Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H8794-022

Medicare Plan

Kaiser Permanente Dual Complete North P22 (HMO D-SNP) · Kaiser Permanente · HMO · North Plan 22

Full CMS plan ID: H8794-022-000

H8794-022-000 is the full CMS identifier for the H8794-022 Medicare plan. Common searches include H8794 022 and H8794022.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Kaiser Permanente Dual Complete North P22 (HMO D-SNP)

H8794-022-000 North Plan 22 HMO Dual-Eligible

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–5 $475 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $2,375
02

Emergency transport

Ambulance

Ground · in-network$400 copay
Air · in-network$400 copay
03

Emergency services

Emergency room

$115 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + outNot reported
05

Skilled care at home

Home health

In-network$0 copay
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network$0 copay
Out-of-networkNot separately reported

Specialist

In-network$0 copay
Out-of-networkNot separately reported

Preventive care

In-network$0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network$0 copay
Out-of-networkNot separately reported

Laboratory services

In-network$0 copay
Out-of-networkNot separately reported

X-rays & standard imaging

In-network$0–$125 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-network$0 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$115 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$400 copay
Out-of-networkNot separately reported

Air ambulance

In-network$400 copay
Out-of-networkNot separately reported

Outpatient hospital

In-network$0 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-network$0 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-network$0 copay
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network$0 copay
Out-of-networkNot separately reported

Occupational therapy

In-network$0 copay
Out-of-networkNot separately reported

Physical & speech therapy

In-network$0 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-network$0 copay
Out-of-networkNot separately reported

Substance use treatment

In-network$0 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-network$0 copay
Out-of-networkNot separately reported

Chiropractic

In-network$0 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-network$0 copay
Out-of-networkNot separately reported

Vision

In-network$0 copay
Out-of-networkNot separately reported

Hearing

In-network$0 copay
Out-of-networkNot separately reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

In-network$0 copay
Out-of-networkNot separately reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

In-network$0 copay
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + outNot reported

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMO · Referrals: Required for some services · Out-of-network coverage: No

Prescription drugs6 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$0 retail copay · 30-day supply

Drug tier 3

$0 retail copay · 30-day supply

Drug tier 4

18% retail coinsurance · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Drug tier 6

$0 retail copay · 30-day supply

Using this plan

Understand H8794-022-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Kaiser Permanente Dual Complete North P22 (HMO D-SNP) is a 2026 HMO offered by Kaiser Permanente in North Plan 22. The CMS record does not indicate routine out-of-network coverage. Referrals are required for some services. Its listed inpatient copay stages total $2,375 across 5 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$0 copay
Specialist
$0 copay
Laboratory services
$0 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0 copay
MRI, CT & PET imaging
$0 copay
Outpatient hospital
$0 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$115 copay
Listed inpatient stages
$2,375 total

5 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
North Plan 22 (CA)
Plan type
HMO
Special Needs Plan
Dual-Eligible
Contract / plan
H8794-022
Coverage year
2026

This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$0 copay
Vision$0 copay
Hearing$0 copay
Fitness & wellness$0 copay
Meals$0 copay

Plan-specific answers

Frequently asked questions

Where is H8794-022-000 available?

Kaiser Permanente Dual Complete North P22 (HMO D-SNP) is listed for North Plan 22 (CA). This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H8794-022-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H8794-022-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H8794-022-000?

The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.

Does H8794-022-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H8794-022-000 fits

Full CMS plan ID
H8794-022-000
Contract
H8794
Base plan code
H8794-022
Segment
000
Carrier
Kaiser Permanente
Plan type
HMO
Service area
North Plan 22 (CA)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • San Mateo, CA

Same CMS contract

H8794-001-000 Kaiser Permanente Dual Complete South P1 (HMO D-SNP) South Plan 1 · HMO H8794-002-000 Kaiser Permanente Dual Complete North P2 (HMO D-SNP) North Plan 2 · HMO H8794-006-000 Kaiser Permanente Dual Complete South P6 (HMO D-SNP) South Plan 6 · HMO H8794-007-000 Kaiser Permanente Dual Complete South P7 (HMO D-SNP) South Plan 7 · HMO H8794-009-000 Kaiser Permanente Dual Complete South P9 (HMO D-SNP) South Plan 9 · HMO H8794-010-000 Kaiser Permanente Dual Complete South P10 (HMO D-SNP) South Plan 10 · HMO H8794-011-000 Kaiser Permanente Dual Complete South P11 (HMO D-SNP) South Plan 11 · HMO H8794-016-000 Kaiser Permanente Dual Complete North P16 (HMO D-SNP) North Plan 16 · HMO

About this code

What H8794-022-000 identifies

H8794-022-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H8794-022, H8794 022, or the compact full CMS ID H8794022000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.