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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your medications. For example, you'll pay a $10 copay for preferred generic drugs at a standard pharmacy. For specialty tier drugs, there is no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage San Diego Value (HMO) plan offers a range of benefits with varying costs. You'll have a $100 copay for inpatient hospital stays, and no copay for many outpatient services, primary care, preventive services, and home health services. The plan includes coverage for hearing, vision, and dental services, with copays for exams and some services. You will also have access to services such as ambulance, emergency, and diagnostic services, as well as medical equipment, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $100 copay for days 1-5, and no copay for days 6-90; additional days have no copay. Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $50, observation services with a copay between $0 and $140, ambulatory surgical center services with a $50 copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan with no copay. A doctor referral is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. Ground and air ambulance services have a $200 copay, with no coinsurance, 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 by the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $200 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The Kaiser Permanente Senior Advantage San Diego Value (HMO) plan covers primary care physician services, chiropractic services, and occupational therapy services with no copay. Physician specialist services have a $5 copay, while mental health specialty services, psychiatric services, and other health care professionals have varying copays. Physical therapy and speech-language pathology services, as well as additional telehealth benefits, have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, kidney disease education, and other preventive services, with no copay for most services. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Fitness Benefit, and Remote Access Technologies, all with no copay. Some preventive services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include Hearing Exams, with a $5 copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered with a maximum benefit of $1,000 per ear every three years, and Prescription Hearing Aids (all types) are covered for 2 visits every three years.
Vision Services See details
Vision services include eye exams with a copay of $0-$5, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $250 every two years, and upgrades are not covered.
Dental Services See details
Dental Services are covered under the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. Medicare Dental Services have a copay between $0 and $5, and other dental services have no copay; however, Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. Medicare Part B Insulin Drugs have a copay of $10-$35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $0-$47. Other Medicare Part B drugs have a copay of $0-$47, and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan, but a doctor referral is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a 0-20% coinsurance, prosthetics and medical supplies with a coinsurance, and diabetic equipment with varying copays and coinsurance depending on the service. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral required. Diagnostic Procedures/Tests have no copay, while Lab Services also have no copay. Diagnostic Radiological Services have a copay of up to $215, Therapeutic Radiological Services have no copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage San Diego 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 not covered by the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor's referral is required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage San Diego Value (HMO) plan. You will have no copay for days 1-20, and a $100 copay for days 21-100.
Other Services See details
The Kaiser Permanente Senior Advantage San Diego Value (HMO) plan covers acupuncture with no copay, and over-the-counter items up to $120 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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