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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 2026, 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 2026.
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:
Sign up for Kaiser Permanente Senior Advantage Ventura (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Ventura (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. For a 30-day supply at standard pharmacies or through standard mail, you will pay a $7 copay for Tier 1 preferred generics, a $47 copay for Tier 2 standard generics, and a $100 copay for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty drugs have no copay at standard pharmacies. These initial coverage costs apply until your total drug costs reach $2,100. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Ventura (HMO) provides comprehensive health coverage with no copay and no coinsurance for inpatient hospital stays, primary care visits, and annual preventive exams. Outpatient services, diagnostic laboratory tests, and urgent care visits also feature no copay, while emergency room visits require a $150 copay that is waived upon hospital admission. For specialized treatments, home health visits and basic preventive dental care are covered at no cost, though dialysis requires a 20% coinsurance. Durable medical equipment and prosthetic devices are covered with no copay and a coinsurance ranging from 0% to 20%, while diabetic supplies have no copay. Skilled nursing facility care is available with no copay for the first 20 days, followed by a $100 daily copay for days 21 through 100. Additionally, members can access acupuncture and an over-the-counter benefit of $50 every three months with no copay, though routine eyewear and transportation services are not covered.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Ventura (HMO) partially covers inpatient hospital services, offering acute and psychiatric hospital stays with no copay and no coinsurance with a doctor referral. Non-Medicare-covered stays for both acute and psychiatric inpatient care are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers outpatient services with no coinsurance, offering no copay for outpatient hospital, ambulatory surgical center, outpatient blood, and substance abuse services. Outpatient observation services are also covered with no coinsurance and a copay ranging from $0 to $150 per stay.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Ventura (HMO), offering ground and air ambulance services for a $225 copay and no coinsurance. However, transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are available with no copay and no coinsurance, while worldwide emergency services and worldwide emergency transportation require copays of $150 and $225, respectively, with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Senior Advantage Ventura (HMO) with no copay and no coinsurance for covered services such as doctor visits, mental health, and physical therapy. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage Ventura (HMO) with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and health education. However, sub-services such as 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 tobacco cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) offers partially covered hearing services with no copay and no coinsurance for covered exams like hearing aid fitting and evaluations. While some prescription hearing aid services are covered, specific sub-services—including inner ear, outer ear, over the ear, and all other prescription types—along with routine hearing exams and OTC hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Ventura (HMO), requiring a doctor referral for eye exams which feature no copay and no coinsurance. However, eyewear is not covered, including contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) partially covers dental services with no copay and no coinsurance, although maxillofacial prosthetics and orthodontics are not covered. Basic preventive care like oral exams and cleanings are covered at no cost, while advanced procedures like implants, endodontics, and restorative services are offered as optional supplemental benefits that may require additional fees.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers home infusion bundled services, including Medicare Part B insulin drugs with a $7.00 to $35.00 copay and no coinsurance. Chemotherapy, radiation, and other Part B drugs are also covered with copayments ranging from no copay up to $47.00 and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Ventura (HMO) plan with no copay and a 20% coinsurance. A doctor referral is required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers medical equipment, including durable medical equipment and medical supplies, with 0% to 20% coinsurance and no copay. Prosthetic devices and diabetic therapeutic shoes require a 20% coinsurance and no copay, while diabetic supplies feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers diagnostic and radiological services with a doctor referral and no coinsurance. Diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays have no copay, while diagnostic radiological services require a copay of up to $240.
Home Health Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) covers Home Health Services with no copay and no coinsurance, although a doctor referral is required.
Cardiac Rehabilitation Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) technically covers cardiac rehabilitation services, but in practice some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Since these specific services are not covered by the plan, there are no copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Kaiser Permanente Senior Advantage Ventura (HMO), requiring a doctor referral and featuring no coinsurance. Covered services require no copay for days 1 through 20 and a $100 daily copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Ventura (HMO) partially covers other services, offering acupuncture, residential substance use treatment, and over-the-counter items up to $50 every three months for no copay and no coinsurance. Non-Medicare durable medical equipment is covered with no copay and 0% to 20% coinsurance, while meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered.
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