Kaiser Permanente Senior Advantage San Diego (HMO)

Kaiser Permanente Senior Advantage San Diego (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in San Diego 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 San Diego (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 San Diego (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.

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:

Drug Coverage

The Kaiser Permanente Senior Advantage San Diego (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay a $10 copay for Tier 1 preferred generic drugs and a $47 copay for Tier 2 standard generic drugs at standard pharmacies and through standard mail. Tier 3 preferred brand drugs require a $100 copay, while there is no copay for Tier 5 specialty drugs at standard pharmacies. For Tier 4 non-preferred drugs, you will pay a 32% coinsurance at standard pharmacies and through standard mail. Once your yearly out-of-pocket drug costs exceed $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy will benefit from no premium for Part D.

Additional Benefits

The Kaiser Permanente Senior Advantage San Diego (HMO) plan offers comprehensive coverage with many essential services featuring no copay and no coinsurance, including primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a $170 daily copay for the first five days and no copay for additional days, with no coinsurance required. Emergency room visits require a $150 copay, while outpatient hospital services and diagnostic radiological tests feature copays ranging from no copay up to $200. Preventive dental care, routine eye exams, and hearing exams are covered with no copay, though routine eyewear and hearing aids are excluded from coverage. Durable medical equipment and dialysis services require no copay but are subject to a 0% to 20% coinsurance and a 20% coinsurance respectively. Additionally, skilled nursing facility stays require no copay for the first 20 days, and ambulance services are covered for a $300 copay with no coinsurance.