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Kaiser Permanente Senior Advantage Basic San Mateo (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic San Mateo (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 San Mateo (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in San Mateo 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 San Mateo (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 San Mateo (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 San Mateo (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 San Mateo (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, standard generic drugs have a $6 copay, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D 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 San Mateo (HMO) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $275. Emergency services and primary care visits have copays, and preventive services are often covered with no copay. This plan covers hearing and vision services, including routine eye exams and hearing exams, with copays. Dental services include Medicare and other dental services, also with copays. The plan also covers home infusion services, dialysis services, and medical equipment, with copays or coinsurance applying to some services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric care have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a copay between $0 and $125, Ambulatory Surgical Center (ASC) Services with a $275 copay, Outpatient Substance Abuse Services with a copay of $10 for individual sessions and $5 for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan, with no copay required and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground and Air Ambulance Services have a $300 copay, but 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, and Urgently Needed Services have a $10 copay, with no coinsurance for either. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $10 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $10 copay, occupational therapy services with a copay between $5 and $10, and physician specialist services with a $20 copay. Mental health specialty services have a copay between $10 and $10 for individual sessions and between $5 and $5 for group sessions. Other covered benefits include telehealth, opioid treatment, psychiatric services, and physical therapy and speech-language pathology services.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and other preventive services including Health Education, Nutritional/Dietary Benefit, and Remote Access Technologies, which have a copay between $0 and $10. Additional preventive services such as In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan. Hearing exams have a $20 copay, and the fitting/evaluation for hearing aids is covered as an optional benefit, so you may have to pay more for access to this benefit. Prescription Hearing Aids and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams with a $10 copay. Eyewear is 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 $10-$20, and Other Dental Services with a copay of $0-$10. Periodontics are covered with no 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. Medicare Part B Insulin Drugs have a copay between $2.00 and $35.00. Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0.00 and $47.00, and a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0.00 and $47.00, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $250, Therapeutic Radiological Services with no copay, and Outpatient X-Ray Services with a $10 copay. All services require a doctor's referral.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Basic San Mateo (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 not covered under the Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. There is no copay for days 1-20, and a $100 copay for days 21-100, and there is no coinsurance.
Other Services See details
The "Other Services" benefit covers acupuncture with a $10 copay, and over-the-counter (OTC) items up to $60 every three months, including nicotine replacement therapy. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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