A non-government entity
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 2026, 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 2026.
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 $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 $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:
Sign up for Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay a $10 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brand-name drugs at standard pharmacies or through standard mail. Non-preferred drugs require a 32% coinsurance, while specialty tier drugs feature no copay at standard pharmacies. These copays and coinsurance rates apply until your yearly out-of-pocket drug costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Furthermore, individuals who qualify for Extra Help or the low-income subsidy can reduce their Part D premium to zero.
Additional Benefits
The Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan offers affordable coverage for core medical needs, featuring a $5 copay for primary care visits, a $30 copay for specialists, and no coinsurance. If you require hospital care, inpatient stays have a $375 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $130 copay. Outpatient services, diagnostic lab tests, and x-rays are also highly accessible, with many of these services requiring low copays and no coinsurance. Many essential benefits under this plan require no copay and no coinsurance, including most preventive services, home health care, and diabetic supplies. While Medicare-covered dental and vision exams are available with low copays, it is important to note that routine eyewear, hearing aids, and transportation services are not covered. For specialized care like dialysis and durable medical equipment, members should expect up to a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO), requiring a $375 daily copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance. Non-Medicare-covered stays for both acute and psychiatric inpatient hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) with no coinsurance and copays ranging from no copay for blood services up to $325 for ambulatory surgical center and outpatient hospital services. Additionally, observation services carry a copay of up to $130 per stay, while outpatient substance abuse sessions require a copay of $2 to $5.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) partially covers Ambulance and Transportation Services, as transportation services to health-related locations are not covered. Covered ground and air ambulance services require a $350 copay and have no coinsurance.
Emergency Services See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgent care with a $5 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with copays of $130, $5, and $350, respectively, and no coinsurance.
Primary Care See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers primary care visits with a $5 copay and specialist visits with a $30 copay, with no coinsurance. Telehealth, mental health, and therapy services are also covered with copays ranging from no copay to $20, though podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO), offering most services like annual exams and screenings with no copay and no coinsurance, though kidney, health, and nutritional education require a $0 to $5 copay and no coinsurance. Excluded services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management programs, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO), which offers hearing exams with a $30 copay and no coinsurance, though routine hearing exams and OTC hearing aids are not covered. Additionally, while some prescription hearing aid services are covered, in practice all sub-services, including inner ear, outer ear, over the ear, and all other prescription hearing aid types, are not covered.
Vision Services See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers eye exams with a copay ranging from no copay to $30 (including a $5 copay for routine exams) and no coinsurance, though a doctor referral is required. Eyewear benefits are not covered, which includes contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO), with a $5 to $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers home infusion bundled services, including Part B chemotherapy, radiation, and other Part B drugs with no copay to a $47 copay and no coinsurance up 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 Sr Advantage Basic Sac., Sonoma (HMO) with a 20% coinsurance and no copay.
Medical Equipment See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers durable medical equipment and medical supplies with 0% to 20% coinsurance and no copay, while prosthetic devices and diabetic shoes require a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) with no coinsurance, though doctor referrals are required. There is no copay for diagnostic tests, lab services, and therapeutic radiological services, while outpatient X-rays require a $30 copay and diagnostic radiological services have a copay ranging from $30 to $275.
Home Health Services See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) covers Home Health Services with no copay and no coinsurance, although a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) plan. Although the plan indicates some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) partially covers Skilled Nursing Facility (SNF) services, which require a doctor referral and exclude additional days beyond Medicare-covered SNF care. Covered stays feature no copay and no coinsurance for days 1 through 20, and a $150 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO), with meal benefits and Dual Eligible SNPs being excluded from coverage. Covered services include acupuncture for a $5 copay and no coinsurance, residential substance use treatment for a $100 copay and no coinsurance, select non-Medicare medical supplies for no copay and 0% to 20% coinsurance, and over-the-counter items with no copay or coinsurance (excluding Naloxone).
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved