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Kaiser Permanente Senior Advantage Basic Alameda (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic Alameda (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 Alameda (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic Alameda (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Alameda 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 Senior Advantage Basic Alameda (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 Alameda (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 Alameda (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 Senior Advantage Basic Alameda (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs when using standard pharmacies or standard mail. For other prescription tiers, standard 30-day supplies cost a $35 copay for Tier 2 standard generics, a $90 copay for Tier 3 preferred brands, and 30% coinsurance for Tier 4 non-preferred drugs. These cost-sharing rates apply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach this $2,100.00 limit, you enter the catastrophic coverage phase and pay nothing for your covered Medicare Part D prescription drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Alameda (HMO) offers comprehensive medical coverage featuring low, predictable copays and no coinsurance for many core services. Inpatient hospital stays require a $290 copay for days 1 through 5 and no copay thereafter, while outpatient services range from no copay up to $240. Additionally, primary care visits cost up to a $25 copay, preventive services have no copay, and emergency room visits require a $130 copay. This plan also partially covers specialty care, including dental and vision exams with copays starting at $5 and hearing exams for a $20 copay, though eyewear and hearing aids are excluded. Skilled nursing facility care is covered with no copay for the first 20 days, and home health services require no copay. For durable medical equipment, members pay no copay and up to 20% coinsurance, while dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), as non-Medicare-covered acute and psychiatric stays are not covered. Covered inpatient stays require a $290 copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) covers outpatient services with no coinsurance and copays ranging from no copay up to $240. Outpatient hospital services require no copay to $240, ambulatory surgical center visits have a $240 copay, observation stays cost no copay to $130, substance abuse sessions cost $2 to $5, and blood services have no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO) with no copay and no coinsurance. A doctor referral is required to access this coverage.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), requiring a $350 copay and no coinsurance for both ground and air ambulance services. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic Alameda (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 require a $5 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $5, and $350, respectively.
Primary Care See details
Primary care benefits are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), featuring no coinsurance and copays ranging from no copay up to $25 for covered services. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) covers many preventive services, including annual physicals and glaucoma screenings, with no copay and no coinsurance. While some supplemental health and nutritional benefits require a copay of up to $5, other services like weight management, massage, and in-home safety assessments are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) partially covers hearing services with a $20 copay and no coinsurance or deductible for covered exams. Fitting and evaluation for hearing aids is covered, but routine hearing exams and OTC hearing aids are not covered; for prescription hearing aids, some services are covered but all types, inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), which offers eye exams with no coinsurance and copays ranging from no copay to $20, including a $5 copay for routine exams. Eyewear is not covered by the plan, meaning contact lenses, eyeglasses, lenses, frames, and upgrades are excluded from coverage.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), offering Medicare-covered dental care with a $5 to $20 copay and other covered services with no copay and no coinsurance. While preventive care is included, some services like orthodontics and maxillofacial prosthetics are not covered, and other treatments are only available as optional supplemental benefits for an additional fee.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) covers home infusion bundled services, including Part B chemotherapy, radiation, and other drugs with no copay to a $47 copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are also covered with a $10 to $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. Members pay no copay and 0% to 20% coinsurance for DME and medical supplies, 20% coinsurance and no copay for prosthetics and diabetic shoes, and no copay or coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Basic Alameda (HMO) covers diagnostic and radiological services with no coinsurance, though doctor referrals are required. There is no copay for diagnostic procedures, lab services, and therapeutic radiological services, while outpatient X-rays require a $15 copay and diagnostic radiological services have a copay ranging from $15 to $275.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO) with no copay and no coinsurance. A doctor referral is required to receive these covered medical services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan, meaning there is no benefit coverage, copay, or coinsurance for any of the rehabilitation sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO) with a doctor referral, excluding additional days beyond the Medicare-covered limit. There is no copay or coinsurance for days 1 through 20, followed by a $150 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO), excluding meal benefits and dual eligible SNPs. Covered benefits include acupuncture for a $5 copay and no coinsurance, OTC items with no copay or coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and supplemental DME with no copay and 0% to 20% coinsurance.
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