Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO)

Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Marin and San Mateo Counties 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 Marin San Mateo (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 Marin San Mateo (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 Marin San Mateo (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy and standard mail-order copays for a 30-day supply are $7 for preferred generics, $47 for standard generics, and $100 for preferred brand-name drugs. These costs apply until your total drug costs reach $2,100, at which point you enter the next coverage phase. For higher-tier medications, non-preferred drugs require a 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 Medicare Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy, or Extra Help, will pay nothing for their Part D premium.

Additional Benefits

The Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs. Members benefit from no copay for primary care, telehealth, mental health visits, and routine eye exams, while specialist visits require low copays ranging from no copay to $15. For hospital stays, there is a $285 copay for the first five days of inpatient care and no copay thereafter, while emergency room visits carry a $150 copay that is waived upon admission. Additionally, standard dental services and preventative care are available with no copay, though advanced dental options may require additional costs and eyewear is not covered. Outpatient diagnostic labs and home health services also feature no copay, while durable medical equipment and dialysis require up to 20% coinsurance with no copay. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $100 daily copay up to 100 days.