A non-government entity
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Los Angeles and Orange Counties Plan. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Senior Advantage LA, Orange Co. (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $699.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy and standard mail-order copays are $5 for preferred generics, $47 for standard generics, and $100 for preferred brands. Non-preferred drugs require a 32% coinsurance, while specialty tier drugs have no copay at standard pharmacies. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy will benefit from a reduced premium and pay no cost for Part D coverage.
Additional Benefits
The Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan offers robust medical coverage with no copay and no coinsurance for primary care, specialist visits, inpatient hospital stays, and outpatient services. Emergency room visits require a $150 copay, which is waived if you are admitted, while urgent care services are available with no copay. Diagnostic labs, X-rays, and home health services are also fully covered with no copay and no coinsurance. For supplemental care, members enjoy routine eye exams, dental services, and fitness programs with no copay and no coinsurance, though eyewear and routine hearing exams are not covered. Durable medical equipment and dialysis services carry a 0% to 20% coinsurance with no copay, while Medicare Part B insulin is covered with a $5 to $35 copay. Additional perks include acupuncture and a $50 quarterly over-the-counter allowance, both featuring no copay and no coinsurance.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) partially covers inpatient hospital benefits, offering acute and psychiatric care with no copay and no coinsurance. However, non-Medicare-covered stays for both acute and psychiatric inpatient hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) with no coinsurance and no copay for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Observation services are also covered with no coinsurance and a copay of $0 to $150 per stay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) with no copay and no coinsurance. Members must obtain a doctor referral to access these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), which features a $225 copay and no coinsurance for both ground and air ambulance services. Regular transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with no copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $150 copay for emergency care, a $225 copay for emergency transportation, and no copay for urgent care.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), with podiatry services and routine chiropractic care excluded from coverage. Covered services—including primary care, specialist visits, therapy, and telehealth—are available with no copay and no coinsurance.
Preventive Services See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) offers partially covered preventive services with no copay and no coinsurance for covered care such as annual physicals, health education, and fitness programs. However, sub-services including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), featuring hearing aid fitting and evaluation exams with no copay and no coinsurance as an optional supplemental benefit, though routine hearing exams and OTC hearing aids are not covered. For prescription hearing aids, some services are covered but all specific types, including inner ear, outer ear, and over the ear devices, are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), which features routine eye exams with no copay and no coinsurance. Eyewear benefits, including contact lenses, eyeglasses, frames, lenses, and upgrades, are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) partially covers dental services with no copay and no coinsurance for covered benefits, although some services are optional and may require an additional fee. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), including Medicare Part B chemotherapy, radiation, and other drugs with copays ranging from no copay to $47.00 and coinsurance from no coinsurance to 20%. Medicare Part B insulin is also covered with a $5.00 to $35.00 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) with no copay and a 20% coinsurance, though a doctor referral is required.
Medical Equipment See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic shoes, with 0% to 20% coinsurance and no copays. Diabetic supplies are covered under this plan with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) covers diagnostic and radiological services with a doctor referral. There is no copay or coinsurance for lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require a copay of up to $175 and no coinsurance.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) with no copay and no coinsurance, though a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) partially covers Skilled Nursing Facility (SNF) services with a doctor referral, featuring no copay and no coinsurance for days 1 through 20, and a $100 daily copay with no coinsurance for days 21 through 100. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), as meal benefits and highly integrated dual eligible SNP services are not covered. Covered benefits such as acupuncture, residential substance use treatment, and a $50 quarterly over-the-counter allowance require no copay and no coinsurance, while non-Medicare durable medical equipment and medical supplies carry no copay and 0% to 20% coinsurance.
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