Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)

Kaiser Permanente Senior Advantage Enhanced Fresno (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Greater Fresno Area Plan - Enhanced. 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 Enhanced Fresno (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 Fresno (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 Enhanced Fresno (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy and mail-order costs include an $8 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands. Additionally, non-preferred drugs require a 33% coinsurance, while specialty tier drugs feature no copay. If you qualify for low-income subsidy Extra Help, your Part D premium is reduced to $20.50. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs.

Additional Benefits

The Kaiser Permanente Senior Advantage Enhanced Fresno (HMO) plan offers robust coverage for everyday medical needs, featuring no copay for primary care visits, telehealth, and urgently needed services. Specialist visits, dental care, and routine vision exams are highly affordable, requiring low copays of fifteen dollars or less. For emergency and hospital care, emergency room visits require a one hundred fifty dollar copay, while inpatient hospital stays have a daily copay of two hundred thirty dollars for the first five days and no copay for subsequent days. Diagnostic labs, outpatient X-rays, and home health services are fully covered with no copay or coinsurance, though advanced diagnostic imaging may require a copay up to two hundred seventy-five dollars. While routine hearing aids and prescription eyewear are not covered, members benefit from no copay on over-the-counter items and acupuncture. Additionally, diabetic supplies are covered with no copay, whereas durable medical equipment and dialysis services generally require a twenty percent coinsurance.