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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 2025, 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 2025.
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 $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 Senior Advantage Basic Alameda (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $10 copay for preferred generic drugs at a standard or mail order pharmacy. For standard generic drugs, the copay is $47, while preferred brand drugs have a $100 copay. Non-preferred drugs will cost 33% coinsurance, and specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay after the first five days. Outpatient services and emergency services have copays, while primary care, preventive services, and home health services often have no copay or a small copay. This plan also covers hearing and vision services with copays, and dental services, including some optional restorative, adjunctive, and oral surgery services. Additional benefits include ambulance services with a $250 copay, and coverage for medical equipment, diagnostic services, and skilled nursing facilities, as well as various other services, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under this plan. For days 1-5, there is a $260 copay, and for days 6-90, there is no copay. Additional days for inpatient hospital acute and psychiatric care have no copay. Non-Medicare-covered stays for inpatient hospital acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $225, observation services with a copay between $0 and $125, and outpatient substance abuse services with a copay of $5 for individual sessions and $2 for group sessions. Ambulatory Surgical Center (ASC) Services have a $225 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan, with a doctor referral required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $5 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under this plan. Chiropractic services require a doctor referral and have a $5 copay, while Routine Chiropractic Care is not covered. Occupational Therapy Services have a $5-$10 copay, and Physician Specialist Services have a $10 copay. Mental Health Specialty Services have a $5 copay for individual sessions and a $2 copay for group sessions. Other Health Care Professional services require prior authorization and a doctor referral and have a $3-$10 copay. Psychiatric Services have a $0-$5 copay for individual sessions and a $0-$2 copay for group sessions. Physical Therapy and Speech-Language Pathology Services have a $0-$10 copay, while Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services including health education with a copay between $0 and $5, nutritional/dietary benefits with a copay between $0 and $5, and remote access technologies with no copay. Some preventive services, such as In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and more, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription Hearing Aids and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $5-$10, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams have a $5 copay.
Dental Services See details
Dental services include coverage for Medicare dental services, other dental services, and orthodontic services. Medicare dental services have a copay between $5 and $10, while other dental services have a copay between $0 and $5; Oral and Maxillofacial Surgery has a $5 copay. Restorative services, Adjunctive General Services, Endodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery are offered as optional, supplemental benefits. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, the copay ranges from $4.00 to $35.00. For Medicare Part B Chemotherapy/Radiation Drugs, the copay ranges from $0.00 to $47.00, and the coinsurance ranges from 0% to 20%. For Other Medicare Part B Drugs, the copay ranges from $0.00 to $47.00, and the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), which has a coinsurance of 0% to 20%, but does not cover DME for use outside the home, and Prosthetics/Medical Supplies, which has a coinsurance for Medicare-covered prosthetic devices and medical supplies. The plan also covers Diabetic Equipment, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have no copay, while Lab Services also have no copay. Diagnostic Radiological Services have a maximum copay of $200, while Therapeutic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Basic Alameda (HMO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Basic Alameda (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, while days 21-100 have a $100 copay; this plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
Other Services includes acupuncture with a $5 copay, over-the-counter (OTC) items with a maximum benefit of $60 every three months, and other services including DME and prosthetic/medical supplies not covered by Medicare that may have a 0% - 20% coinsurance. Meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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