A non-government entity
Kaiser Permanente Sr Adv Basic Santa Clara (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Adv Basic Santa Clara (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 Santa Clara (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Santa Clara 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 Santa Clara (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 Santa Clara (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 Santa Clara (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. 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:
Sign up for Kaiser Permanente Sr Adv Basic Santa Clara (HMO)
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Drug Coverage
The Kaiser Permanente Sr Adv Basic Santa Clara (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs at standard pharmacies. For other medications, 30-day standard copays are $40 for Tier 2 standard generics and $90 for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 33% coinsurance for standard retail and standard mail-order purchases. 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, individuals who qualify for the low-income subsidy, or Extra Help, will pay a $0 Part D premium.
Additional Benefits
The Kaiser Permanente Sr Adv Basic Santa Clara (HMO) plan offers comprehensive coverage for core medical needs with predictable copays and no coinsurance for many services. Inpatient hospital stays require a $320 daily copay for the first five days followed by no copay, while primary care visits range from no copay up to $20. Emergency room visits carry a $130 copay, and urgent care is highly affordable with a $5 copay. Preventive care, home health services, and diagnostic laboratory tests are fully covered with no copay and no coinsurance. Specialty services like Medicare-covered dental, acupuncture, and routine eye exams are also affordable, featuring copays of $20 or less. For specialized medical equipment and dialysis, members will pay no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO), as non-Medicare-covered stays for both acute and psychiatric care are not covered. Covered acute and psychiatric admissions require a $320 daily copay for days 1 through 5, followed by no copay for days 6 through 999 and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO) with no coinsurance and copays ranging from $0 to $300 depending on the service. Members will pay no copay to $300 for outpatient hospital services, $300 for ambulatory surgical center visits, $2 to $5 for substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) partially covers ambulance and transportation services, featuring a $300 copay and no coinsurance for both ground and air ambulance services. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) covers emergency and urgent care services with no coinsurance, featuring a $130 copay for emergency room visits and a $5 copay for urgent care. Worldwide emergency and urgent services are also covered with no coinsurance, with copays of $130 for emergency care, $5 for urgent care, and $300 for emergency transportation.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO), as podiatry and routine chiropractic services are not covered. Covered services, including doctor visits, mental health sessions, and telehealth, require copays ranging from no copay up to $20.00, with no coinsurance.
Preventive Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) offers partial coverage for preventive services, featuring no copay and no coinsurance for annual exams, screenings, and remote access, alongside a $0 to $5 copay and no coinsurance for health, nutritional, and kidney education. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, disease management, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO), which offers hearing aid fitting and evaluation with a $20 copay and no coinsurance. However, routine hearing exams, OTC hearing aids, and prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO), offering eye exams with no deductible, no coinsurance, and a copay ranging from no copay to $20 ($5 copay for routine exams). For eyewear, some services are covered but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) provides partially covered dental services, with maxillofacial prosthetics and orthodontics not covered under the plan. Covered Medicare dental services require a $5.00 to $20.00 copay, while other covered dental benefits feature no copay and no coinsurance.
Home Infusion bundled Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) covers home infusion bundled services, including Medicare Part B insulin with a $10.00 to $35.00 copay and no coinsurance. Medicare Part B chemotherapy, radiation, and other Part B drugs are also covered with coinsurance ranging from no coinsurance to 20% and copays ranging from no copay to $47.00.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) covers medical equipment, prosthetics, and diabetic supplies, with prior authorization required for these services. Members will pay no copays, and coinsurance ranges from 0% to 20% depending on the item, including a 20% coinsurance for prosthetic devices and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO) with no coinsurance, though a doctor referral is required. There is no copay for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services carry a copay of up to $275.
Home Health Services See details
Home health services are covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO) with no copay and no coinsurance. Access to these fully covered services requires a doctor referral.
Cardiac Rehabilitation Services See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) does not cover Cardiac Rehabilitation Services in practice, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) partially covers Skilled Nursing Facility (SNF) care with a doctor referral, though additional days beyond Medicare-covered stays are not covered. Patients pay no copay and no coinsurance for days 1 through 20, and a $150 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by Kaiser Permanente Sr Adv Basic Santa Clara (HMO), excluding meal benefits and dual eligible SNP services. Covered benefits include 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 non-Medicare durable medical equipment for 0% to 20% coinsurance and no copay.
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