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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 2025, 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 2025.
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 $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 Inland Empire Value (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy or through the mail, and pay a $32 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay no cost-sharing for your Part D drugs.
Additional Benefits
The Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan offers comprehensive coverage with a range of benefits. This plan includes inpatient hospital stays with a copay, outpatient services, emergency services, and various therapies with varying copays. Preventive services, hearing exams, vision services, dental, home health, and other services are also covered, with specific copays or coinsurance amounts depending on the service. Additionally, the plan covers ambulance services, home infusion, dialysis services, and medical equipment with specific cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $75 copay for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric have no copay, while Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $40, observation services with a copay ranging from $0 to $140, ambulatory surgical center services with a $40 copay, individual and group sessions for outpatient substance abuse with no copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan, with no copay required. A doctor referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan, with no coinsurance for any ambulance services. Ground and air ambulance services have a $300 copay, while 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 has a $140 copay and no coinsurance. Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, and Additional Telehealth Benefits have no copay. Occupational Therapy Services have a copay between $2 and $5, while Physician Specialist Services have a $5 copay. Individual and Group Sessions for Mental Health and Psychiatric Services also have no copay. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $5. Other Health Care Professional and Opioid Treatment Program Services have 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 services like health education and fitness benefits are covered with no copay. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay. Some preventive services, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others, are not covered.
Hearing Services See details
Hearing exams are covered with a $5 copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered for a plan-specified amount of $1000 per ear every three years, while routine hearing exams, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$5, and eyewear with a combined maximum benefit of $250 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. Upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services and other dental services. Medicare dental services have a copay between $0 and $5, while other dental services have no copay. Orthodontic Services, Restorative Services, Adjunctive General Services, Periodontics, and Oral and Maxillofacial Surgery are covered, with copays ranging from $0 to $229. Endodontics, Prosthodontics (removable and fixed), and Implant Services are offered as optional supplemental benefits. 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 with no copay, and Medicare Part B Chemotherapy/Radiation Drugs with a copay between $0 and $32 and coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $32 and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Sr Advantage Inland Empire Value (HMO) plan with a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance on Medicare-covered items, while Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay of at most $215.00, and Therapeutic Radiological Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Sr Advantage Inland Empire Value (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 covered, but none of the sub-services are covered, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. There is no copay for days 1-20, and a $100 copay for days 21-100, with no coinsurance.
Other Services See details
Other Services include acupuncture with no copay, over-the-counter items with a maximum benefit of $120 every three months, and other services, which include Residential Substance Use Disorder and MH Treatment with a $75 copay and DME and Prosthetic/Medical Supplies with 0% to 20% coinsurance. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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