|In Network||Out of Network1|
|Primary care visit||$10||$30|
|Most lab tests and X-rays||$0||$20|
|Generic (in-network/community pharmacy)2||$5 / $15||$25|
|Preferred brand (in-network/community pharmacy)2||$15 / $25||$45|
|Non-preferred brand (in-network/community pharmacy)2||$15/$25||$70|
|Emergency room services||$150|
|Routine prenatal care, first postpartum visit||$20||Covered in-network|
|In-patient delivery||$0||Covered in-network|
|Outpatient surgery||$20||Covered in-network|
|Inpatient hospital care (per admission)||$0||Covered in-network|
For illustrative purposes only.
1This plan covers up to 10 out-of-network medical visits for certain physician, laboratory and radiology services, and 5 pharmacy refills a year with any licensed provider outside of the Kaiser Permanente care delivery system, anywhere in the United States.
2For more information about prescription drugs and other common medical events, including exclusions and limitations, read Summary of Benefits and Coverage below.
3Out-of-network urgent care available when out of service area.
Medicare retirees enrolled in Kaiser Permanente Medicare Advantage (HMO)
|Primary care visit copay (waived for children through age 5)||$10|
|Medicare-covered preventive care/screening/immunization||$0|
|Diagnostic test (xray, blood work)||$0|
|Imaging (CT/PETscans, MRI)||$0|
Mail Order (up to a 90-day supply)–$3
Plan Pharmacies (up to a 60-day supply)–$5
Participating retail pharmacies (up to a 60-day supply)–$10
|Emergency room services, per visit (waived if admitted)||$50|
|Urgent care, per visit||$10|
|Hospitalization, facility or surgeon||$0|
|Video appointments with the doctor||$0|
All copays and costs with preferred providers.
1For more information about prescription drugs and other common medical events, including exclusions and limitations, read Summary of Benefits below.
In the survey Best Health Insurance Companies for 2021 by Insure.com, Kaiser Permanente as a national enterprise is rated #1 overall among 15 companies.
In the National Committee for Quality Assurance (NCQA) Commercial Health Plan Ratings 2021, our commercial health plan is rated 5 out of 5, the highest rating in MD, VA, and DC. The 2019 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest multispecialty medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Northern Virginia Magazine (2021), Washingtonian magazine (2020), and Baltimore magazine (2020). According to NCQA’s Quality Compass® 2021, we lead DC, MD, and VA in the following categories: childhood immunizations, adolescent immunizations, prenatal care, postpartum care, breast cancer screening, colorectal cancer screening, and cervical cancer screening. Quality Compass is a registered trademark of the NCQA.