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Kaiser Permanente Senior Advantage Ventura Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Ventura 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 Ventura Value (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Ventura Value (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Ventura 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 Ventura 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 Ventura 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 Ventura 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 Ventura Value (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, depending on the drug tier and whether you use a preferred or standard pharmacy. For example, preferred generic drugs have no copay, while standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Kaiser Permanente Senior Advantage Ventura Value (HMO) plan offers a range of benefits with varying costs. Many services, like primary care, preventive services, and home health, have no copay. Other services, such as inpatient hospital stays, outpatient services, and ambulance services, have copays ranging from $0 to $300, and some services also have coinsurance. This plan includes coverage for hearing, vision, and dental services. Hearing aids are covered up to $1,000 every three years, eye exams have no copay, and eyewear has a maximum benefit of $250 every two years. Dental services include no copay for many services, with some copays for restorative, adjunctive, periodontics, and oral surgery.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require a doctor's referral. For Inpatient Hospital-Acute, you will pay a $180 copay for days 1-5, and no copay for days 6-90, while additional days (91-999) have no copay. Inpatient Hospital Psychiatric has the same cost structure as Inpatient Hospital-Acute. 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 $100, Observation Services with a copay between $0 and $140, Ambulatory Surgical Center (ASC) Services with a $100 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 with a doctor's referral and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Ventura Value (HMO) plan. Ground and Air Ambulance Services have a $300 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 and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Ventura Value (HMO) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational Therapy Services have a copay between $2 and $5, and Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $5. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include Medicare-covered zero dollar services, an annual physical exam with no copay, and additional preventive services including health education, nutritional/dietary benefits, fitness benefits, and remote access technologies, all of which have a $0 copay. Other services such as in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), and more are not covered. Additionally, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits are covered with no copay.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, but routine hearing exams are not covered. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to $1,000 every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with no copay, and eyewear with a combined maximum benefit of $250 every two years. Upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare and other dental services, with additional benefits like oral exams, dental x-rays, and cleanings also covered. Restorative services have a copay between $36 and $124, and adjunctive general services have a $58 copay. Periodontics have a copay between $0 and $71, and oral and maxillofacial surgery has a copay between $0 and $229. Endodontics, prosthodontics, and implant services are available as optional supplemental benefits, while 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, and Medicare Part B Chemotherapy/Radiation Drugs. The copay for Medicare Part B Insulin Drugs is between $10 and $35, while the copay for Medicare Part B Chemotherapy/Radiation Drugs is between $0 and $47, with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Ventura Value (HMO) plan with a doctor referral required. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $225, and Therapeutic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Ventura 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 Ventura Value (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
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, but there is a $100 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Ventura Value (HMO) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit of $120 every three months. Other services include residential substance use disorder and MH treatment with a $100 copay, and DME and prosthetic/medical supplies with 0-20% coinsurance. However, meal benefits, 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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