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Kaiser Permanente Senior Advantage San Diego Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage San Diego 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 Senior Advantage San Diego Value (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage San Diego Value (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in San Diego County 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 Senior Advantage San Diego 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 Senior Advantage San Diego 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 Senior Advantage San Diego 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 $2900.00 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 San Diego Value (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, a 30-day supply at standard pharmacies or through standard mail costs a $3 copay for preferred generics and a $45 copay for standard generics. Preferred brands require a $95 copay, non-preferred drugs carry a 31% coinsurance, and specialty tier drugs have no copay at standard pharmacies. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, if you qualify for the low-income subsidy Extra Help, your Part D cost-sharing is reduced to $0.00.
Additional Benefits
The Kaiser Permanente Senior Advantage San Diego Value (HMO) plan features affordable coverage with no copays for primary care visits, routine eye exams, and key preventive services. For specialized medical care, members can expect low copays ranging from $0 to $15 for specialists, while inpatient hospital stays require a $225 copay for days one through five and no copay for subsequent days. Emergency room visits carry a $150 copay that is waived if admitted, while urgent care services are provided with no copay and no coinsurance. The plan also includes valuable vision, hearing, and dental benefits, featuring up to $250 for eyewear every two years and up to $1,000 per ear for prescription hearing aids every three years. Home health services and medical equipment are covered with no copays, though some durable medical equipment may require up to 20 percent coinsurance. However, certain services like cardiac rehabilitation and routine transportation are not covered under this plan.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) partially covers inpatient hospital benefits, as non-Medicare-covered stays for acute and psychiatric care are not covered. Covered acute and psychiatric stays require a $225 copay for days 1 through 5, no copay for days 6 through 999, and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage San Diego Value (HMO) with no coinsurance. Members pay a $0 to $200 copay for outpatient hospital services, a $0 to $150 copay per stay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient blood services and outpatient substance abuse sessions are covered with no copay.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) covers partial hospitalization services with no copay and no coinsurance. A doctor referral is required to receive this coverage.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) partially covers ambulance and transportation services. Ground and air ambulance services require a $325 copay and no coinsurance, but for transportation benefits, some services are covered though transportation to plan-approved health-related locations and any health-related locations is not covered in practice.
Emergency Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) covers emergency services 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 coverage are offered with no copay and no coinsurance, while worldwide emergency coverage requires a $150 copay and worldwide emergency transportation has a $325 copay.
Primary Care See details
Primary Care benefits are partially covered by Kaiser Permanente Senior Advantage San Diego Value (HMO), featuring no copay for primary care visits, mental health sessions, and telehealth, alongside copays of $0 to $15 for specialists and therapy services. There is no coinsurance for any of these covered services, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Kaiser Permanente Senior Advantage San Diego Value (HMO), offering key benefits like annual exams, fitness programs, and health education with no copay and no coinsurance. However, the plan does not cover 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, tobacco cessation, disease management, telemonitoring, bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage San Diego Value (HMO), featuring a $10 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for hearing aid fittings. Prescription hearing aids are covered up to $1,000 per ear every three years, but routine hearing exams, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services under the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan include routine eye exams with no copay and other exams with a copay of up to $10, both with no coinsurance. Eyewear, including lenses and frames, is covered up to a $250 combined limit every two years with no copay or coinsurance, though eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) partially covers dental services, as maxillofacial prosthetics and orthodontics are not covered. Covered Medicare dental services require no copay to a $10 copay and no coinsurance, while other covered dental services feature no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage San Diego Value (HMO), which includes chemotherapy, radiation, and other Medicare Part B drugs with copays ranging from no copay to $47 and coinsurance from no coinsurance to 20%. Medicare Part B insulin drugs are also covered under this plan with a copay of $12 to $35 and no coinsurance.
Dialysis Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) covers dialysis services with a 20% coinsurance and no copay. A doctor referral is required to access these covered services.
Medical Equipment See details
Medical equipment is covered under Kaiser Permanente Senior Advantage San Diego Value (HMO), including durable medical equipment, prosthetics, and diabetic supplies. There are no copays for these benefits, and coinsurance ranges from no coinsurance up to 20% depending on the specific device or supply.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Kaiser Permanente Senior Advantage San Diego Value (HMO) with a doctor referral. There is no copay or coinsurance for diagnostic procedures, lab services, and therapeutic radiological services, while outpatient X-rays require a $15 copay and diagnostic radiological services range from a $15 to $250 copay, with no coinsurance.
Home Health Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) covers home health services with no copay and no coinsurance. A doctor referral is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. This lack of coverage applies to all related sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) covers Skilled Nursing Facility (SNF) care with a doctor referral, offering no copay for days 1 to 20, a $150 daily copay for days 21 to 100, and no coinsurance. This benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage San Diego Value (HMO) partially covers other services, excluding meal benefits and Dual Eligible SNPs. Covered benefits include acupuncture and OTC items with no copay and no coinsurance, residential substance use treatment with a $100 copay and no coinsurance, and non-Medicare DME with no copay and no coinsurance to 20% coinsurance.
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