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 2025, 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 2025.
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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at standard and mail order pharmacies. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan offers a range of benefits with varying costs. Many services have no copay, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision exams, dental services, and home health services. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while ambulance services have a $100 copay. Other services have copays or coinsurance, such as ambulance services, diagnostic and radiological services, and medical equipment. The plan also covers services like partial hospitalization, home infusion, skilled nursing facilities, and dialysis services. Please note that some services may not be covered, such as some vision and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which have no copay for days 1-90 and additional days 91-999. Non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services, Ambulatory Surgical Center (ASC) Services, Individual and Group Sessions for Outpatient Substance Abuse, and Outpatient Blood Services have no copay, while Observation Services may have a copay between $0 and $140.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan, with no copay required and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan. Ground and air ambulance services have a $100 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Worldwide Emergency Transportation has a $100 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational therapy services, and psychiatric services are covered with a copay, while routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional services such as health education, nutritional/dietary benefits, fitness benefits, and remote access technologies, all with no copay. Other services, such as in-home safety assessments, personal emergency response systems, and others, are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, and fitting/evaluation for hearing aids which may be an optional, supplemental benefit, but routine hearing exams and prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear, although contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include Medicare Dental Services and Other Dental Services with no copay. Restorative Services have a copay of $36-$124, and Adjunctive General Services have a $58 copay. Periodontics has a copay of $0-$71, and Oral and Maxillofacial Surgery has a copay of $0-$229. Maxillofacial Prosthetics and Orthodontics are not covered. Endodontics, Prosthodontics (removable), Implant Services, and Prosthodontics (fixed) are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan, including Medicare Part B Insulin Drugs with a copay of $5.00 - $35.00. Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0.00 - $47.00 with 0% - 20% coinsurance, while Other Medicare Part B Drugs have a copay of $0.00 - $47.00 with 0% - 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with a doctor referral, and require 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Medicare-covered Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay, including Medicare-covered diagnostic procedures, tests, and lab services, as well as lab services with no copay. Diagnostic Radiological Services have a copay of at most $15, while Therapeutic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral. However, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Kaiser Permanente Senior Advantage LA, Orange Co. (HMO). You will pay no copay for days 1-20, and a $100 copay for days 21-100.
Other Services See details
Other Services include acupuncture, Over-the-Counter (OTC) items, and other services. Acupuncture has no copay, while Over-the-Counter (OTC) items are covered up to $90 every three months, and other services have a coinsurance of 0% - 20%. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved