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Kaiser Permanente Senior Advantage Basic Fresno (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic Fresno (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 Fresno (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic Fresno (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Greater Fresno Area 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 Fresno (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 Fresno (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 Fresno (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 $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 Fresno (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $18 copay at standard pharmacies and mail order, while preferred brand drugs have a $100 copay at standard pharmacies and mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also covers primary care, preventive, hearing, vision, and dental services, with copays ranging from $0 to $205. This plan provides additional benefits such as ambulance services, emergency services, and home health services, along with some coverage for medical equipment and prescription drugs. Other services such as skilled nursing facilities, and dialysis services are covered with copays and coinsurance, while some services like Cardiac Rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $260 copay for days 1-5, and no copay for days 6-90, as well as no coinsurance; additional days 91-999 have no copay and no coinsurance; however, Non-Medicare-covered Stay is not covered. For Inpatient Hospital Psychiatric, you will pay a $260 copay for days 1-5, and no copay for days 6-90, as well as no coinsurance; additional days 91-999 have no copay and no coinsurance; however, Non-Medicare-covered Stay is not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $205, observation services with a copay from $0 to $125, and ambulatory surgical center services with a $205 copay. Outpatient substance abuse services have a $5 copay for individual sessions and a $2 copay for group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan with no copay, and a doctor's referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, but 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 by the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $5 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $300 copay; all of these have no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the "Kaiser Permanente Senior Advantage Basic Fresno (HMO)" plan. Chiropractic Services and Other Health Care Professional require prior authorization and a doctor referral, while Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services require a referral. Primary Care Physician Services and Chiropractic Services have a $5 copay, Physician Specialist Services have a $10 copay, Occupational Therapy Services have a $5-$10 copay, Mental Health Specialty Services (individual sessions) have a $5 copay, and (group sessions) have a $2 copay, Other Health Care Professional has a $3-$10 copay, Psychiatric Services (individual sessions) have a $0-$5 copay, and (group sessions) have a $0-$2 copay, Physical Therapy and Speech-Language Pathology Services have a $0-$10 copay, and Additional Telehealth Benefits and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with a copay for Health Education, and Nutritional/Dietary benefits. Other services like in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams, and fitting/evaluation for hearing aids. Hearing exams have a $10 copay, while fitting/evaluation for hearing aids is an optional, supplemental benefit. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $10, with routine eye exams costing $5. 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 include coverage for Medicare Dental Services with a copay between $5 and $10, and Other Dental Services with a copay between $0 and $5. Oral exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services are covered. Periodontics is covered with no copay, 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, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $18 and $35. Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47, with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan. This plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment with coinsurance for Medicare-covered diabetic supplies and coinsurance for diabetic therapeutic shoes/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, and lab services, are covered under the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan. Diagnostic procedures and tests have no copay, while lab services have no copay. Diagnostic Radiological Services have a copay of at most $200, while therapeutic radiological services 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 Fresno (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 Basic Fresno (HMO) plan. A doctor referral is required to receive these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan covers acupuncture with a $5 copay, and over-the-counter items with a $60 maximum benefit every three months. The plan also covers Other 1 benefits with a $100 copay, and Other 2 benefits with 0% - 20% coinsurance. However, the plan does not cover meal benefits, Dual Eligible SNPs with Highly Integrated Services, and many other services listed.
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