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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 2026, 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 2026.
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 $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 $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 offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay a $10 copay for preferred generics and a $47 copay for standard generics at standard pharmacies. Preferred brands carry a $100 copay, non-preferred drugs require a 33% coinsurance, and specialty tier drugs have no copay at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for Extra Help can reduce their Part D premium to $0.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan offers affordable coverage for primary care visits with a $5 copay and specialist visits with a $25 copay, both with no coinsurance. For inpatient hospital stays, members pay a $325 daily copay for days 1 through 5, followed by no copay for days 6 through 999. Emergency care is accessible with a $130 copay, which is waived if admitted within 24 hours, while urgently needed services require a $5 copay. Many preventive services, diagnostic lab tests, and home health visits are available with no copay and no coinsurance. Outpatient surgery at ambulatory centers carries a $325 copay, while durable medical equipment ranges from no copay up to a 20% coinsurance. While routine vision exams have a low $5 copay, please note that eyewear, routine hearing exams, and transportation services are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO), excluding non-Medicare-covered stays for both acute and psychiatric hospitalizations. For covered stays, patients pay a $325 daily copay for days 1 through 5, followed by no copay for days 6 through 999, and there is no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers outpatient services with no coinsurance, including outpatient hospital visits ranging from no copay to $325 and ambulatory surgical center services at a $325 copay. Patients also pay no copay for outpatient blood services, $0 to $130 per stay for observation services, and $2 to $5 for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO) with no copay and no coinsurance. A doctor referral is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO), featuring a $350 copay and no coinsurance for both ground and air ambulance services. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $5 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $130, $5, and $350, respectively, and no coinsurance.
Primary Care See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers primary care visits for a $5 copay and specialist visits for a $25 copay, with no coinsurance. While telehealth and opioid treatment are covered with no copay, podiatry is not covered, and chiropractic care is only partially covered because routine chiropractic care is excluded.
Preventive Services See details
Preventive Services are partially covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO). Covered benefits like annual physicals, remote access technologies, and diabetes self-management training have no copay and no coinsurance, while health education, nutritional benefits, and kidney disease education require a $0 to $5 copay and no coinsurance. Uncovered sub-services include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, caregiver support, tobacco cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services under Kaiser Permanente Senior Advantage Basic Fresno (HMO) are partially covered, requiring a $25 copay and no coinsurance for exams, though routine hearing exams and OTC hearing aids are not covered. For prescription hearing aids, some services are covered, but all sub-services—including inner ear, outer ear, and over the ear devices—are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers eye exams with no deductible, no coinsurance, and a copay ranging from no copay to $25, including a $5 copay for routine exams. Eyewear is not covered under this plan, which includes contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO), featuring a copay of $5.00 to $25.00 with no coinsurance for Medicare dental services and no copay for other covered dental services. Maxillofacial prosthetics and orthodontics are not covered, and several services are offered as optional supplemental benefits which may require an additional fee.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers home infusion bundled services, featuring Part B insulin drugs with a $10 to $35 copay and no coinsurance. Medicare Part B chemotherapy, radiation, and other drugs are also covered under this benefit with copays ranging from no copay to $47 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan, with prior authorization required for most services. Durable medical equipment and medical supplies require no copay and no coinsurance to 20% coinsurance, prosthetic devices and diabetic shoes carry a 20% coinsurance and no copay, and diabetic supplies are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO) with a required doctor referral and no coinsurance. Diagnostic procedures, lab services, and therapeutic radiological services have no copay, while outpatient X-rays require a $5 copay and diagnostic radiological services have a copay ranging from $5 to $275.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic Fresno (HMO) covers home health services with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Basic Fresno (HMO) plan, meaning there is no copay or coinsurance coverage for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Kaiser Permanente Senior Advantage Basic Fresno (HMO) with a doctor referral, featuring no copay for days 1 to 20, a $150 daily copay for days 21 to 100, and no coinsurance. This benefit is partially covered, as 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 Fresno (HMO), as meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include acupuncture for a $5 copay, over-the-counter items with no copay, and residential substance use treatment for a $100 copay (all with no coinsurance), plus non-Medicare durable medical equipment and supplies for 0% to 20% coinsurance and no copay.
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