Kaiser Permanente Medicare Advantage High VA (HMO-POS) 2026 Plan Details for Alexandria City County, Virginia Residents
Kaiser Permanente Medicare Advantage High VA (HMO-POS) 2026 Plan Details for Alexandria City County, Virginia Residents
When selecting a Medicare Advantage plan in Alexandria City County for 2026, it's important to compare all your options. Kaiser Permanente Medicare Advantage High VA (HMO-POS) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Based on the most recent CMS data, plan enrollments topped 1,681 members, with 68 in Alexandria City County, Virginia.
Kaiser Permanente Medicare Advantage High VA Overview
| Plan ID H2172-008-0 Overview | |
|---|---|
| Health Plan ID: | H2172-008-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $137.00 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: | Alexandria City County, VA |
| Insured By: | Kaiser Permanente |
Why Choose Kaiser Permanente Medicare Advantage High VA?
This Medicare Advantage MAPD HMO-POS plan offers both structure and flexibility — including hospital, medical, and prescription drug coverage. With a monthly premium of $137.00, 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 $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. 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 H2172-008-0. 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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Cost-Sharing Overview
Kaiser Permanente Medicare Advantage High VA includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H2172-008-0.
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 | $290 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 | $290 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-$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: $10-$47 copay, 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: $10-$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 VA as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Kaiser Permanente Medicare Advantage High VA 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: | $66.60 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $66.60 |
| Low-Income Premium Subsidy: | $24.56 |
| Low-Income Premium Subsidy Paid by CMS: | $24.60 |
| Low-Income Subsidy Premium: | $42.00 |
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 VA 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 | $10.00 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. | ||
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| 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 VA
To qualify for enrollment in Kaiser Permanente Medicare Advantage High VA, 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 VA and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Kaiser Permanente Medicare Advantage High VA?
Understanding the right time to enroll in Kaiser Permanente Medicare Advantage High VA is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Kaiser Permanente Medicare Advantage High VA
Joining Kaiser Permanente Medicare Advantage High VA is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Kaiser Permanente Medicare Advantage High VA.
- Direct Enrollment: You can also choose to enroll directly with Kaiser Permanente Medicare Advantage High VA. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H2172-008-0:
What’s the monthly premium for Kaiser Permanente Medicare Advantage High VA (HMO-POS)?
The 2026 premium is $137.00 each month, and you must continue to pay your Part B premium.
What’s the MOOP for Kaiser Permanente Medicare Advantage High VA in 2026?
For 2026, the maximum you’d spend out-of-pocket in-network is $5700.00.
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?
CMS rates it ★4.5 out of 5 stars for 2026.
How many members does Kaiser Permanente Medicare Advantage High VA have?
As of last month, about 1,681 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, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your 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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