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Kaiser Permanente Senior Advantage Basic Solano (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic Solano (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 Solano (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic Solano (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Solano 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 Solano (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 Solano (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 Solano (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 $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 Solano (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $7 copay for preferred generic drugs at a standard pharmacy and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy (LIS), your costs for Part D drugs are $0.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Solano (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, and outpatient services range from no copay to a $200 copay, depending on the service. Emergency services have a copay, and primary care visits are $5. Preventive services, like annual physical exams, have no copay, and vision and dental services have copays. Home health services, and skilled nursing facility services have no copay. Dialysis and medical equipment services have coinsurance, while other services like acupuncture have a copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $235 copay for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric services have no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a copay between $0 and $125, Ambulatory Surgical Center (ASC) Services with a $200 copay, and Outpatient Substance Abuse Services with a $5 copay for individual sessions and a $2 copay for group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Kaiser Permanente Senior Advantage Basic Solano (HMO) with no copay, and a doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic Solano (HMO) plan. Ground and Air Ambulance Services have a $250 copay, but there is no coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Basic Solano (HMO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $5 copay with no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $250 copay, with no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic Solano (HMO) plan covers primary care physician services and chiropractic services with a $5 copay, and occupational therapy services with a $5-$10 copay. Physician specialist services have a $10 copay, while mental health specialty services have a $2-$5 copay depending on the session type. Other health care professional services range from $3-$10, and psychiatric services have a $0-$5 copay. Physical therapy and speech-language pathology services have a $0-$10 copay, and additional telehealth benefits have no copay. Opioid Treatment Program Services have no copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, as well as health education and nutritional/dietary benefits with a copay between $0 and $5. Other services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the Kaiser Permanente Senior Advantage Basic Solano (HMO) plan. Hearing exams have a $10 copay, but routine hearing exams are not covered, and prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $5.00 for routine eye exams, and other eye exams with a copay between $0.00 and $10.00. Eyewear is partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay between $5 and $10, as well as other dental services with a copay between $0 and $10. Oral exams are limited to 2 per year and Dental X-Rays are limited to 1, and other diagnostic services, other preventive services, and prophylaxis (cleaning) are also covered, all of which require prior authorization and a doctor referral. Periodontics has no copay, but is limited to 1 treatment every 12 months, and Oral and Maxillofacial Surgery has a $5 copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, the copay is between $7 and $35. For Medicare Part B Chemotherapy/Radiation Drugs, the copay is between $0 and $40, and the coinsurance is between 0% and 20%. For Other Medicare Part B Drugs, the copay is between $0 and $40, and the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Basic Solano (HMO). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, with Durable Medical Equipment (DME) subject to a 0% to 20% coinsurance and no copay. Prosthetics/Medical Supplies are covered with no copay, and coinsurance applies for Medicare-covered devices and supplies. Diabetic equipment is covered, with coinsurance for Medicare-covered diabetic supplies, and a copay for diabetic therapeutic shoes or inserts, and no copay for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay up to $175, while Therapeutic Radiological Services have no copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Basic Solano (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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not. A doctor referral is required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, requiring prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $100 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Kaiser Permanente Senior Advantage Basic Solano (HMO) plan, acupuncture has a $5 copay. Over-the-counter items are covered up to $60 every three months, and Other 1 has a $100 copay. Other 2 has a coinsurance of 0% - 20%, and other services are not covered.
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