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Kaiser Permanente Senior Advantage Enhanced Solano (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced Solano (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 Enhanced Solano (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Solano County Plan - Enhanced. 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 Enhanced Solano (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 Enhanced Solano (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 Enhanced Solano (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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 $3400.00 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:
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Drug Coverage
The Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, standard generic drugs have a $5 copay, while preferred brand drugs have a $100 copay. For non-preferred drugs, you'll pay 33% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan offers a comprehensive range of benefits. This plan includes coverage for inpatient and outpatient hospital services, with varying copays depending on the service. You'll find no copays for primary care, preventive services, hearing exams, vision exams, dental services, home health, and many other services, providing significant cost savings. Additional benefits include coverage for ambulance and emergency services, as well as services like home infusion, dialysis, medical equipment, and diagnostic services. The plan also covers skilled nursing facility stays and offers acupuncture and over-the-counter items. However, be aware that some services, such as certain vision and dental services, and some other services have limited coverage or may not be covered at all.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $105 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you'll pay a $105 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days (91-999) have no copay. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $50, observation services with a copay between $0 and $140, ambulatory surgical center services with a $50 copay, outpatient substance abuse services with no copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan with no copay. A doctor's referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $150 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $140 copay with no coinsurance, Urgently Needed Services has no copay and no coinsurance, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $150 copay; all have no coinsurance.
Primary Care See details
The Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a $0 copay.
Preventive Services See details
Preventive services include no copay for annual physical exams, Health Education, Nutritional/Dietary Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Some other services, like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan, including hearing exams with no copay, and fitting/evaluation for hearing aids. The plan does not cover routine hearing exams, prescription hearing aids, and over-the-counter hearing aids.
Vision Services See details
Vision services include eye exams with no copay and routine eye exams with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services, including Medicare dental services and other dental services, are covered with no copay. Oral exams and dental cleanings are covered twice per year, while dental x-rays are limited to one set of bitewings every six months. Orthodontic services, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and implant services are offered as optional, supplemental benefits, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay of $5-$35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0-$47, and Other Medicare Part B Drugs have a copay of $0-$47.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, and Prosthetics/Medical Supplies, with 0% to 20% coinsurance and no copay. The plan also covers Diabetic Equipment, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, and lab services with no copay. Diagnostic radiological services have a copay of at most $100, while therapeutic radiological services and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral is required for Cardiac Rehabilitation Services, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Enhanced Solano (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with no copay, Over-the-Counter (OTC) Items with a $60 maximum benefit every three months, and coverage for Nicotine Replacement Therapy (NRT), as well as Other 1 benefits with a $100 copay, and Other 2 benefits with 0% - 20% coinsurance. 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.
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