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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 2026, 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 2026.
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 $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:
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Drug Coverage
The Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs at standard pharmacies. Other drug tiers at standard pharmacies and standard mail options require a $40 copay for Tier 2 standard generics, an $85 copay for Tier 3 preferred brands, and 33% coinsurance for Tier 4 non-preferred drugs. After 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, the plan premium may be reduced to $0 for beneficiaries who qualify for the low-income subsidy.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan offers comprehensive medical coverage with fixed copays and no coinsurance for most standard services. Primary care doctor visits require a low $5 copay, specialist visits are $25, and emergency room care is covered with a $130 copay. For inpatient hospital stays, members pay a $325 copay per day for the first five days and no copay for additional days. Diagnostic tests, home health care, and select dental services are available with no copay, while routine vision and hearing exams feature low copays. Durable medical equipment and dialysis are covered with no copays and coinsurance ranging from 0% to 20%. Notably, this plan does not cover routine hearing aids, eyewear, or cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Senior Advantage Basic San Mateo (HMO), with the exception of non-Medicare-covered stays. Covered acute and psychiatric stays require a $325 copay per day for days 1 to 5 and no copay for days 6 and beyond, with no coinsurance.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $285 for outpatient hospital and ambulatory surgical center services. Patients also pay between no copay and a $130 copay per stay for observation services, a $2 to $5 copay for outpatient substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers partial hospitalization benefits with no copay and no coinsurance, although a doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Basic San Mateo (HMO), which features a $350 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $5 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $5, and $350, respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers primary care visits with a $5 copay and specialist visits with a $25 copay, both with no coinsurance. The primary care benefit is partially covered, offering services like telehealth and mental health with no coinsurance and copays ranging from no copay up to $25, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage Basic San Mateo (HMO) with no coinsurance and copays ranging from no copay up to $5. Uncovered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home and bathroom modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Basic San Mateo (HMO), which offers hearing exams with a $25 copay, no coinsurance, and no deductible. Although some prescription hearing aid services are covered, routine hearing exams, OTC hearing aids, and all prescription hearing aid types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) partially covers vision services, offering eye exams with no coinsurance and a copay ranging from no copay to $25, including routine eye exams for a $5 copay. Eyewear benefits, including contact lenses, eyeglasses, frames, and upgrades, are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) partially covers dental services, excluding maxillofacial prosthetics and orthodontics. Covered Medicare dental services require a $5 to $25 copay, other covered services have no copay, and there is no coinsurance, though some optional services may require an additional fee.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers home infusion bundled services, including Medicare Part B drugs. Medicare Part B insulin drugs have a $12 to $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs range from no copay to a $47 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Basic San Mateo (HMO) plan with a 20% coinsurance and no copay.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, subject to prior authorization. There are no copays for these benefits, with coinsurance ranging from 0% to 20% for durable medical equipment and medical supplies, a flat 20% coinsurance for prosthetic devices and diabetic therapeutic shoes or inserts, and no coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Basic San Mateo (HMO) with no coinsurance, though a referral is required. Members pay no copay for diagnostic tests, lab services, and therapeutic radiological services, a $15 copay for outpatient X-rays, and a copay ranging from $15 to $275 for diagnostic radiological services.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (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 Kaiser Permanente Senior Advantage Basic San Mateo (HMO), which offers no coverage or cost-sharing benefits for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. For covered days, there is no copay for days 1 to 20, a $150 daily copay for days 21 to 100, and no coinsurance.
Other Services See details
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) partially covers other services, excluding meal benefits and dual eligible SNPs. 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 select medical supplies for no copay and 0% to 20% coinsurance.
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