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Kaiser Permanente Senior Advantage Basic Kern (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic 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 Basic Kern (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic 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 - Basic. 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 Basic 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 Basic 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 Basic Kern (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 $2900.00 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 Basic Kern (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, Tier 1 drugs have a $10 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for 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 Basic Kern (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient hospital services, emergency services, primary care, and preventive services, often with no copay. The plan also includes hearing, vision, and dental services with varying copays, as well as coverage for home health, skilled nursing, and other services. Additionally, this plan covers ambulance services, diagnostic and radiological services, and medical equipment, along with other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $100 copay for days 1-5, and no copay for days 6-90, with no coinsurance, while additional days have no copay. For Inpatient Hospital Psychiatric, there is a $100 copay for days 1-5, and no copay for days 6-90, with no coinsurance, while additional days have no copay. Upgrades for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $50, observation services with a copay between $0 and $140, and outpatient blood services with no copay. Ambulatory Surgical Center (ASC) Services have a $50 copay, and Outpatient Substance Abuse services for individual and group sessions have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Basic Kern (HMO) plan with no copay. A doctor referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic Kern (HMO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Kaiser Permanente Senior Advantage Basic Kern (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Worldwide Emergency Transportation has a $250 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic Kern (HMO) plan covers primary care physician services, chiropractic services, and additional telehealth benefits with no copay. Occupational Therapy Services have a copay between $2 and $5, and a referral is required. Physician Specialist Services have a $5 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a copay of $0. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $5. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services such as Health Education, Nutritional/Dietary Benefit, Fitness Benefit, and Remote Access Technologies also have no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $5 copay, and fitting/evaluation for hearing aids, although this is an optional benefit with additional costs. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams, with a copay of $0-$5 for routine eye exams, and no copay for other eye exams; however, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. A doctor referral is required.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay between $0 and $5, Other Dental Services with no copay, Oral Exams (2 visits per year), Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), Fluoride Treatment (2 visits per year), Other Preventive Dental Services, Restorative Services with a copay between $36 and $124 (2 visits per year), Adjunctive General Services with a $58 copay, Periodontics with a copay between $0 and $71 (1 visit per 2 years), and Oral and Maxillofacial Surgery with a copay between $0 and $229 (3 visits per year). Endodontics, Prosthodontics (removable and fixed), Implant Services, and Orthodontic Services are offered as optional, supplemental benefits. 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 $10 and $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47 and a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, requiring a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies (non-Medicare benefit), and Diabetic Equipment, is covered. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral required. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $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 Basic Kern (HMO) plan. There is no copay and no coinsurance for this benefit, although Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but 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 are not covered. The copay for these services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Basic Kern (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Basic Kern (HMO) plan covers acupuncture with no copay, and Over-the-Counter (OTC) items with a maximum benefit of $50 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, and others are not covered.
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