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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 2026, 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 2026.
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 $85.00. 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 features an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to begin immediately. During the initial coverage phase, standard retail and mail-order prescriptions cost 7 dollars for preferred generics, 47 dollars for standard generics, and 100 dollars for preferred brands. Non-preferred drugs require a 33 percent coinsurance, while specialty tier drugs have no copay at standard pharmacies. These cost-sharing rates apply until your total drug costs reach 2,100 dollars. Once you reach this 2,100 dollar out-of-pocket threshold, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D premium costs to zero dollars.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan offers comprehensive coverage for essential medical needs with low out-of-pocket costs. Members benefit from no copay and no coinsurance for primary care, telehealth, mental health services, and routine preventive care. Inpatient hospital stays require a $175 daily copay for the first five days, with no copay for subsequent days, while emergency room visits carry a $150 copay that is waived upon hospital admission. This plan also features strong coverage for supplemental care, including dental services with copays of $5 or less and diagnostic lab tests with no copay. Skilled nursing facility stays require no copay for the first 20 days and a $100 daily copay for days 21 to 100. Additionally, durable medical equipment and home health services are covered with no copay, though some medical equipment may require up to 20% coinsurance.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) partially covers inpatient hospital services, excluding non-Medicare-covered stays for both acute and psychiatric care. Covered inpatient acute and psychiatric stays require a $175 daily copay for days 1 to 5, with no copay for days 6 to 999 and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) with no coinsurance, featuring copays of $0 to $140 for outpatient hospital services and $0 to $150 per stay for observation services. Additionally, ambulatory surgical center services require a $140 copay, while outpatient blood and substance abuse services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) with no copay and no coinsurance, though a doctor referral is required.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) partially covers Ambulance and Transportation Services, with covered ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are covered with no copay and no coinsurance, while worldwide emergency coverage and emergency transportation require copays of $150 and $250, respectively, with no coinsurance.
Primary Care See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) covers primary care, telehealth, mental health, psychiatric, and opioid treatment services with no copays and no coinsurance. Physical, occupational, speech, and specialist services are covered with copays ranging from $0 to $10 and no coinsurance, while chiropractic services are partially covered (routine care is not covered) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) with no copays and no coinsurance for covered benefits like annual physical exams and kidney disease education. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO), featuring a $5 copay and no coinsurance for covered services. While fitting and evaluation for hearing aids is covered as an optional supplemental benefit, routine hearing exams, prescription hearing aids, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO), which features eye exams with no coinsurance, no deductible, and a copay of $0 to $5, including no copay for routine exams. Eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades, is not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) partially covers dental services with no coinsurance and copays ranging from no copay up to $5.00. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) covers home infusion bundled services, including Medicare Part B chemotherapy, radiation, and other drugs with costs ranging from no copay to a $47.00 copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are also covered with a $7.00 to $35.00 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, though prior authorization is required. Durable medical equipment and medical supplies carry no copay and 0% to 20% coinsurance, prosthetic devices and diabetic shoes require no copay and 20% coinsurance, and diabetic supplies have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) covers diagnostic and radiological services with a required doctor referral and no coinsurance. Diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays have no copay, while diagnostic radiological services require a copay of up to $225.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) with no copay and no coinsurance, though a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered under Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) where some services are covered; however, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice, resulting in no copays or coinsurance for these excluded options.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. With a doctor referral, patients pay no copay for days 1 to 20, a $100 daily copay for days 21 to 100, and no coinsurance.
Other Services See details
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) partially covers other services, offering acupuncture and over-the-counter items with no copay or coinsurance, and non-Medicare medical supplies with no copay and 0% to 20% coinsurance. Residential substance use and mental health treatments are covered with a $100 copay and no coinsurance, while meal benefits and highly integrated SNP services are not covered.
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