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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 2025, 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 2025.
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 has an enhanced alternative drug benefit. The plan has a $0 deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $7.00 at standard and mail order pharmacies. For standard generic drugs, the copay is $47.00 at standard and mail order pharmacies. For preferred brand drugs, the copay is $100.00 at standard and mail order pharmacies. For non-preferred drugs, you pay 33% coinsurance. Specialty tier drugs have no copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan offers comprehensive coverage with a focus on outpatient services, and a wide array of other benefits. Many services have no copay, including primary care, preventive services, hearing exams, vision exams, and home health services. This plan provides coverage for inpatient hospital stays, emergency services, and ambulance services with varying copays. You'll also find coverage for dental, hearing aids, and vision eyewear, along with services like dialysis and durable medical equipment, each with its own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5, there is a $100 copay, and for days 6-90, there is no copay. Additional days for both acute and psychiatric care have no copay.
Outpatient Services See details
Outpatient Services include no copay for outpatient hospital services, ambulatory surgical center (ASC) services, and outpatient blood services. Observation Services have a copay between $0 and $140. Outpatient Substance Abuse Services have no copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan with no copay. A doctor referral is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan. Ground and air ambulance services have a $250 copay, and there is 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 have a $140 copay, Urgently Needed Services have no copay, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with no copay. Occupational Therapy Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services are covered with a $0 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that cover health education, nutritional/dietary benefits, and fitness benefits, all with no copay. Other preventive services are covered, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. Some preventive services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others.
Hearing Services See details
Hearing Services includes hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered with a maximum benefit of $1,000 every three years. Routine hearing exams, inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear benefits are covered, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. However, upgrades are not covered, and there is a combined maximum of $250 per period for eyewear, which is every two years.
Dental Services See details
The Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan covers Medicare and other dental services with no copay. Restorative Services have a copay between $36 and $124, and Adjunctive General Services have a $58 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay of $7.00 - $35.00. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a copay between $0.00 - $47.00 and a coinsurance between 0% - 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with 0% to 20% coinsurance. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have no copay.
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 up to $175, Therapeutic Radiological Services with no copay, and Outpatient X-Ray Services with no copay. A doctor referral is required.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor's referral, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. More information on copays is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Sr Advantage LA, Orange Value (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other Services include acupuncture with no copay and over-the-counter items with a $120 maximum every three months, while meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered. Other services such as Private Duty Nursing Services, Case Management (Long Term Care), and Home and Community Based Services are not covered. Other 1 has a $100 copay, and Other 2 has a 0-20% coinsurance.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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