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Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced SnJoaq (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 SnJoaq (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in San Joaquin 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 SnJoaq (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 SnJoaq (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 SnJoaq (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.00. 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 SnJoaq (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. The copay depends on the drug tier and the pharmacy you use. For instance, you will pay a $6.00 copay for preferred generic drugs at a standard or mail pharmacy. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan offers a variety of benefits with varying costs. You can expect no copay for many services, including primary care visits, outpatient substance abuse services, preventive services, hearing exams, eye exams, dental services, and home health services. However, some services like inpatient hospital stays and ambulance services have copays, and some services may have coinsurance, such as dialysis services and some medical equipment. This plan covers inpatient and outpatient services, including emergency and hearing services, and offers coverage for home infusion, and skilled nursing facilities. Additionally, the plan provides coverage for a range of other services, including acupuncture and over-the-counter items, with some limitations and exclusions.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays. For acute stays, you will pay a $125 copay for days 1-5, and no copay for days 6-90, while additional days (91-999) have no copay; upgrades are also covered. For psychiatric stays, you will pay a $125 copay for days 1-5, and no copay for days 6-90, while additional days (91-999) have no copay. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $75, observation services with a copay between $0 and $140, and ambulatory surgical center services with a $75 copay. Outpatient substance abuse services, including individual and group sessions, have no copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) with no copay and a doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan. Ground and Air Ambulance Services have a $200 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 has a $140 copay, Urgently Needed Services has no copay, and Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage, no copay for Worldwide Urgent Coverage, and a $200 copay for Worldwide Emergency Transportation.
Primary Care See details
The Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan offers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and additional telehealth benefits have no copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $0 copay for individual and group sessions. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services are covered, including Health Education, with no copay. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 are not covered. Nutritional/Dietary Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services are partially covered by the Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan. Hearing exams have no copay, but routine hearing exams are not covered; fitting/evaluation for hearing aids is covered, but is an optional, supplemental benefit.
Vision Services See details
Vision services include eye exams with 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 are covered, with no copay for Medicare Dental Services, Other Dental Services, Periodontics, and Oral and Maxillofacial Surgery, though Oral Exams are limited to 2 visits per year and Dental X-Rays are limited to 1 set of bitewings every 6 months. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan. Medicare Part B Insulin Drugs have a copay of $6 to $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0 to $47 with a coinsurance of 0% to 20%. Other Medicare Part B Drugs have a copay of $0 to $47 with a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan. You will pay a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, and Diabetic Equipment with a coinsurance for Medicare-covered supplies and a copay for therapeutic shoes or inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Lab Services and Outpatient X-Ray Services have no copay, while Diagnostic Radiological Services have a copay of up to $150.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Enhanced SnJoaq (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 SnJoaq (HMO) plan. Doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
The Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO) plan covers acupuncture with no copay, and over-the-counter (OTC) items with a maximum benefit of $60 every three months. Other services include 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. The plan does not cover meal benefits, 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, 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.
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