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Kaiser Permanente Sr Advantage LA, Orange Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Advantage LA, Orange Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Sr Advantage LA, Orange Value (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Los Angeles and Orange Counties Value Plan. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Sr Advantage LA, Orange Value (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 Sr Advantage LA, Orange Value (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 Sr Advantage LA, Orange Value (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 $1999.00 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 Sr Advantage LA, Orange Value (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs filled at standard pharmacies. For other tiers, you will pay a $40 copay for Tier 2 standard generics, a $100 copay for Tier 3 preferred brands, and a 33% coinsurance for Tier 4 non-preferred drugs. These cost-sharing rates apply at standard retail pharmacies and standard mail order services until your total drug costs reach $2,100. After your yearly out-of-pocket drug costs reach this $2,100 threshold, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, beneficiaries who qualify for the Extra Help low-income subsidy will pay nothing for their Part D coverage.
Additional Benefits
The Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan offers cost-effective medical coverage with no copay or coinsurance for primary care, specialist visits, telehealth, and preventive services. For hospital care, inpatient stays require a $150 copay for days one through five with no copay for additional days, while outpatient hospital services range from no copay to a $150 copay. Emergency room visits have a $150 copay that is waived if admitted, and urgently needed care requires no copay. Members also receive generous supplemental benefits, including no copay for routine dental cleanings and routine eye exams, alongside a $250 allowance for eyewear every two years. The plan provides a hearing aid allowance of up to $1,000 per ear every three years and a $75 quarterly allowance for over-the-counter items with no copay. Diagnostic lab tests, x-rays, and home health services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) inpatient hospital benefits are partially covered, excluding non-Medicare-covered stays for both acute and psychiatric care. Covered admissions require a referral and carry a $150 copay for days 1 through 5, with no copay for days 6 through 999 and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Sr Advantage LA, Orange Value (HMO) with no coinsurance, featuring a $0 to $150 copay for outpatient hospital and observation services, and a $150 copay for ambulatory surgical center services. Outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Sr Advantage LA, Orange Value (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 Sr Advantage LA, Orange Value (HMO) partially covers Ambulance and Transportation Services, offering ground and air ambulance coverage with a $250 copay and no coinsurance. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers emergency services with a $150 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with no copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance, requiring a $150 copay, no copay, and a $250 copay respectively.
Primary Care See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers primary care, specialist visits, mental health specialty services, and telehealth with no copay and no coinsurance. Physical, occupational, and speech-language therapy services are covered with no coinsurance and copays ranging from $0 to $15, though podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Sr Advantage LA, Orange Value (HMO) with no copay and no coinsurance for covered benefits, though some services require a doctor referral. Uncovered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation counseling, home safety modifications, and counseling.
Hearing Services See details
Hearing Services are partially covered under Kaiser Permanente Sr Advantage LA, Orange Value (HMO), offering Medicare-covered exams and fitting evaluations with no copay and no coinsurance, alongside a prescription hearing aid allowance of up to $1,000 per ear every three years. However, routine hearing exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers vision services with no copay or coinsurance for routine eye exams, plus a $250 combined allowance every two years for contacts and eyeglasses. The vision benefit is partially covered, as eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) partially covers dental services with no copay and no coinsurance for covered benefits like exams, cleanings, and x-rays. However, maxillofacial prosthetics and orthodontics are not covered, and some services are only available as optional supplemental benefits that require an additional fee.
Home Infusion bundled Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers Home Infusion bundled Services, featuring Medicare Part B insulin drugs with a $7.00 to $35.00 copay and no coinsurance. Chemotherapy, radiation, and other Part B drugs are also covered with cost-sharing ranging from no copay to a $47.00 copay, and from no coinsurance to 20% coinsurance.
Dialysis Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers Dialysis Services with 20% coinsurance and no copay. A doctor referral is required to access this benefit.
Medical Equipment See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers durable medical equipment and medical supplies with 0% to 20% coinsurance and no copays, while prosthetic devices and diabetic shoes require a 20% coinsurance and no copays. Diabetic supplies are covered with no copays or coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers diagnostic and radiological services with a doctor's referral and no coinsurance. There is no copay for lab services, diagnostic tests, outpatient X-rays, and therapeutic radiological services, while diagnostic radiological services require a copay of up to $250.
Home Health Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) covers home health services with no copay and no coinsurance. A doctor referral is required to access this benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) does not cover Cardiac Rehabilitation Services, so there is no copay or coinsurance. None of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD services, are covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Kaiser Permanente Sr Advantage LA, Orange Value (HMO) with a doctor referral and no prior hospital stay required. There is no copay or coinsurance for days 1 through 20, and a $100 daily copay with no coinsurance for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Sr Advantage LA, Orange Value (HMO), offering acupuncture and over-the-counter (OTC) items with no copay or coinsurance, including a $75 quarterly OTC allowance. Residential substance use and mental health treatments are covered with a $100 copay and no coinsurance, while non-Medicare medical supplies require 0% to 20% coinsurance with no copay; meal benefits and highly integrated SNP services are not covered.
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