Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits, including Acute and Psychiatric services, are covered. For days 1-5, there is a $100 copay, and for days 6-90, there is no copay; additional days (91-999) have no copay.

Outpatient Services See details

Outpatient services include outpatient hospital services with a copay between $0 and $60, observation services with a copay between $0 and $140, ambulatory surgical center services with a $60 copay, outpatient substance abuse services with no copay, and outpatient blood services with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered under the Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan. There is no copay for this benefit, and a doctor referral is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan. Both ground and air ambulance services have a $200 copay with no coinsurance, while 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 Sr Adv Enhanced Contra Costa (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $200 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay.

Primary Care See details

Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with no copay, but routine care is not covered, and requires prior authorization and a doctor referral.

Occupational Therapy Services are covered with no coinsurance and no copay.

Physician Specialist Services are covered with a $5 copay. Mental Health Specialty Services, including individual and group sessions, are covered with no copay.

Other Health Care Professional services are covered with a copay between $0 and $5. Psychiatric Services, including individual and group sessions, are covered with no copay.

Physical Therapy and Speech-Language Pathology Services are covered with no copay and no coinsurance. Additional Telehealth benefits are covered with no copay.

Opioid Treatment Program Services are covered with no copay, and require prior authorization and a doctor referral.

Preventive Services See details

Preventive services include an annual physical exam with no copay, as well as additional preventive services and kidney disease education services, both requiring a doctor referral; additional services may have a copay. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with no copay.

Hearing Services See details

Hearing Services include hearing exams and prescription hearing aids, but routine hearing exams and prescription hearing aids of all types are not covered. Hearing exams have a $5 copay, and the fitting/evaluation for hearing aids is offered as an optional, supplemental benefit.

Vision Services See details

Vision services include eye exams with a copay between $0 and $5. Routine eye exams have no copay. Eyewear benefits are partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental Services are covered, including Medicare Dental Services with a copay of $0-$5, and Other Dental Services with no copay. Orthodontic Services are covered, and some services such as Maxillofacial Prosthetics and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a copay between $5 and $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47 with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47 with a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services and Outpatient X-Ray Services have no copay.

Home Health Services See details

Home Health Services are covered under the Kaiser Permanente Sr Adv Enhanced Contra Costa (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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral is required, and copays apply.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan, requiring prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $100 copay for days 21-100, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.

Other Services See details

The "Other Services" benefit covers acupuncture with no copay, and over-the-counter items with a maximum benefit coverage amount of $60 every three months. Other services include Residential Substance Use Disorder and MH Treatment with a $100 copay, and DME and Prosthetic/Medical Supplies not covered by Medicare with 0% - 20% coinsurance. However, meal benefits, 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.