A non-government entity
Kaiser Permanente Senior Advantage Santa Cruz (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Santa Cruz (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 Santa Cruz (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Santa Cruz (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Santa Cruz County Plan. 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 Santa Cruz (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 Santa Cruz (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 Santa Cruz (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $88.00. 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:
Sign up for Kaiser Permanente Senior Advantage Santa Cruz (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 Senior Advantage Santa Cruz (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, members pay a $10 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brand drugs at standard pharmacies or through standard mail. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs are available with 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 Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can lower their plan premium and pay no drug costs.
Additional Benefits
The Kaiser Permanente Senior Advantage Santa Cruz (HMO) plan offers robust coverage with no copay and no coinsurance for primary care, mental health, telehealth, and preventive services. For specialized medical needs, specialist visits require a low copay of up to $15, while emergency room visits have a $130 copay that is waived if you are admitted. Outpatient hospital services and diagnostic tests are also highly affordable, featuring no coinsurance and copays that range from no copay up to $200. Inpatient hospital stays require a $230 daily copay for the first five days, with no copay for subsequent days, while home health services feature no copay or coinsurance. Dental and vision benefits are available with low to no copays, though routine eyewear and hearing aids are not covered under this plan. Additionally, beneficiaries pay no copay and up to 20% coinsurance for durable medical equipment and dialysis services.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) partially covers inpatient hospital services, excluding non-Medicare-covered stays for both acute and psychiatric care. Covered acute and psychiatric stays require a $230 daily copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) covers outpatient services with no coinsurance. Outpatient hospital services have a $0 to $200 copay, observation services have a $0 to $130 copay per stay, and ambulatory surgical center services require a $200 copay, while outpatient blood and substance abuse services have no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO) with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), with ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are available with no copay and no coinsurance, while worldwide emergency services require a $130 copay and worldwide emergency transportation requires a $250 copay, both with no coinsurance.
Primary Care See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) offers primary care, mental health, and telehealth services with no copay and no coinsurance. Specialist visits and therapy services have copays ranging from $0 to $15 with no coinsurance, while chiropractic services are partially covered (excluding routine care) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), featuring no copay and no coinsurance for covered benefits like annual physical exams and health education. Sub-services not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), offering covered exams with a $15 copay and no coinsurance, with fitting and evaluation available as an optional supplemental benefit. Routine exams and OTC hearing aids are not covered, and while prescription hearing aids are technically covered, some services are covered but all types, including inner ear, outer ear, and over the ear devices, are not covered.
Vision Services See details
Vision services are covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), offering routine eye exams with no copay and other eye exams with a $0 to $15 copay, both with no coinsurance. While eyewear is technically covered, some services are covered but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), featuring copays ranging from no copay to $15 and no coinsurance. While preventive, diagnostic, and restorative options are available, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) covers home infusion bundled services, including Medicare Part B insulin with a $10.00 to $35.00 copay and no coinsurance. For Medicare Part B chemotherapy, radiation, and other Part B drugs, cost sharing ranges from no copay to a $47.00 copay, and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Santa Cruz (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO) with prior authorization required. Beneficiaries will pay no copay for these benefits, with coinsurance ranging from 0% to 20% for durable medical equipment and medical supplies, a flat 20% coinsurance for prosthetics and diabetic shoes, and no coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), though a doctor referral is required. There is no coinsurance for these services, with no copay for lab services, diagnostic tests, outpatient X-rays, and therapeutic radiology, while diagnostic radiological services carry a copay of up to $200.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO) with no copay and no coinsurance. A doctor referral is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Kaiser Permanente Senior Advantage Santa Cruz (HMO), including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET). Since these services are not covered, there are no associated copays or coinsurance.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Santa Cruz (HMO) partially covers Skilled Nursing Facility (SNF) services with a doctor referral, requiring no copay and no coinsurance for days 1 through 20, and a $100 daily copay with no coinsurance for days 21 through 100. While the plan allows admissions with less than a three-day prior hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Santa Cruz (HMO), excluding meal benefits and Dual Eligible SNPs. Covered benefits include acupuncture and over-the-counter items with no copay or coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and select medical supplies for no copay and 0% to 20% coinsurance.
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