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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 2026, 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 2026.
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 $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 SF (HMO) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay a $9 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands at standard pharmacies or standard mail. Non-preferred drugs require a 28% 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 Part D prescription drugs. Furthermore, individuals who qualify for the full low-income subsidy will benefit from a premium reduced to zero.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic SF (HMO) plan offers robust coverage for core medical services with clear, predictable cost-sharing. Inpatient hospital stays require a $380 daily copay for the first five days with no coinsurance, while primary care visits feature low copays up to $25. Emergency room visits carry a $130 copay, and outpatient surgery copays range up to $375 with no coinsurance. Preventive care, basic dental, and eye exams are highly accessible with low or no copays, though routine hearing aids and eyeglasses are not covered. Home health services and diagnostic lab tests are available with no copay, whereas dialysis and durable medical equipment require up to 20% coinsurance. Additionally, members can access acupuncture for a $10 copay and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Kaiser Permanente Senior Advantage Basic SF (HMO), as non-Medicare-covered stays are not covered. For covered acute and psychiatric hospitalizations, there is a $380 daily copay for days 1 through 5, no copay for days 6 and beyond, and no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic SF (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from no copay to $375, and ambulatory surgical center services for a $375 copay. Patients will also pay a copay of up to $130 per stay for observation services, $5 to $10 for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Basic SF (HMO) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under Kaiser Permanente Senior Advantage Basic SF (HMO) include ground and air ambulance coverage with a $350 copay and no coinsurance. However, additional transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Senior Advantage Basic SF (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $130, $10, and $350, respectively, and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered under the Kaiser Permanente Senior Advantage Basic SF (HMO) plan, featuring no coinsurance and copays ranging from no copay up to $25. While services like doctor visits, telehealth, and physical therapy are included, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Basic SF (HMO) partially covers preventive services with no coinsurance and copays ranging from no copay to $10. Covered benefits include annual physical exams, health education, and glaucoma screenings, while services like in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic SF (HMO) partially covers hearing services, offering hearing exam fitting and evaluation with a $25 copay and no coinsurance. Routine hearing exams, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services covered by Kaiser Permanente Senior Advantage Basic SF (HMO) include eye exams with no deductible, no coinsurance, and copays ranging from no copay to $25. While some eyewear services are covered, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered in practice.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Basic SF (HMO), with copays ranging from no copay to $10.00 - $25.00 and no coinsurance for covered services. Preventive care and several specialized treatments are included, though maxillofacial prosthetics and orthodontics are not covered, and some services may require optional supplemental enrollment.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Basic SF (HMO), including Medicare Part B insulin with a $10 to $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs feature copays ranging from no copay up to $47 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Senior Advantage Basic SF (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Basic SF (HMO), including durable medical equipment, prosthetics, and diabetic supplies, with prior authorization required. These services feature no copays, with coinsurance ranging from no coinsurance up to 20% depending on the item.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Basic SF (HMO) with a required doctor referral and no coinsurance. 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 range from a $30 to $275 copay.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic SF (HMO) covers home health services with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage Basic SF (HMO) plan, as all individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic SF (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $150 daily copay for days 21 to 100. This benefit is partially covered, as a doctor referral is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Basic SF (HMO) covers acupuncture with a $10 copay and no coinsurance, over-the-counter items with no copay or coinsurance, and residential substance use treatment with a $100 copay and no coinsurance. Non-Medicare durable medical equipment is also covered with no copay and a 0% to 20% coinsurance, while meal benefits and dual-eligible SNP services are not covered.
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