroll in Kaiser Permanente Medicare Advantage High MD 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 Enroll in Kaiser Permanente Medicare Advantage High MD
Enrolling in Kaiser Permanente Medicare Advantage High MD is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Kaiser Permanente Medicare Advantage High MD through the official Medicare website.
- Directly with Kaiser Permanente Medicare Advantage High MD: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H2172-002-0:
What’s the monthly premium for Kaiser Permanente Medicare Advantage High MD (HMO-POS)?
The 2026 premium is $104.00 each month, and you must continue to pay your Part B premium.
What is the annual out-of-pocket maximum on this plan?
The annual in-network MOOP is $5700.00, protecting you from larger bills once you hit that limit.
Is there a Part D deductible with this plan?
You’ll pay the first $0.00 in drug costs before coinsurance kicks in.
How is this plan rated by Medicare?
For 2026, plan H2172-002-0 has a ★4.5 rating. The best rating is 5 stars.
How many people are enrolled in this plan?
As of last month, about 4,831 beneficiaries are enrolled.
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
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — 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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