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Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic 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 Basic SnJoaq (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic 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 - 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 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 Basic 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 Basic SnJoaq (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.00. 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 $4400.00 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 SnJoaq (HMO) features an enhanced alternative drug benefit with no prescription drug deductible. For a 30-day supply at standard pharmacies or standard mail, you will pay a $10 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs have no copay at standard pharmacies. These copays and coinsurance rates apply during the initial coverage phase until your total drug costs reach $2,100.00. After reaching this threshold, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy can reduce their Part D premium to $0.00.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan provides robust medical coverage featuring no copays for primary care, telehealth, and annual preventive physicals. For inpatient hospital stays, members pay a $210 daily copay for the first five days, with no copay for additional covered days. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Outpatient services and diagnostic lab tests are highly accessible, requiring no coinsurance and often carrying no copay. Covered dental services, routine eye exams, and home health services also require no copay, while specialist visits require a low copay of up to $15. For specialized needs, durable medical equipment and dialysis services are covered with coinsurance ranging up to 20 percent.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) offers partially covered inpatient hospital services, excluding non-Medicare-covered stays for both acute and psychiatric care. For covered acute and psychiatric admissions, you will pay a $210 daily copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) with no coinsurance and copays ranging from $0 to $160. There is no copay or deductible for outpatient blood services, no copay for outpatient substance abuse sessions, a $160 copay for ambulatory surgical center services, and a copay of up to $130 per stay for observation services.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) partially covers ambulance and transportation services, featuring ground and air ambulance services with a $300 copay and no coinsurance. Transportation services to plan-approved health-related locations and transportation services to any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed care and worldwide urgent services are available with no copay, while worldwide emergency coverage has a $130 copay and worldwide emergency transportation requires a $300 copay, all with no coinsurance.
Primary Care See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) offers partially covered primary care benefits with no coinsurance, including no copay for primary care, telehealth, psychiatric, and mental health services. Copayments range from $0 to $15 for specialists, physical therapy, occupational therapy, and other healthcare professionals, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) provides partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physicals, health education, and glaucoma screenings. However, sub-services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, bathroom safety modifications, and counseling are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) partially covers hearing services, offering fitting and evaluation for hearing aids as an optional supplemental benefit. Covered hearing exams require a $15 copay and no coinsurance, while routine hearing exams, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) covers eye exams with a copay of $0 to $15 and no coinsurance, including routine eye exams with no copay. While eyewear is technically covered, some services are covered but contact lenses, eyeglasses, frames, lenses, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO), as maxillofacial prosthetics and orthodontics are not covered. Covered Medicare dental services require a $0 to $15 copay and no coinsurance, while other covered dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO), with chemotherapy, radiation, and other Part B drugs ranging from no copay to a $47 copay and no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require a $10 to $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Diabetic supplies are covered with no copay, while DME, medical supplies, prosthetics, and diabetic shoes range from no coinsurance to 20% coinsurance with no copays.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) covers diagnostic and radiological services with a required doctor referral. There is no coinsurance for these benefits, and you will pay no copay for diagnostic tests, lab services, therapeutic radiology, and outpatient x-rays, while diagnostic radiological services require a copay of up to $275.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan with no copay and no coinsurance, though a doctor referral is required for coverage.
Cardiac Rehabilitation Services See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) states that some services are covered for Cardiac Rehabilitation Services with a doctor referral, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. As these specific services are not covered, there are no copay or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) covers Skilled Nursing Facility (SNF) care with a doctor referral and does not require a prior three-day inpatient hospital stay. You will pay no copay and no coinsurance for days 1 through 20, and a $100 daily copay with no coinsurance for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Basic SnJoaq (HMO), featuring acupuncture and over-the-counter items with no copay and no coinsurance, alongside residential substance use treatment for a $100 copay and no coinsurance. Additionally, non-Medicare medical supplies and durable medical equipment are covered with no copay and a 0% to 20% coinsurance, while meal benefits and dual-eligible SNP services are not covered.
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