Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)

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 2026.

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.

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:

Drug Coverage

The Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay a $10 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands at standard pharmacies and standard mail. Non-preferred drugs require 33% coinsurance, while specialty tier drugs have no copay at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. For those who qualify for the low-income subsidy, the Part D premium is reduced to $11.10. Please check the plan's formulary to confirm the coverage and tier of your specific prescription medications.

Additional Benefits

The Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO) plan offers comprehensive medical coverage with no copays for primary care, telehealth visits, urgent care, and annual preventive physicals. For covered inpatient hospital stays, members pay a $290 copay per day for the first five days, followed by no copay for days six through 999. Emergency room visits carry a $150 copay, which is waived if you are admitted, and there is no coinsurance for most outpatient, emergency, and primary care services. Ancillary benefits include routine dental cleanings and routine eye exams with no copay, while hearing evaluations require a $15 copay. Skilled nursing facility stays feature no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance. Durable medical equipment is available with no copay and coinsurance ranging up to 20 percent, though this plan does not cover routine transportation, eyewear, or prescription hearing aids.