This webpage provides information on Kaiser Permanente's supplemental health plan for Medicare eligible retirees and employees.

All other employees should visit the Kaiser Permanente Medical Insurance webpage to learn about health insurance benefits with Kaiser Permanente.

New in 2022: Kaiser Permanente Medicare Supplemental Plan

Kaiser Permanente Logo

Medicare eligible Prince William County Schools (PWCS) retirees and employees have a new health insurance option in 2022 from Kaiser Permanente.

The 2022 monthly premium for this plan is $251.35 per person, per month.

When you choose a Kaiser Permanente Medicare health plan through Prince William County Public Schools, Kaiser Permanente will bill you directly and you will receive a bill in the mail for your monthly premium.

For more information or to enroll, please call 1-800-747-2189 or visit Kaiser Permanente's website:

Extras included with the plan

Preventive dental care

You pay a $30 copayment for each preventive care office visit, which includes up to two oral exams, two cleanings, and two bitewing X-rays every year. Other covered dental services are provided at a reduced fee.

Hearing aids

You pay $0 for one hearing aid for each ear, every 36 months. You are also covered for medically necessary hearing aid evaluations and diagnostic procedures to determine the hearing aid model which will best compensate for loss of hearing.

Routine eye care

Benefits include coverage for routine eye exams, glaucoma and cataract screenings, and an allowance on glasses and contact lenses. Visit kp2020.org for more information and to view optical locations, conveniently located in many Kaiser Permanente medical centers.

The Silver&Fit Healthy Aging and Exercise Program

Fitness center membership with a local participating Silver&Fit fitness center and digital fitness choices with home fitness tools to help you thrive in the comfort of your home. Visit SilverAndFit.com for more information.

Transportation to medical appointments

The plan includes 24 one-way rides per contract year for nonemergency medical appointments at Kaiser Permanente medical centers and contracted facilities at no extra cost. Call 1-855-932-5412, 24 hours a day, 7 days a week, to schedule a ride.

Virtual care options

The plan offers flexible virtual care options to visit with your Kaiser Permanente doctor by phone or video from the comfort of home. You can also call our 24/7 advice line and email your Kaiser Permanente doctor for nonurgent questions. Visit kp.org/GetCare for more information.

Learn more about the plan

Coverage and Copayments

The annual deductible for this plan is $0.

Benefits and Services Coverage and Copayment
Preventative care Covered in full
Office visit - primary and specialty $15 copay
Physical therapy $15 copay
Labs, X-rays, and other outpatient diagnostic tests Covered in full
Other imaging procedures, such as MRI, CT, and PET Covered in full
Inpatient hospital $100 per benefit period
Outpatient services/surgery Covered in full
Emergency room1 $50 copay
Urgent care $15 copay
Ambulance Covered in full
Durable medical equipment Covered in full
Routine eye exam2 $15 copay
Preventive dental exam and cleaning3 $30 copay
Hearing aids $0 for one hearing aid for each ear (every 36 months)

1 Copay waived if admitted to inpatient hospital
2 At Vision Essentials by Kaiser Permanente locations
3 With the Preventive Dental plan underwritten by Kaiser Permanente and administered by Dominion National.

Drug Coverage Included with the Plan

Part D prescription drug coverage is included in Kaiser Permanente Medicare Advantage plans.

When you order prescription refills from a Kaiser Permanente pharmacy or online, you can use the preferred prescription home delivery option for many drugs and have them sent to your home at no extra charge.

Initial coverage stage

You pay the copays and coinsurance shown in the chart below until your total yearly drug costs reach $7,050. (Total yearly drug costs are the amounts paid by both you and any Part D plan during a calendar year.) If you reach the $7,050 limit, you move on to the catastrophic stage and your coverage changes. There is not a coverage gap with the Kaiser Permanente Medicare Advantage plan.

Prescription Drug Copayment (Plan A with Part D)
Tier Preferred pharmacy
(up to a 60-day supply)
Standard pharmacy
(up to a 60-day supply)
OON pharmacy
(up to a 30-day supply) and
LTC pharmacy
(up to a 31-day supply)
Prescription home delivery 1
(up to a 90-day supply)
Tier 1
(preferred generic)
$15 $25 $12.50 $10
Tier 2
(generic)
$15 $25 $12.50 $10
Tier 3
(preferred brand)
$15 $25 $12.50 $10
Tier 4
(non-preferred brand)
$15 $25 $12.50 $10
Tier 5
(specialty)
$15 $25 $12.50 $10
Tier 6
(vaccines)
$0 $0 $0 Not available

1 For certain drugs, you can get prescription refills mailed to you through Kaiser Permanente prescription home delivery. You should receive them within 3-5 days.

Catastrophic coverage stage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order)
reach $7,050, you pay:

  • Generic drugs - $2
  • Brand drugs - $7.50
  • Vaccines - $0

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