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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 2026, 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 2026.
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 $1300.00 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 features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs at standard pharmacies. Tier 2 standard generic drugs require a $40 copay, Tier 3 preferred brand drugs carry a $95 copay, and Tier 4 non-preferred drugs require a 32% coinsurance. These cost-sharing rates apply until your total yearly out-of-pocket drug costs reach $2,100. After reaching this threshold, you enter the catastrophic coverage phase and will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Inland Empire (HMO) plan offers affordable access to core healthcare services, with no copay and no coinsurance for most primary care, specialist, and preventive visits. For inpatient hospital stays, members pay a $100 daily copay for days one through five and no copay for additional days, while emergency room visits require a $150 copay that is waived upon admission. Outpatient services, diagnostic tests, and home health care are also highly accessible, featuring no coinsurance and mostly no copays. For specialized medical needs, dialysis and durable medical equipment require up to a 20% coinsurance with no copay, while diabetic supplies feature no copay. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, though the plan does not cover eyeglasses, hearing aids, or transportation. Additionally, cardiac rehabilitation is excluded from coverage, but members can take advantage of acupuncture and a $40 quarterly over-the-counter allowance with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) partially covers inpatient acute and psychiatric hospital services, excluding non-Medicare-covered stays. For covered admissions, there is a $100 daily copay for days 1 through 5, no copay for days 6 and beyond, and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Inland Empire (HMO) with no coinsurance. Copays range from $0 to $100 for outpatient hospital services, $0 to $150 per stay for observation services, and $100 for ambulatory surgical center services, while outpatient substance abuse and blood services require no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Inland Empire (HMO) with no copay and no coinsurance. A doctor referral is required to receive these services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) partially covers ambulance and transportation services, offering ground and air ambulance coverage with a $325 copay and no coinsurance. However, transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are covered with no copay and no coinsurance, while worldwide emergency coverage has a $150 copay and worldwide emergency transportation has a $325 copay, both with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Senior Advantage Inland Empire (HMO), as podiatry and routine chiropractic services are not covered. Most covered services, including primary care and specialist visits, have no copay or coinsurance, while physical, occupational, and speech therapies require copays of up to $10 and no coinsurance.
Preventive Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) partially covers preventive services, offering key benefits like annual physicals, fitness programs, and health education with no copay and no coinsurance. However, several supplemental options are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) partially covers hearing exams with no copay and no coinsurance, which includes hearing aid fittings and evaluations as an optional supplemental benefit. Routine hearing exams, prescription hearing aids, and over-the-counter hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) covers routine eye exams with no copay and no coinsurance, requiring a doctor referral and no deductible. For eyewear, some services are covered but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Kaiser Permanente Senior Advantage Inland Empire (HMO) with no copay and no coinsurance for covered services. Under this plan, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) covers home infusion bundled services, including Medicare Part B insulin drugs with a $12.00 to $35.00 copay and no coinsurance. Chemotherapy, radiation, and other Part B drugs are also covered with copays ranging from no copay to $47.00 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Inland Empire (HMO) with a 20% coinsurance and no copay, though a doctor referral is required.
Medical Equipment See details
Medical equipment benefits are covered by Kaiser Permanente Senior Advantage Inland Empire (HMO), requiring prior authorization for most items. Durable medical equipment and medical supplies range from no coinsurance to 20% coinsurance with no copay, while prosthetic devices and diabetic shoes require a 20% coinsurance with no copay, and diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan with a required doctor referral. There is no coinsurance for these services, and members pay no copay for diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require a copay of up to $200.
Home Health Services See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) covers Home Health Services with no copay and no coinsurance. A doctor referral is required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Inland Empire (HMO) plan, with all sub-services, including intensive cardiac, pulmonary, and SET for PAD services, excluded from coverage.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Inland Empire (HMO) partially covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $150 daily copay for days 21 through 100. A doctor referral is required, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Inland Empire (HMO), featuring acupuncture and over-the-counter items (up to $40 quarterly) with no copays or coinsurance. Residential substance use treatment requires a $100 copay and no coinsurance, while non-Medicare medical supplies have a 0% to 20% coinsurance and no copay; meal benefits and highly integrated SNP services are not covered.
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