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Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Alam., SF, Napa (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 Alam., SF, Napa (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Alameda, Napa, and SF Counties 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 Alam., SF, Napa (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 Alam., SF, Napa (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 Alam., SF, Napa (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $99.00. 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 Senior Advantage Alam., SF, Napa (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to start immediately. During the initial coverage phase, you will pay a $7 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands at standard pharmacies or through standard mail. Individuals who qualify for the low-income subsidy will see their Part D costs reduced to $3.40. For higher-tier medications, Tier 4 non-preferred drugs require a 32% coinsurance, while Tier 5 specialty drugs feature no copay at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions.
Additional Benefits
The Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) plan offers robust medical coverage with no copay for primary care visits, preventive care, and urgent care services. Specialist office visits require a budget-friendly $15 copay, while emergency room visits carry a $150 copay that is waived if you are admitted. For hospital care, inpatient stays require a $270 daily copay for days 1 through 5 and no copay for subsequent days, while outpatient hospital services range from no copay up to a $240 copay. Routine eye exams, home health care, and diagnostic lab tests are also provided with no copay, though dental and vision benefits are limited with eyewear excluded from coverage. Skilled nursing facility stays are covered with no copay for the first 20 days and a $100 daily copay for days 21 through 100. Additionally, durable medical equipment and diabetic supplies are available with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO), requiring a $270 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 999 for acute and psychiatric stays. Non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) with no coinsurance and copays ranging from no copay up to $240 for outpatient hospital and ambulatory surgical services. Patients will pay a copay of up to $150 per stay for observation services, while outpatient blood and substance abuse services are provided with no copay.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) covers partial hospitalization services with no copay and no coinsurance. A doctor referral is required to access this covered benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) provides partial coverage for ambulance and transportation services, covering ground and air ambulance services with a $350 copay and no coinsurance. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) are covered with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency transportation requires a $350 copay and no coinsurance.
Primary Care See details
Primary care benefits under Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) are partially covered with no coinsurance, featuring no copay for primary care provider visits, mental health, psychiatric, telehealth, and opioid treatment services. Specialist visits require a $15 copay, therapy services range from $0 to $10, and other healthcare professionals cost up to $15, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) plan with no copay and no coinsurance for covered care like annual physicals. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered under the Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) plan, which covers fitting and evaluation for hearing aids with no copay and no coinsurance. Routine hearing exams and OTC hearing aids are not covered, and while some prescription hearing aid services are covered, all specific types including inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) covers eye exams with a $0 to $15 copay and no coinsurance, including routine eye exams with no copay. Eyewear is not covered under this plan, which includes contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO), with Maxillofacial Prosthetics and Orthodontics excluded from coverage. Medicare-covered dental services require a $0 to $15 copay and no coinsurance, while other covered dental services have no copay and no coinsurance. Additional treatments like restorative, endodontic, and implant services are available as optional supplemental benefits for an extra fee.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO), with chemotherapy, radiation, and other Part B drugs requiring a copay of no copay to $47 and coinsurance of no coinsurance to 20%. Covered Part B insulin drugs require a $7 to $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) covers medical equipment with prior authorization, featuring no copays across all categories. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices and diabetic shoes require a 20% coinsurance, and diabetic supplies are provided with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) with no coinsurance, though doctor referrals are required. Members pay no copay for diagnostic procedures, lab services, and therapeutic radiological services, a $10 copay for outpatient X-rays, and a copay between $10 and $275 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) plan with no copay and no coinsurance, though a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) with a doctor referral, although only some services are covered in practice. Specific sub-services, including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services, are not covered, meaning no copay or coinsurance is applicable.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO) partially covers Skilled Nursing Facility (SNF) care with a doctor referral, offering no copay and no coinsurance for days 1 through 20, and a $100 daily copay with no coinsurance for days 21 through 100. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO), excluding meal benefits and dual eligible SNPs with highly integrated services. Covered benefits include acupuncture and over-the-counter items with no copay and no coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and non-Medicare durable medical equipment and supplies with no copay and a 0% to 20% coinsurance.
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