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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 2025, 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 2025.
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 $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 Marin (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, you'll pay a $18 copay for preferred generics at a standard pharmacy or a $100 copay for preferred brands. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic Marin (HMO) plan offers comprehensive coverage with a variety of benefits. It includes coverage for inpatient and outpatient services, with varying copays, as well as emergency, primary care, and preventive services, many of which have no copay. The plan also provides coverage for hearing, vision, and dental services. Additional benefits include ambulance services, home health, and medical equipment, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital services are covered, including services not usually covered by Medicare plans, with a $260 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital are covered with no copay, while non-Medicare-covered stays are not covered. Inpatient Hospital Psychiatric services are covered, including services not usually covered by Medicare plans, with a $260 copay for days 1-5 and no copay for days 6-90; the non-Medicare-covered stay is not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $200, observation services with a copay between $0 and $125, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services have a $5 copay for individual sessions and a $2 copay for group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a doctor referral and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Kaiser Permanente Senior Advantage Basic Marin (HMO). Ground and air ambulance services have a $300 copay, with no coinsurance. 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 has a $125 copay, Urgently Needed Services has a $5 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Under the Kaiser Permanente Senior Advantage Basic Marin (HMO) plan, primary care physician services and chiropractic services have a $5 copay, and physician specialist services have a $10 copay. Occupational therapy has a $5-$10 copay, Individual Sessions for Mental Health Specialty Services have a $5 copay, and Group Sessions for Mental Health Specialty Services have a $2 copay. Physical therapy and speech-language pathology services have a $0-$10 copay, and Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams with no copay, and additional preventive services, including Health Education, Nutritional/Dietary Benefits, and Remote Access Technologies, each with a copay between $0 and $5. In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing services include hearing exams, with a $10 copay, and fitting/evaluation for hearing aids, which is an optional supplemental benefit. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$10, and routine eye exams with a $5 copay. Eyewear benefits are partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a copay of $5-$10 and other dental services with a copay of $0-$10. Periodontics has a $0 copay, 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 and require prior authorization. Medicare Part B Insulin Drugs have a copay of $18 to $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0 to $47 and a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay of $0 to $47 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Basic Marin (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has no copay, and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. 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 by the Kaiser Permanente Senior Advantage Basic Marin (HMO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, 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 Marin (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. The copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Basic Marin (HMO) plan covers acupuncture with a $5 copay, as well as over-the-counter (OTC) items with a maximum coverage amount of $60 every three months, and a $100 copay for other services for residential substance use disorder and MH treatment. Additionally, the plan covers other services for DME and Prosthetic/Medical Supplies not covered by Medicare with 0% to 20% coinsurance. However, meal benefits, 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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