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Kaiser Permanente Senior Advantage Basic SF (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic SF (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 SF (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic SF (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in San Francisco 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 SF (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 SF (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 SF (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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 SF (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, a standard generic drug has a $18 copay, while a preferred brand drug has a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, your premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Kaiser Permanente Senior Advantage Basic SF (HMO) plan offers a range of benefits, including inpatient hospital stays with a $310 copay for days 1-5, and no copay for days 6-999. Outpatient services have copays ranging from $0 to $255, and emergency services have a $125 copay. Primary care, preventive services, and home health services are covered, with varying copays. The plan also covers hearing and vision services with copays, dental services, and medical equipment, with a coinsurance for some services. Additional benefits include ambulance services with a $350 copay, and skilled nursing facility services. Other benefits include acupuncture and coverage for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $310 copay for days 1-5, and no copay for days 6-90, and no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-5, and no copay for days 6-90, and no copay for days 91-999. 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 $255, observation services with a copay between $0 and $125, and ambulatory surgical center services with a $255 copay. Outpatient substance abuse services include individual sessions with a $10 copay and group sessions with a $5 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Basic SF (HMO) plan, with no copay required. A doctor's referral is necessary to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan. Ground and air ambulance services have a $350 copay, with no coinsurance, but 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. Emergency Services have a $125 copay, Urgently Needed Services have a $10 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $10 copay, and Worldwide Emergency Transportation has a $350 copay; all services have no coinsurance.
Primary Care See details
Primary Care includes coverage for 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. 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 all have a copay, while Chiropractic Services requires prior authorization and a doctor referral, and Individual Sessions for Psychiatric Services have a copay between $0 and $10, and Group Sessions for Psychiatric Services have a copay between $0 and $5.
Preventive Services See details
Preventive services include annual physical exams with no copay, Health Education with a copay between $0 and $10, Nutritional/Dietary Benefits with a copay between $0 and $10, and Remote Access Technologies with no copay. Other services like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing services include hearing exams and fitting/evaluation for hearing aids. Hearing exams have a $15 copay, and fitting/evaluation for hearing aids is offered as an optional, supplemental benefit and may require additional payment.
Vision Services See details
Vision services include eye exams with a copay of $10, and routine eye exams with a copay of $10, and eyewear. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $10-$15 copay, and other services with a $0-$20 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, and oral exams are covered, with some limitations on the number of visits or x-rays. Orthodontic Services are covered, and some additional services are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $13 and $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47 and a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $20 and $275, while Therapeutic Radiological Services have no copay. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Basic SF (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 not covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Basic SF (HMO) plan with prior authorization and a doctor referral required. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, acupuncture has a $10 copay, and over-the-counter items are covered up to $60 every three months. Other 1 has a $100 copay, and Other 2 has 0-20% coinsurance. Services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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