Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO)

Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Santa Clara County 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 Sr Adv Enhanced Santa Clara (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 Sr Adv Enhanced Santa Clara (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 Sr Adv Enhanced Santa Clara (HMO) plan offers 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 $7 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands at standard pharmacies or through standard mail. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs feature no copay at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, can reduce their costs to $0. Please check the plan formulary to confirm coverage for your specific prescription drugs.

Additional Benefits

The Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) plan provides comprehensive medical coverage with highly predictable costs, including no copay and no coinsurance for primary care visits, telehealth, and preventive services. Specialist visits require a low copay of up to $15, while emergency room visits carry a $150 copay that is waived if you are admitted to the hospital. For inpatient hospital care, members pay a $260 copay per day for days 1 through 5, with no copay for days 6 through 999. Ancillary benefits include no copay for home health care, routine eye exams, and preventive dental services, though certain advanced diagnostic radiological services require a copay of up to $275. Standard diagnostic lab tests, outpatient X-rays, acupuncture, and select over-the-counter items are also covered with no copay. Durable medical equipment and dialysis services feature no copay but require coinsurance ranging up to 20%.