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Kaiser Permanente Senior Advantage Enhanced Stanis (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced Stanis (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 Stanis (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Stanislaus 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 Stanis (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 Stanis (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 Stanis (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $65.00. 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 $2500.00 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 Stanis (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy or a $47 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D 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 Enhanced Stanis (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, but many services have no copay, including primary care, preventive services, outpatient substance abuse, and mental health services. The plan also includes coverage for emergency services, hearing and vision services, and dental services with varying copays. Additional benefits include home health services with no copay, and coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Acute and Psychiatric services. For days 1-5 of inpatient acute or psychiatric care, the copay is $175, and days 6-90 have no copay. Additional days for both acute and psychiatric care (days 91-999) have no copay. Non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $110, observation services have a copay between $0 and $140, and ambulatory surgical center services have a $110 copay. Outpatient substance abuse services and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with no copay required. A doctor referral is needed to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan. Emergency Services has a $140 copay and no coinsurance, while Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with no copay, and Occupational Therapy Services with a $5-$10 copay. Physician Specialist Services have a $5 copay, and Mental Health Specialty Services, including individual and group sessions, have no copay. Other Health Care Professional services have a $0-$5 copay, and Psychiatric Services, including individual and group sessions, have no copay. Physical Therapy and Speech-Language Pathology Services have a $0-$10 copay, and Additional Telehealth benefits and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. The plan also covers additional preventive services like Health Education, Nutritional/Dietary Benefit, and Remote Access Technologies with no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several others are not covered.
Hearing Services See details
Hearing Services include a $5 copay for hearing exams, but fitting/evaluation for hearing aids and prescription hearing aids are not covered. OTC hearing aids are also not covered by this plan.
Vision Services See details
Vision services include eye exams with a copay between $0 and $5, with routine eye exams having no copay. Eyewear is partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare and other dental services. Medicare Dental Services have a copay between $0 and $5, while other dental services have no copay. Orthodontic Services are covered, and some services such as Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, the copay is $5-$35. For Medicare Part B Chemotherapy/Radiation Drugs, the copay is $0-$47, and there is a coinsurance between 0-20%. Other Medicare Part B Drugs have a copay of $0-$47, and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment includes 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, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay of at most $225, therapeutic radiological services with no copay, and outpatient X-ray services with no copay. A doctor's referral is required.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Enhanced Stanis (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 Stanis (HMO) plan. The plan does not cover any of the listed sub-services, including 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 by the Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $100 copay for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services", Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) covers acupuncture with no copay, and also covers over-the-counter items with a maximum benefit of $60 every three months. This plan does not cover meal benefits, and many other services are not covered.
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