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Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Contra Costa County 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 Contra Costa (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 Contra Costa (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 Sr Adv Enhanced Contra Costa (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $89.00. 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 $3400.00 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 Sr Adv Enhanced Contra Costa (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. Under the initial coverage phase, standard pharmacy copays are $7.00 for preferred generics, $47.00 for standard generics, and $100.00 for preferred brands. Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty drugs have no copay at standard pharmacies. These copays and coinsurance rates apply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan offers robust coverage for essential medical needs, often featuring no coinsurance and low out-of-pocket costs. For inpatient hospital stays, members pay a $260 daily copay for the first five days and no copay for additional covered days. Primary care visits, urgent care, and annual physicals require no copay, while specialist visits and emergency room care feature low copays of up to $10 and $150, respectively. Many diagnostic, lab, and home health services are available with no copay, though diagnostic radiological services can cost up to a $250 copay. While dental, vision, and hearing exams are covered with low or no copays, routine eyewear and hearing aids are not covered under this plan. Medical equipment and dialysis services generally require no copay but may carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO), as non-Medicare-covered stays are not covered. For covered acute and psychiatric stays, there is a $260 daily copay for days 1 to 5, no copay for days 6 to 999, and no coinsurance.
Outpatient Services See details
Outpatient Services are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with no coinsurance. Covered benefits include outpatient hospital services with a copay of no copay to $215, observation services with a copay of no copay to $150, ambulatory surgical center visits for a $215 copay, and outpatient substance abuse and blood services with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with no copay and no coinsurance, provided you have a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO). Ground and air ambulance services are covered with a $250 copay and no coinsurance, while transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency and urgently needed services are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with no coinsurance, featuring a $150 copay for emergency room visits (waived if admitted within 24 hours) and no copay for urgent care. Worldwide emergency and urgent services are also covered with no coinsurance, requiring a $150 copay for emergency care, a $250 copay for emergency transportation, and no copay for urgent care.
Primary Care See details
Primary care benefits are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO), with podiatry and routine chiropractic services not covered. Covered services, including primary care and telehealth visits, feature no copay and no coinsurance, while specialist and therapy visits have copays ranging from $0 to $10 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with no copay and no coinsurance for covered care like annual physical exams. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and adult day health services.
Hearing Services See details
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) partially covers hearing services with a $10 copay and no coinsurance or deductible for hearing aid fitting and evaluation exams. Routine hearing exams, prescription hearing aids, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO), offering routine eye exams with no copay, other eye exams with a copay up to $10, and no coinsurance. Eyewear is not covered, meaning contact lenses, eyeglasses, frames, lenses, and upgrades are not covered.
Dental Services See details
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) partially covers dental services with a $0 to $10 copay for Medicare-covered dental care, no copay for other covered services, and no coinsurance. Maxillofacial prosthetics and orthodontics are not covered under this plan, and some services are only available as optional supplemental benefits.
Home Infusion bundled Services See details
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) covers home infusion bundled services, including Part B chemotherapy, radiation, and other drugs with copays ranging from no copay to $47 and coinsurance from no coinsurance up to 20%. Covered Medicare Part B insulin drugs require a $7 to $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with a 20% coinsurance and no copay.
Medical Equipment See details
Medical Equipment is covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) and generally requires prior authorization. Durable medical equipment, prosthetic devices, and medical supplies have no copay and a coinsurance ranging from 0% to 20%, while diabetic supplies feature no copay and no coinsurance, and diabetic therapeutic shoes or inserts require a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with no coinsurance, though a doctor referral is required. There is no copay for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require a copay of up to $250.
Home Health Services See details
Home health services are covered by the Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) plan with no copay and no coinsurance, though a doctor referral is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered under Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) indicating some services are covered, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. As a result, there are no established copays or coinsurance rates for these excluded services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) with a doctor referral and no prior hospital stay requirement. The benefit is partially covered, offering no copay for days 1 to 20, a $100 daily copay for days 21 to 100, and no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO), with meal benefits and Dual Eligible SNPs excluded from coverage. Covered benefits include acupuncture and over-the-counter items with no copay or coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and non-Medicare medical supplies for 0% to 20% coinsurance and no copay.
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