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Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Greater Sac and Sonoma 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 Sr Advantage Basic Sac., Sonoma (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 Sr Advantage Basic Sac., Sonoma (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 Sr Advantage Basic Sac., Sonoma (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 $6000.00 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 Sr Advantage Basic Sac., Sonoma (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 example, you will pay a $18 copay for preferred generic drugs at a standard pharmacy. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $250 copay for days 1-5, with no copay for subsequent days, and outpatient services have copays ranging from $0 to $200. Emergency services have a $125 copay, waived if admitted to the hospital within 24 hours. This plan also provides benefits for primary care with a $5 copay, preventive services with no copay for annual exams, and dental services with copays between $0 and $15. Additional benefits include coverage for home health services with no copay, along with coverage for hearing and vision services. There are also other benefits like ambulance services, and skilled nursing facility services.
Inpatient Hospital See details
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $250 copay for days 1-5 and no copay for days 6-90. Additional days (91-999) have no copay. The plan also covers inpatient hospital psychiatric services with the same cost structure as inpatient hospital stays. Non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $200, observation services with a copay between $0 and $125, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services have a copay of $5 for individual sessions and $2 for group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan, and a doctor referral is required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by this plan, with a $125 copay and no coinsurance; however, the copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services have a $5 copay with no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered, with copays of $125, $5, and $300 respectively, and no coinsurance.
Primary Care See details
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan covers primary care physician services and chiropractic services with a $5 copay, and occupational therapy services with a $7-$15 copay. Physician specialist services have a $15 copay, while mental health specialty services range from no copay to a $5 copay for individual sessions and a $2 copay for group sessions. Additional telehealth benefits, individual psychiatric sessions, and group psychiatric sessions have no copay, and physical therapy and speech-language pathology services have a $0-$15 copay. Opioid Treatment Program Services have no copay. Other Health Care Professional services have a $3-$15 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay, while additional preventive services have varying copays. Health education has a copay between $0 and $5, and nutritional/dietary benefits have a copay between $0 and $5. Other services such as in-home safety assessments, personal emergency response systems, and several more are not covered.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $15 copay, but routine hearing exams are not covered. Fitting/evaluation for hearing aids and prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and routine eye exams with a $5 copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. Eyewear also requires a doctor's referral.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a copay between $5 and $15, and Other Dental Services with a copay between $0 and $10. Periodontics are 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, including Medicare Part B Insulin Drugs with a copay of $18-$35, and Medicare Part B Chemotherapy/Radiation Drugs with a copay of $0-$47 and 0-20% coinsurance. Other Medicare Part B Drugs are covered with a copay of $0-$47 and 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered items, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay between $10 and $240, Therapeutic Radiological Services with no copay, and Outpatient X-Ray Services with a $10 copay. A doctor's referral is required for all services.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (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 generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services are not covered. A doctor's referral is required, and copays may apply for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (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.
Other Services See details
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan covers acupuncture with a $5 copay, and also covers over-the-counter items with a maximum benefit of $60 every three months. Other services such as meal benefits, early and periodic screening, diagnostic, and treatment services, and others are not covered.
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