Kaiser Permanente Dual Complete North P25 (HMO D-SNP)
Available to residents of Napa County, CA for 2026. Contract H8794, plan 025, segment 0.
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- Browse the Kaiser Permanente Dual Complete North P25 (HMO D-SNP) formulary
Renewed for 2026. CMS crosswalks 2025’s Kaiser Permanente Dual Complete North P4 (HMO D-SNP) (H8794-004-0) into this plan, so its members move here unless they choose otherwise.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00Tier 1, 2, 3 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H8794-025-0 |
| Offered by | Kaiser Permanente |
| Parent organization | Kaiser Foundation Health Plan, Inc. |
| Formulary drugs | 3,355 |
| Formulary exception tier | 5? |
| Pharmacy search | kp.org/directory |
| Member services | (800)777-1238TTY 711 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 4.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H8794 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(referral required) |
| Other health care professional | $0 copay(authorization and referral required) |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay(referral required) |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay(referral required) |
| Diabetes self-management training | $0 copay(referral required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay(referral required) |
| Lab services | $0 copay(referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$500 copay(referral required) |
| Therapeutic radiology | $0 copay(referral required) |
| Outpatient x-rays | $0 copay(referral required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | $115 copay |
| Worldwide urgent care | $0 copay |
| Worldwide emergency transportation | $400 copay |
| Hospital care | |
| Inpatient hospital stay | $475 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(authorization and referral required) |
| Outpatient hospital services | $0–$455 copay |
| Outpatient observation | $0–$115 copay |
| Ambulatory surgical center | $455 copay |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $214 per day for days 21–100(referral required) |
| Home health care | $0 copay(referral required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $0 copay(referral required) |
| Physical therapy and speech-language therapy | $0 copay(referral required) |
| Cardiac rehabilitation | $0 copay(referral required) |
| Pulmonary rehabilitation | $0 copay(referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $405 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(referral required) |
| Outpatient mental health, individual session | $0 copay |
| Outpatient mental health, group session | $0 copay |
| Psychiatrist, individual session | $0 copay |
| Psychiatrist, group session | $0 copay |
| Partial hospitalization | $0 copay(referral required) |
| Intensive outpatient program | $0 copay(referral required) |
| Outpatient substance use, individual session | $0 copay |
| Outpatient substance use, group session | $0 copay |
| Opioid treatment program | $0 copay(referral required) |
| Ambulance and transportation | |
| Ground ambulance | $400 copay |
| Air ambulance | $400 copay |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 0%–20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay(authorization and referral required) |
| Routine chiropractic care | Not covered |
| Acupuncture | $0 copay(authorization and referral required) |
| Foot exams and treatment (Medicare-covered) | $0 copay(referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $0 copay(authorization and referral required) |
| Oral exams | Not covered |
| Cleanings | Not covered |
| Fluoride treatment | Not covered |
| Dental x-rays | Not covered |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(referral required) |
| Routine eye exam | $0 copay(referral required) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(referral required, limits apply) |
| Eyewear plan limit | $350 plan limit every year |
| Contact lenses | $0 copay(referral required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(referral required, limits apply) |
| Eyeglass lenses | $0 copay(referral required, limits apply) |
| Eyeglass frames | $0 copay(referral required, limits apply) |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $0 copay |
| Chemotherapy and radiation drugs | $0 copay; 0%–20% coinsurance |
| Other Part B drugs | $0 copay; 0%–20% coinsurance |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $75 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(referral required) |
| Health education | $0 copay(referral required) |
| Nutritional / dietary benefit | $0 copay(referral required) |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(referral required) |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | $0.00 |
| Tier 4 | 24% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | n/a | n/a | n/a |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | 24% | 24% | 24% | 24% | 24% | 24% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 3 other CA counties
Benefits in plain text
Kaiser Permanente Dual Complete North P25 (HMO D-SNP) (H8794-025-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by Kaiser Permanente, available to residents of Napa County, CA.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00. Tier 1, 2, 3 and 6 exempt.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,355 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: $0.00; tier 4: 24%; tier 5: 25%; tier 6: $0.00.
CMS gives the plan's contract (H8794) an overall rating of 4 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.