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Kaiser Permanente Senior Advantage Basic Stanis (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic 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 Basic Stanis (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic 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 - Basic. 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 Basic 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 Basic 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 Basic Stanis (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $4900.00 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 Basic Stanis (HMO) plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $12 copay at standard and mail order pharmacies. For non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, but no copay for most days. Outpatient services, primary care, and preventive services often have copays, while some services like home health and specific diagnostic tests have no copay. This plan covers emergency services, hearing and vision exams, and dental services with copays, along with ambulance and dialysis services. Additionally, the plan includes benefits like home infusion services, durable medical equipment, and skilled nursing facility stays with specific cost-sharing structures.
Inpatient Hospital See details
The Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan covers inpatient hospital stays, including acute and psychiatric care, with a $230 copay for days 1-5 and no copay for days 6-90. Additional days for acute and psychiatric care have no copay. Upgrades for inpatient hospital-acute are also covered. Non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay of $0-$165, observation services with a copay of $0-$125, ambulatory surgical center (ASC) services with a $165 copay, outpatient substance abuse services with a $5 copay for individual sessions and a $2 copay for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. A doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan. Both ground and air ambulance services have a $300 copay, with no coinsurance, while 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $5 copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan covers primary care physician services and chiropractic services with a $5 copay, physician specialist services with a $10 copay, and occupational therapy services with a $5 - $10 copay. Mental health specialty services have a $5 copay for individual sessions and a $2 copay for group sessions. Other health care professionals have a $3 - $10 copay, while individual psychiatric sessions have no copay and group sessions have a $0 - $2 copay. Physical therapy and speech-language pathology services have a $0 - $10 copay. Additional telehealth benefits and opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive services include Medicare-covered services, annual physical exams with no copay, and additional preventive services which include Health Education with a copay between $0 and $5, and Nutritional/Dietary Benefits with a copay between $0 and $5. This plan does not cover In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services. This plan covers Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$10 for routine eye exams, and no deductible. Eyewear is not covered, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a copay of $5-$10, and Other Dental Services with a copay of $0-$5. Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, and Oral Exams are covered, and Oral and Maxillofacial Surgery is covered with a $5 copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a copay between $12 and $35. For Medicare Part B Chemotherapy/Radiation Drugs, you will pay a copay between $0 and $47, with coinsurance between 0% and 20%. For Other Medicare Part B Drugs, you will pay a copay between $0 and $47, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic 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 of 0% to 20%, and Prosthetics/Medical Supplies and Diabetic Equipment, both of which are covered. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have no copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Basic 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 covered, but not in practice, as 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 are not covered. A doctor's referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $5 copay, over-the-counter (OTC) items with a maximum benefit of $60 every three months, and other services, including Residential Substance Use Disorder and MH Treatment with a $100 copay and DME and Prosthetic/Medical Supplies not covered by Medicare with 0% - 20% coinsurance. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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