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Kaiser Permanente Senior Advantage Inland Empire (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Inland Empire (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 Inland Empire (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Inland Empire (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Inland Empire 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 Inland Empire (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 Inland Empire (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 Inland Empire (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 Inland Empire (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Inland Empire (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay a $7 copay for preferred generic drugs at a standard pharmacy and a $47 copay for standard generic drugs. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Inland Empire (HMO) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, primary care visits, preventive services, and home health services. The plan also includes coverage for hearing and vision services, with no copays for routine eye exams. Additional benefits include coverage for dental services, ambulance services, emergency services, and diagnostic services, with varying copays and coinsurance amounts depending on the specific service. The plan also covers home infusion services and dialysis services, with coinsurance requirements.
Inpatient Hospital See details
The Kaiser Permanente Senior Advantage Inland Empire (HMO) plan covers inpatient hospital stays with no copay for days 1-90, and additional days for inpatient hospital-acute and psychiatric stays also have no copay for days 91-999. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with no copay, and observation services, with a copay between $0 and $95. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services, including individual and group sessions, have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan with no copay. A doctor referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Kaiser Permanente Senior Advantage Inland Empire (HMO). Ground and air ambulance services have a $100 copay, and there is 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 by the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $95 copay, while Worldwide Emergency Transportation has a $100 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay; all services have no coinsurance.
Primary Care See details
Primary Care benefits with the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan include no copay for Primary Care Physician Services, and Chiropractic Services, and no copay for Physical Therapy and Speech-Language Pathology Services. Physician Specialist Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a $0 minimum and maximum copay, and Other Health Care Professional services have a $0 minimum and maximum copay. Occupational Therapy Services have no coinsurance, and a $0 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services including health education, nutritional/dietary benefits, fitness benefits, and remote access technologies, all with no copay. Some services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids, but only the fitting/evaluation for hearing aids is covered, and routine hearing exams are not covered. Hearing exams have no copay, and prescription hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with no copay, but eyewear is partially covered. Eyewear coverage does not include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and orthodontic services, with no copay for Medicare Dental Services and Other Dental Services; however, Restorative Services have a copay of $36-$124, Adjunctive General Services have a copay of $58, Periodontics have a copay of $0-$71, and Oral and Maxillofacial Surgery has a copay of $0-$229. Maxillofacial Prosthetics and Orthodontics are not covered, and Endodontics, Prosthodontics (removable, fixed), and Implant Services are optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay of $7 to $35, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $0 to $47 and 0% to 20% coinsurance, and Other Medicare Part B Drugs with a copay of $0 to $47 and 0% to 20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan, and a doctor referral is required. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 10% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of at most $0.00, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Inland Empire (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, but the plan does not cover any of the listed sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Inland Empire (HMO) plan covers acupuncture with no copay, and over-the-counter (OTC) items with a maximum benefit of $90 every three months. The plan also covers other services, including residential substance use disorder and MH treatment with no copay, and DME and prosthetic/medical supplies with 0% to 10% coinsurance. Meal benefits, 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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