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Kaiser Permanente Senior Advantage Ventura (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Ventura (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 Ventura (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Ventura (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Ventura County Plan. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Ventura (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 Ventura (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 Ventura (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 $1999.00 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 Ventura (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Ventura (HMO) plan offers a range of benefits with varying costs. You'll find no copays for many services, including primary care, preventive services, outpatient services, and home health. However, you can expect copays for inpatient hospital stays, emergency services, ambulance services, and some outpatient services. The plan also covers services like home infusion, dialysis, and medical equipment, with costs varying based on the specific service. While some dental and vision services are covered, certain services like hearing aids, cardiac rehabilitation, and additional hours of care are not covered by this plan.
Inpatient Hospital See details
The Kaiser Permanente Senior Advantage Ventura (HMO) plan covers inpatient hospital services, including acute and psychiatric care, with a doctor referral required. For inpatient hospital acute and psychiatric stays, you'll pay a $90 copay for days 1-5, and no copay for days 6-90; additional days for both acute and psychiatric stays have no copay. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, ambulatory surgical center services, and outpatient blood services have no copay. Observation services have a copay of $0-$140, and outpatient substance abuse services have no copay for individual or group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Ventura (HMO) plan, and requires a doctor's referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Ventura (HMO) plan. 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. Emergency Services have a $140 copay with no coinsurance, Urgently Needed Services have no copay and no coinsurance, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $200 copay, all with no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Occupational Therapy Services, Other Health Care Professional, and Opioid Treatment Program Services have a $0 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with no copay.
Hearing Services See details
Hearing Services are covered by the Kaiser Permanente Senior Advantage Ventura (HMO) plan, but routine hearing exams and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. Fitting/evaluation for hearing aids is covered, but may require additional payment.
Vision Services See details
Vision Services include routine eye exams with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare Dental Services and Other Dental Services. Restorative Services have a copay between $36 and $124, Adjunctive General Services have a $58 copay, Periodontics have a copay between $0 and $71, and Oral and Maxillofacial Surgery has a copay between $0 and $229. 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 with a copay of $5-$35, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $0-$47, and Other Medicare Part B Drugs with a copay of $0-$47 and a coinsurance of 0%-20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered under the Kaiser Permanente Senior Advantage Ventura (HMO) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $200, Therapeutic Radiological Services have no copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Ventura (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 not covered by the Kaiser Permanente Senior Advantage Ventura (HMO) plan. A doctor referral is required for this benefit, but the services themselves are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Ventura (HMO) plan, but require prior authorization and a doctor referral. There is no copay for days 1-20, and a $100 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF 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 of $50 every three months. This plan also covers "Other 1" benefits with a $90 copay, and "Other 2" benefits with 0-20% coinsurance, while meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other additional services are not covered.
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