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Kaiser Permanente Sr Advantage Inland Empire Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Sr Advantage Inland Empire 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 Inland Empire Value (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Inland Empire 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 Inland Empire 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 Inland Empire 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 Inland Empire 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 $2500.00 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 Inland Empire Value (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay no copay for tier 1 preferred generic drugs and tier 5 specialty drugs at standard pharmacies. For other tiers, you will pay a $40 copay for tier 2 standard generics, a $95 copay for tier 3 preferred brands, and a 32% coinsurance for tier 4 non-preferred drugs. This initial coverage phase lasts until your total drug costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy can receive a reduced Part D premium of nothing.
Additional Benefits
The Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan offers comprehensive coverage with predictable costs and no coinsurance for many primary medical services. Members benefit from no copay for primary care, telehealth, and preventive care, while specialist visits require a $10 copay. Inpatient hospital stays require a $230 daily copay for days 1 through 5, and emergency room visits carry a $150 copay that is waived if you are admitted. Vision, dental, and hearing services are partially covered, featuring no copay to a $10 copay for exams, alongside a $1,000 hearing aid allowance every three years and a $250 eyewear allowance every two years. Home health care and diabetic supplies are available with no copay and no coinsurance, though durable medical equipment requires up to 20% coinsurance. Please note that this plan does not cover transportation or cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO), which excludes non-Medicare-covered stays. Covered acute and psychiatric stays require a $230 daily 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 Inland Empire Value (HMO) with no coinsurance required. Members pay no copay to $230 for outpatient hospital services, no copay to $150 per stay for observation services, a $230 copay for ambulatory surgical center visits, and no copay for outpatient blood and substance abuse services.
Partial Hospitalization See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) covers partial hospitalization benefits with no copay and no coinsurance. A doctor referral is required to access these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) partially covers ambulance and transportation services, offering Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance. However, transportation services to both plan-approved and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide urgent care are available with no copay and no coinsurance, while worldwide emergency care has a $150 copay and worldwide emergency transportation requires a $350 copay.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO), as chiropractic and podiatry services are not covered. Covered services feature no coinsurance, with no copay for primary care, telehealth, mental health, psychiatric, and opioid treatment, a $10 copay for specialists, and copays up to $20 for occupational, physical, and speech therapies.
Preventive Services See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physicals and fitness programs. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO), which features a $10 copay and no coinsurance for hearing exams, and no copay or coinsurance for hearing aid fittings. The plan also provides up to a $1,000 allowance per ear every three years for prescription hearing aids, but routine hearing exams, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) partially covers vision services, as eyewear upgrades are not covered. Covered eye exams require a doctor referral and feature no coinsurance and a copay ranging from no copay to $10, while eyewear is covered up to a $250 combined maximum every two years with no deductible.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO), excluding Maxillofacial Prosthetics and Orthodontics. Covered Medicare dental services require no copay to a $10 copay and no coinsurance, while other covered dental benefits feature no copay and no coinsurance.
Home Infusion bundled Services See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) covers home infusion bundled services, featuring Medicare Part B insulin drugs with a $12.00 to $35.00 copay and no coinsurance. Medicare Part B chemotherapy, radiation, and other Part B drugs are also covered with copayments ranging from no copay up to $47.00 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan with a 20% coinsurance and no copay. A doctor referral is required to access this benefit.
Medical Equipment See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required for most services. Durable medical equipment, prosthetics, and diabetic therapeutic shoes carry a coinsurance ranging from no coinsurance up to 20%, while diabetic supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO) with a doctor referral and no coinsurance. There is no copay for lab services, diagnostic procedures, or therapeutic radiological services, while outpatient X-rays require a $10 copay and diagnostic radiological services carry a copay ranging from $10 to $250.
Home Health Services See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) covers Home Health Services with no copay and no coinsurance. A doctor referral is required to receive this covered care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Kaiser Permanente Sr Advantage Inland Empire Value (HMO), as the plan does not cover cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) partially covers Skilled Nursing Facility (SNF) care, requiring no copay or coinsurance for days 1 through 20, and a $150 daily copay with no coinsurance for days 21 through 100. A doctor referral is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Sr Advantage Inland Empire Value (HMO), as meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include acupuncture and 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 0% to 20% coinsurance and no copay.
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