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Kaiser Permanente Senior Advantage Enhanced Kern (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced Kern (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 Enhanced Kern (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Kern County Plan - Enhanced. 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 Enhanced Kern (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 Enhanced Kern (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 Enhanced Kern (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $1500.00 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 Enhanced Kern (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at standard pharmacies, while non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D premium is $11.10.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a $50 copay for the first five days, and no copay for the remainder of the stay. Outpatient services, primary care, preventive services, hearing, vision, and dental services have no copay. This plan also covers ambulance services with a $200 copay, emergency services with a $140 copay, and home health services with no copay. Additionally, the plan provides coverage for medical equipment, diagnostic and radiological services, and dialysis services. There is a copay for prescription drugs, and for some dental and outpatient services.
Inpatient Hospital See details
Inpatient Hospital care, including acute and psychiatric, is covered, but a doctor's referral is required. For inpatient hospital acute care, you will pay a $50 copay for days 1-5, and no copay for days 6-90. For inpatient hospital psychiatric care, you will pay a $50 copay for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric inpatient hospital stays have no copay. Non-Medicare-covered stays for both acute and psychiatric inpatient hospitals are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $20, observation services with a copay between $0 and $140, ambulatory surgical center (ASC) services with a $20 copay, and outpatient substance abuse services with no copay for individual and group sessions. Outpatient blood services are covered with no copay and a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan with no copay. A doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for Medicare-covered ground and air ambulance services with a $200 copay, but transportation services to any health-related location are not covered. There is no coinsurance for any of these services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have no copay, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay, but routine chiropractic care is not covered. Occupational Therapy Services have no coinsurance, but have a copay of $0.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services, including health education, nutritional/dietary benefits, fitness benefits, and remote access technologies, with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are also covered with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while fitting/evaluation for hearing aids is covered with no copay. Prescription hearing aids are covered with a maximum benefit of $1,000 every three years for all types, however, Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with no copay, and eyewear with a combined maximum benefit of $250 every two years. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services, Other Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics. Medicare Dental Services and Other Dental Services have no copay. Restorative Services have a copay between $36 and $124, while 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. Endodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan. Medicare Part B Insulin Drugs have a copay of $5 to $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0 to $47, with a coinsurance between 0% and 20%. Other Medicare Part B Drugs may have a copay of $0 to $47, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under this plan, and a doctor referral is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and a coinsurance, and Diabetic Equipment with a coinsurance and copay, and Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan. Diagnostic Procedures/Tests have no copay, while 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 by the Kaiser Permanente Senior Advantage Enhanced Kern (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 Enhanced Kern (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. You will have no copay for days 1-20, and a $100 copay for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Enhanced Kern (HMO) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit of $120 every three months. Other services covered include Residential Substance Use Disorder and MH Treatment with a $50 copay, and DME and Prosthetic/Medical Supplies with 0-20% coinsurance.
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