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Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Greater Sac and Sonoma 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 Sr Adv Enhanced Sac., Sonoma (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 Sr Adv Enhanced Sac., Sonoma (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 Sr Adv Enhanced Sac., Sonoma (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $65.00. 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 $3900.00 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 Sr Adv Enhanced Sac., Sonoma (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay an $8.00 copay for preferred generic drugs at a standard pharmacy. For non-preferred drugs, you will pay 33% coinsurance. In the specialty tier, there is no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan offers a range of benefits with varying costs. This plan provides inpatient hospital care with a $215 copay for days 1-5 and no copay for days 6-90, as well as coverage for outpatient services, emergency services, primary care, preventive services, and home health services with no copay. Additional benefits include coverage for ambulance services with a $300 copay, hearing exams with a $5 copay, and vision and dental services with copays between $0 and $10. The plan also covers medical equipment and diagnostic services with varying coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $215 copay for days 1-5, and no copay for days 6-90, along with no coinsurance. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric have no copay. 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 all outpatient hospital services with a copay between $0 and $175, observation services with a copay between $0 and $140, and ambulatory surgical center (ASC) services with a $175 copay. Outpatient substance abuse services and outpatient blood services are also covered, with no copay for individual and group sessions for substance abuse, and no copay for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan, with no copay required. A doctor referral is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance. Ground and Air Ambulance Services have a $300 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan. Emergency Services has a $140 copay and no coinsurance, while Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $300 copay, with no coinsurance for any of these services.
Primary Care See details
Primary Care for the Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan covers primary care physician services with no copay, chiropractic services with no copay, and occupational therapy services with a copay between $7 and $15. This plan also covers physician specialist services with a $5 copay, mental health specialty services with no copay, Other Health Care Professional services with a copay between $0 and $5, psychiatric services with no copay, physical therapy and speech-language pathology services with a copay between $0 and $15, additional telehealth benefits with no copay, and opioid treatment program services with no copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and an annual physical exam, are covered with no copay. Additional preventive services, including health education, nutritional/dietary benefits, and remote access technologies, are covered with no copay.
Hearing Services See details
Hearing services are partially covered under the Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan. Hearing exams have a $5 copay, but routine hearing exams are not covered. Fitting/evaluation for hearing aids is covered, but is offered as an optional, supplemental benefit. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0 to $5, and routine eye exams with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. A doctor referral is required for eye exams and eyewear.
Dental Services See details
Dental services include coverage for Medicare dental services with a copay of $0 - $5, and other dental services with a copay of $0 - $10. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered. Periodontics and oral and maxillofacial surgery are covered with no copay, and orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but prior authorization is required. Medicare Part B Insulin Drugs have a copay between $8 and $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47, with coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan. The coinsurance for these services is 20%.
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. Diabetic Equipment includes Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, and outpatient X-ray services with a $10 copay. Diagnostic Radiological Services have a copay up to $200, while therapeutic radiological services have no copay.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) 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, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $100 copay for days 21-100; there is no coinsurance.
Other Services See details
The "Other Services" benefit covers acupuncture with no copay, over-the-counter items with a $60 benefit every three months, and "Other 1" services with a $100 copay. The plan does not cover meal benefits, and many other services are also not covered. "Other 2" services are covered with 0-20% coinsurance.
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