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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 2025, 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 2025.
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 $0.00. 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, you'll pay a $12 copay for preferred generic drugs at a standard or mail-order pharmacy. For non-preferred drugs, you'll pay 33% coinsurance. The plan also offers a $0 copay for specialty tier drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs in the catastrophic coverage phase.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a $160 copay for the first 5 days, with no copay for the remaining days. Outpatient services, primary care, preventive services, and many other services have no copay, including mental health and chiropractic services. The plan includes coverage for ambulance services with a $200 copay and emergency services with a $125 copay. You'll also find coverage for vision and dental services, home health, and skilled nursing facilities, often with no copay. Dialysis services have 20% coinsurance, and some services like hearing aids and eyewear are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $160 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $160 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $85, observation services with a copay between $0 and $125, and ambulatory surgical center services with an $85 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 with a doctor referral and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan. Ground and Air Ambulance Services have a $200 copay, and there is no coinsurance. 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 under the Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Worldwide Emergency Transportation has a $200 copay. Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with a $0 copay), Occupational Therapy Services (with a $0 copay), Physician Specialist Services (with no copay), Mental Health Specialty Services (with a $0 copay for individual and group sessions), Other Health Care Professional, Psychiatric Services (with a $0 copay for individual and group sessions), Physical Therapy and Speech-Language Pathology Services (with no copay), Additional Telehealth Benefits (with no copay), and Opioid Treatment Program Services (with a $0 copay). Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay, while additional preventive services, kidney disease education services, and other preventive services are covered with no copay. Some services, such as in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services are covered, but routine hearing exams and prescription hearing aids are not covered. Fitting/evaluation for hearing aids has no copay, and there is no coinsurance.
Vision Services See details
Vision Services include eye exams with no copay, and a doctor referral is required. Eyewear is covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare Dental Services, Other Dental Services, Periodontics, and Oral and Maxillofacial Surgery. Oral exams are limited to 2 visits per year, while Dental X-Rays are limited to 1.
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, and coinsurance between 0% and 20%. For Other Medicare Part B Drugs, you will pay a copay between $0 and $47, and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 0% to 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 0% to 20% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not 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, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have no copay.
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. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of 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 for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $100 copay for days 21-100; there is no coinsurance.
Other Services See details
The Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit of $60 every three months. The plan does not cover meal benefits, and many additional services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services. Other 1 has a $100 copay, and Other 2 has a 0% - 20% coinsurance.
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