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Kaiser Permanente Senior Advantage Basic Marin (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic Marin (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 Marin (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic Marin (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Marin 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 Marin (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 Marin (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 Marin (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 Marin (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible, meaning your coverage starts right away. During the initial coverage phase, 30-day fills at standard pharmacies or standard mail service carry a $10 copay for preferred generics, a $47 copay for standard generics, and a $100 copay for preferred brands. Non-preferred drugs require a 31% coinsurance, while specialty tier drugs have no copay. These cost-sharing rates apply until your drug costs reach $2,100, at which point you transition to the next coverage phase. Once your out-of-pocket spending reaches $2,100, you enter the catastrophic coverage phase and pay nothing for your covered Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy will see their Part D premium reduced to $7.00.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Marin (HMO) plan offers robust medical coverage with predictable cost-sharing, featuring no deductible for core services. Inpatient hospital stays require a $340 daily copay for the first five days and no copay thereafter, while emergency care has a $130 copay and urgent care is just $5. Outpatient services, primary care, and preventive screenings are highly affordable, with many carrying no copay and no coinsurance. For specialized care, members enjoy no copay for preventive dental and home health services, alongside a $5 copay for routine eye exams. Diagnostic lab tests and X-rays feature low to no copays, while durable medical equipment and dialysis services require no copay and up to 20% coinsurance. Skilled nursing facility care is also covered with no copay for the first 20 days and a $150 daily copay for days 21 through 100.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) partially covers inpatient hospital services, excluding non-Medicare-covered stays for both acute and psychiatric care. Covered acute and psychiatric stays require a $340 daily copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers outpatient services with no coinsurance across all categories. Outpatient hospital and observation services feature copays ranging from no copay up to $340 and $130 respectively, while ambulatory surgical center services require a $340 copay, substance abuse sessions carry a $2 to $5 copay, and blood services have no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered under Kaiser Permanente Senior Advantage Basic Marin (HMO) with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) partially covers ambulance and transportation services, offering ground and air ambulance coverage with a $350 copay and no coinsurance. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgent care with a $5 copay, both with no coinsurance. Worldwide coverage is also included with no coinsurance, featuring a $130 copay for emergency care, a $5 copay for urgent care, and a $350 copay for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) provides partially covered primary care benefits, with podiatry services and routine chiropractic care not covered under the plan. Covered services feature no coinsurance, with copayments ranging from no copay for telehealth and opioid treatment services up to $30 for specialist visits.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage Basic Marin (HMO) with no coinsurance, offering annual physical exams and screenings for no copay, and health education for a $0 to $5 copay. Sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, alternative therapies, therapeutic massage, and adult day health are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) partially covers hearing services, offering hearing aid fittings and evaluations with a $30 copay and no coinsurance. Routine hearing exams and OTC hearing aids are not covered, and while some prescription hearing aid services are covered, all types—including inner ear, outer ear, and over the ear models—are not covered in practice.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Basic Marin (HMO), offering eye exams with no deductible, no coinsurance, and copays ranging from no copay to $30, including a $5 copay for routine exams. Eyewear is not covered, including contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers dental services with no copay or coinsurance for preventive care, periodontics, and adjunctive services, and a copay of $5.00 to $30.00 (no coinsurance) for Medicare-covered dental. Some advanced procedures are available as optional supplemental benefits, though maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers home infusion bundled services, including Medicare Part B insulin with a copay of $10.00 to $35.00. Other covered Part B drugs, including chemotherapy and radiation treatments, range from no copay to a $47.00 copay and from no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Basic Marin (HMO) with no copay and a 20% coinsurance. This coverage ensures you pay a consistent 20% coinsurance for all your dialysis treatment needs.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers medical equipment, prosthetics, and diabetic supplies with no copays and coinsurance ranging from no coinsurance up to 20%, depending on the item. Specifically, durable medical equipment and medical supplies require no copay and up to 20% coinsurance, while diabetic therapeutic shoes carry a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers diagnostic and radiological services with no coinsurance, though doctor referrals are required. There is no copay for lab services, diagnostic tests, and therapeutic radiological services, while outpatient X-rays require a $10 copay and diagnostic radiological services carry a copay of $10 to $275.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) covers home health services with no copay and no coinsurance, though a doctor referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Basic Marin (HMO) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic Marin (HMO) partially covers Skilled Nursing Facility (SNF) services, which require a doctor referral but no prior three-day hospital stay. There is no copay for days 1 to 20 and a $150 daily copay for days 21 to 100, with no coinsurance, though additional days beyond Medicare-covered stays are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Basic Marin (HMO), excluding meal benefits and Dual Eligible SNPs with Highly Integrated Services. Covered options include acupuncture for a $5 copay and no coinsurance, over-the-counter items with no copay or coinsurance, residential substance use treatment for a $100 copay and no coinsurance, and non-Medicare durable medical equipment for no copay and 0% to 20% coinsurance.
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