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Kaiser Permanente Sr Adv Basic Contra Costa (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Adv Basic Contra Costa (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Sr Adv Basic Contra Costa (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Contra Costa 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 Sr Adv Basic Contra Costa (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 Sr Adv Basic Contra Costa (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 Sr Adv Basic Contra Costa (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 $5000.00 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 Sr Adv Basic Contra Costa (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay a $4 copay for preferred generic drugs and a $40 copay for standard generic drugs at standard pharmacies or through standard mail. Preferred brand drugs require a $90 copay for a 30-day supply before your total drug costs reach $2,100. For higher-tier prescriptions, non-preferred drugs have a 33% coinsurance, while specialty tier drugs have 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 Medicare Part D covered drugs. Additionally, those who qualify for Extra Help or the low-income subsidy will see their Part D costs reduced to $0.
Additional Benefits
The Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan offers robust medical coverage with predictable costs, featuring no coinsurance for many key services. For inpatient hospital stays, you will pay a daily copay of $270 for the first five days and no copay for subsequent days. Visiting your primary care doctor requires a low $5 copay, while specialist visits cost a $15 copay, and emergency room visits have a $130 copay. Preventive care, home health services, and laboratory tests are available with no copay, while diagnostic radiology and outpatient services feature copays up to $250 with no coinsurance. For specialized care, skilled nursing facilities require no copay for the first 20 days, and medical equipment or dialysis services may require up to 20% coinsurance. While the plan covers routine hearing, vision, and dental exams with low or no copays, it is important to note that eyewear, hearing aids, and transportation services are not covered.
Inpatient Hospital See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) partially covers inpatient hospital services, excluding non-Medicare-covered stays for both acute and psychiatric care. Covered admissions require a daily copay of $270 for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO) with no coinsurance, featuring copays ranging from no copay to $225 for hospital services and a flat $225 copay for ambulatory surgical center visits. Observation services require a copay of up to $130 per stay, outpatient substance abuse sessions cost a $2 to $5 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO) with no copay and no coinsurance. A doctor referral is required to access this care.
Ambulance and Transportation Services See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) partially covers Ambulance and Transportation Services, with ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation services to plan-approved and any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers emergency services with a $130 copay and no coinsurance, which is 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 coverages are available with copays ranging from $5 to $250 and no coinsurance.
Primary Care See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers primary care visits for a $5 copay and specialist visits for a $15 copay, with no coinsurance required. Other covered services like telehealth, mental health, and physical therapy feature copays ranging from no copay up to $20 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO) with no coinsurance, offering no copay for annual exams and remote access, and a $0 to $5 copay for health, nutrition, and kidney disease education. However, the plan does not cover in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, bathroom safety modifications, and counseling.
Hearing Services See details
Hearing Services are partially covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO), with covered exams requiring a $15 copay and no coinsurance. While fitting and evaluation services are covered, routine exams, OTC hearing aids, and prescription hearing aids are not covered, meaning some prescription services are covered but inner ear, outer ear, and over the ear aids are not covered in practice.
Vision Services See details
Vision Services are partially covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO), which offers covered eye exams with no copay to a $15 copay and no coinsurance. However, eyewear is not covered under this plan, meaning contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO), though maxillofacial prosthetics and orthodontics are not covered. Covered Medicare dental services require a $5 to $15 copay, while other covered dental services have no copay; there is no coinsurance for any covered dental services, though some benefits are optional and require an extra fee.
Home Infusion bundled Services See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers home infusion bundled services, including chemotherapy, radiation, insulin, and other Medicare Part B drugs. Chemotherapy, radiation, and other Part B drugs require a copay ranging from no copay to $47 and coinsurance from no coinsurance to 20%, while insulin drugs have a $12 to $35 copay and no coinsurance.
Dialysis Services See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers medical equipment, prosthetics, and diabetic services with prior authorization required. Diabetic supplies feature no copay and no coinsurance, while durable medical equipment, prosthetic devices, and diabetic shoes require no copay and between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO) with a doctor's referral and no coinsurance. There is no copay for lab services, diagnostic procedures, and therapeutic radiological services, while outpatient x-rays require a $15 copay, and diagnostic radiological services carry a copay of $15 to $250.
Home Health Services See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) covers home health services with no copay and no coinsurance, though a doctor referral is required. This benefit ensures you can access necessary in-home medical care with no out-of-pocket costs.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan, as all associated sub-services, including intensive cardiac and pulmonary rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) partially covers Skilled Nursing Facility (SNF) services with a doctor referral, though additional days beyond Medicare-covered limits are not covered. There is no copay for days 1 through 20, a $100 daily copay for days 21 through 100, and no coinsurance is required for covered stays.
Other Services See details
Other Services offered by Kaiser Permanente Sr Adv Basic Contra Costa (HMO) are partially covered, featuring acupuncture for a $5 copay and no coinsurance, over-the-counter items with no copay and no coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and select medical supplies for no copay and no coinsurance to 20% coinsurance. Meal benefits and highly integrated Dual Eligible SNP services are not covered.
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