Kaiser Permanente Urgent Care Copay

Posted : admin On 1/29/2022

If you are not a Kaiser member, you can't use their emergency room or urgent care, unless it's a life of death emergency. They are required to turn you away because Kaiser is a managed care organization, which means the benefits are available to members only.

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Kaiser Permanente Medicare Advantage Value Balt (HMO) H2172-006 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Kaiser Permanente available to residents in Maryland. This plan includes additional Medicare prescription drug (Part-D) coverage. The Kaiser Permanente Medicare Advantage Value Balt (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,200 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,200 out of pocket. This can be a extremely nice safety net.

  1. If a Kaiser Permanente facility is not easily accessible, you can get urgent care at a military hospital or clinic (if space is available). If neither a Kaiser Permanente facility nor a military hospital or clinic is available, you can visit any TRICARE-authorized urgent care center or network provider without a referral.
  2. The mail service pharmacy for 2x copay. Out-Of-Area Urgent Care n Physician’s office visit $40 copayment (For unexpected conditions n Kaiser Permanente urgent care center/after hours care center $40 copayment requiring immediate attention n Emergency room $75, waived if admitted such as high fever, vomiting, or sprains — no referral needed).

Kaiser Permanente Medicare Advantage Value Balt (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Kaiser Permanente works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Kaiser Permanente Medicare Advantage Value Balt (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Kaiser Permanente and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Kaiser Permanente except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

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2021 Kaiser Permanente Medicare Advantage Plan Costs

Kaiser Permanente Medicare Advantage Value Balt (HMO)
Plan ID:
Provider:Kaiser Permanente
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $7,200
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H2172-008

Kaiser Permanente Medicare Advantage Value Balt (HMO) Part-C Premium

Kaiser Permanente plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H2172-006 Part-D Deductible and Premium

Kaiser Permanente Medicare Advantage Value Balt (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Kaiser Permanente plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Kaiser Permanente above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Kaiser Permanente Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Kaiser Permanente plan does offer additional coverage through the gap.

H2172-006 Formulary or Drug Coverage

Kaiser Permanente Medicare Advantage Value Balt (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Kaiser permanente urgent care copay cards

2021 Kaiser Permanente Medicare Advantage Value Balt (HMO) Summary of Benefits

Additional Benefits


Comprehensive Dental

Diagnostic services$11-69 copay
Endodontics$47-1,047 copay
Extractions$72-429 copay
Non-routine services$0-55 copay
Periodontics$76-836 copay
Prosthodontics, other oral/maxillofacial surgery, other services$30-3,658 copay
Restorative services$40-755 copay



Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)$175 copay
Diagnostic tests and procedures$0 copay
Lab services$0 copay
Outpatient x-rays$20 copay

Doctor Visits

Primary$10 copay per visit
Specialist$50 copay per visit

Emergency care/Urgent Care

Emergency$90 copay per visit (always covered)
Urgent care$50 copay per visit (always covered)

Is urgent care covered by kaiser

Foot Care (podiatry services)

Foot exams and treatment$50 copay
Routine foot careNot covered

Ground Ambulance

$275 copay


Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Hearing exam$50 copay

Inpatient Hospital Coverage

$300 per day for days 1 through 5
$0 per day for days 6 through 90

Medical Equipment/Supplies

Diabetes supplies$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item

Medicare Part B Drugs

Chemotherapy$0-47 copay
Other Part B drugs$0-47 copay

Mental Health Services

Inpatient hospital - psychiatric$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit$10 copay
Outpatient group therapy visit with a psychiatrist$10 copay
Outpatient individual therapy visit$20 copay
Outpatient individual therapy visit with a psychiatrist$20 copay


$7,200 In-network



Optional supplemental benefits


Outpatient Hospital Coverage

$0-300 copay per visit

Package #1

Monthly Premium$25.00

Preventive Care

$0 copay

Preventive Dental

CleaningCovered under office visit
Dental x-ray(s)Covered under office visit
Fluoride treatmentCovered under office visit
Office visit$30.00
Oral examCovered under office visit

Rehabilitation Services

Occupational therapy visit$40 copay
Physical therapy and speech and language therapy visit$40 copay

Skilled Nursing Facility

$0 per day for days 1 through 20
$167 per day for days 21 through 100


$0 copay


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)$0 copay
OtherNot covered
Routine eye exam$10-50 copay
UpgradesNot covered

Wellness Programs (e.g. fitness nursing hotline)


Reviews for Kaiser Permanente Medicare Advantage Value Balt (HMO) H2172

2019 Overall Rating
Part C Summary Rating
Part D Summary 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

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Kaiser Permanente Medicare Advantage Value Balt (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Kaiser Permanente Medicare Advantage Value Balt (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language
Kaiser Permanente Urgent Care Copay

Kaiser Permanente Medicare Advantage Value Balt (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

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Coverage Area for Kaiser Permanente Medicare Advantage Value Balt (HMO)

Kaiser Permanente Urgent Care Pasadena

(Click county to compare all available Advantage plans)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Participants enrolled in the Kaiser Permanente Health Maintenance Organization (HMO) receive all medical treatment from Kaiser physicians, facilities, and pharmacies. The Plan does not cover services rendered by out-of-network providers unless participants require immediate medical care for an urgent medical condition and are outside the Kaiser service area at the time. You may designate your primary care physician who refers you to specialists within Kaiser.

  • Receive all medical, hospitalization and pharmacy services at Kaiser facilities
  • Primary care physician refers you to specialists within Kaiser
  • Lower premiums
  • No deductible
  • Low co-pay
  • Out-of-pocket limit is $1,500 for individual, $3,000 for family

24/7 Health Resources

Kaiser Permanente Urgent Care Copays

Take advantage of the free tools offered by Kaiser. As a Kaiser participant, register for My Health Manager, and take charge of your health 24 hours a day, 7 days a week. This free online and mobile service allows you to view your and your family members' health information, email your doctor, set appointments, refill prescriptions, and much more. To get started, visit kp.org/registernow.

Medical Coverage While Traveling

Whether you’re traveling domestically or internationally, participation in your Kaiser Permanente medical plan will grant you coverage in the event of a life- or limb-threatening medical emergency. If you are traveling and receive emergency services, remember to retain all your receipts and related documentation. Call your insurance carrier at your earliest opportunity to inform them of any emergency services received.

Nearest Kaiser Permanente Urgent Care

Urgent Care

Kaiser Permanente Urgent Care Copay Assistance

You have more choices than just the emergency room (ER) that can save you time and out-of-pocket costs. The ER shouldn’t be your first stop — unless there’s a true emergency. While both urgent and emergency care situations are serious, urgent care is for medical symptoms, pain, or conditions that require immediate medical attention but are not severe or life-threatening and do not require use of a hospital or ER. Urgent care conditions include, but are not limited to: earache, sore throat, rash, sprained ankle, flu and fever not higher than 104°. So what do you do when you need care right away, but it is not an emergency?


Kaiser Permanente Hmo Urgent Care Cost

• Kaiser Permanente Plan Participants – Call Kaiser’s 24/7 NurseLine at 800-464-4000 – Find an urgent care center by visiting kp.org.