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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 2025, 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 2025.
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 $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 $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:
Sign up for Kaiser Permanente Sr Adv Basic Contra Costa (HMO)
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Drug Coverage
The Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. The copays range from $7 to $100, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for all drugs. Always check the plan's formulary for specific drugs covered.
Additional Benefits
The Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $200 copay for the first five days and no copay thereafter. Outpatient services have varying copays, while services like primary care, preventive care, and home health services come with either a low copay or no copay. The plan also includes coverage for emergency services, ambulance services, and a range of diagnostic and therapeutic services. Hearing, vision, and dental services are covered with copays, and the plan also offers additional benefits such as home infusion, dialysis, medical equipment, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $200 copay for days 1-5 and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric have no copay, while non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $150, observation services with a copay between $0 and $125, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with a $5 copay for individual sessions and a $2 copay for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan. Ground and Air Ambulance Services have a $200 copay, with no coinsurance, while 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 $5 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan covers primary care physician services and chiropractic services, each with a $5 copay. Physician specialist services have a $10 copay, and individual mental health sessions have a $5 copay while group sessions have a $2 copay.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar services, annual physical exams with no copay, and additional preventive services including health education, nutritional/dietary benefits, and remote access technologies. 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 with a $10 copay, and fitting/evaluation for hearing aids as an optional supplemental benefit, but prescription and OTC hearing aids are not covered. Routine hearing exams and all types of prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams, with a copay between $0 and $10, and routine eye exams with a $5 copay. Eyewear is also covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan covers Medicare Dental Services with a copay of $5-$10, and Other Dental Services with a copay of $0-$5. The plan also covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Periodontics with no copay, and Oral and Maxillofacial Surgery with a $5 copay. However, Maxillofacial Prosthetics and Orthodontics are not covered. Restorative Services, Adjunctive General Services, Endodontics, Prosthodontics, removable, Implant Services, and Prosthodontics, fixed are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. This plan covers Medicare Part B Insulin Drugs with a copay of $4.00 to $35.00, and Medicare Part B Chemotherapy/Radiation Drugs with a copay of $0.00 to $47.00 with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0.00 and $47.00 with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Sr Adv Basic Contra Costa (HMO) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. For DME, there is no copay, and coinsurance ranges from 0% to 20%; however, DME for use outside the home is not covered. Prosthetics/medical supplies have no copay, and coinsurance applies to Medicare-covered prosthetic devices and medical supplies. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services with no copay, and Diagnostic Radiological Services with a copay of up to $190.00, Therapeutic Radiological Services and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Sr Adv Basic Contra Costa (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 covered with a doctor referral, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100 per day; additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with a $5 copay, and over-the-counter items with a maximum benefit of $60 every three months. Also covered are residential substance use disorder and MH treatment with a $100 copay, and DME and Prosthetic/Medical Supplies not covered by Medicare with 0% - 20% coinsurance. Meal Benefit, 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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