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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 2026, 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 2026.
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 $19.00. 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 $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 offers enhanced alternative prescription drug coverage with no prescription drug deductible. During the initial coverage phase, you will pay a standard copay of $11 for Tier 1 preferred generics, $47 for Tier 2 standard generics, and $100 for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty tier drugs feature no copay at standard pharmacies. These cost-sharing rates apply until your total yearly drug costs reach $2,100. Once you cross this threshold, you enter the catastrophic coverage phase and will pay nothing for your covered Medicare Part D prescription drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan provides robust coverage with low, predictable cost-sharing for essential medical services. Inpatient hospital stays require a $230 daily copay for the first five days followed by no copay for additional covered days, while primary care and specialist consultations range from no copay to a $20 copay. Emergency room visits carry a $130 copay, which is waived upon hospital admission, and urgent care services require a $5 copay. Preventive care, diagnostic lab tests, and home health services are available with no copay or coinsurance, though diagnostic radiology can incur a copay up to $275. Basic dental and vision exams are covered with copays ranging from no copay up to $15, but routine eyewear and hearing aids are excluded from the plan. For specialized needs, dialysis and durable medical equipment require up to a 20% coinsurance with no copay, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) partially covers inpatient acute and psychiatric hospital services with a $230 daily copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance. While additional days and upgrades are covered, non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) covers outpatient services with no coinsurance, featuring a $215 copay for ambulatory surgical center services and copays from no copay up to $215 for outpatient hospital care. Observation services range from no copay to a $130 copay per stay, substance abuse sessions cost a $2 to $5 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO) with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO), which offers ground and air ambulance coverage with a $350 copay and no coinsurance per service. Non-emergency transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) covers emergency services with a $130 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $5 copay, with no coinsurance for either. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $5, and $350, respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) offers partially covered Primary Care benefits with no coinsurance, though podiatry services and routine chiropractic care are not covered. Covered services range from no copay for telehealth and opioid treatment to copays between $2 and $20 for primary care visits, specialist consultations, and therapy services.
Preventive Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) partially covers preventive services, offering annual physicals and screenings with no copay or coinsurance, and health education and nutrition benefits with a $0 to $5 copay and no coinsurance. Sub-services not covered include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) partially covers hearing services, featuring a $15 copay and no coinsurance for covered exams. While fitting and evaluation for hearing aids is covered as an optional supplemental benefit, routine hearing exams, OTC hearing aids, and prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO), which covers eye exams with a copay of $0 to $15 and no coinsurance. Eyewear is not covered under this plan, meaning contact lenses, eyeglasses, frames, lenses, and upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) partially covers dental services, excluding maxillofacial prosthetics and orthodontics. Covered Medicare dental services require a $5 to $15 copay and no coinsurance, while other covered dental services, adjunctive general services, and periodontics feature no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO), with cost sharing ranging from no copay to $47 and no coinsurance to 20% coinsurance depending on the drug. Specifically, chemotherapy and other Part B drugs require no copay to a $47 copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs have an $11 to $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic Stanis (HMO) plan with a 20% coinsurance and no copay. This coverage ensures Medicare beneficiaries have access to necessary kidney dialysis treatments with clear, structured cost-sharing.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, subject to prior authorization. DME and medical supplies carry a 0% to 20% coinsurance with no copay, while prosthetic devices and diabetic shoes require a 20% coinsurance with no copay. Diabetic supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO) with no coinsurance, though a doctor referral is required. There is no copay for diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services feature a copay ranging from $0 to $275.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) covers Home Health Services with no copay and no coinsurance, though a doctor referral is required for coverage.
Cardiac Rehabilitation Services See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation services. Because these services are not covered in practice, there are no plan-covered copays or coinsurance options available for patients.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic Stanis (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though a doctor referral is required. There is no copay for days 1 through 20 and a $100 daily copay for days 21 through 100, but additional days beyond Medicare-covered services are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Basic Stanis (HMO), excluding meal benefits and highly integrated services for dual-eligible SNPs. Covered benefits include acupuncture for a $5 copay and no coinsurance, OTC items with no copay or coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and non-Medicare medical supplies with no copay and 0% to 20% coinsurance.
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