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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 2026, 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 2026.
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 offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay a $2 copay for preferred generic drugs, a $45 copay for standard generics, and a $95 copay for preferred brand drugs at standard pharmacies and through standard mail. Non-preferred drugs require a 31% coinsurance, while specialty tier drugs have no copay at standard pharmacies. These cost-sharing rates apply until your total drug costs reach $2,100.00, after which you enter the catastrophic coverage phase. Once your yearly out-of-pocket drug costs reach this $2,100.00 threshold, you pay nothing for covered Medicare Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy can benefit from reduced premiums and no cost for Part D drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Ventura Value (HMO) plan offers robust coverage with no copay and no coinsurance for primary care visits, specialist consultations, preventive care, and home health services. Members also benefit from dental and vision coverage with no copays for exams, alongside valuable allowances for eyewear and prescription hearing aids. For more intensive medical needs, inpatient hospital stays require a $225 daily copay for the first five days, while outpatient hospital services range from no copay to a $200 copay. Emergency room visits carry a $150 copay that is waived if admitted, while urgent care services are available with no copay. Routine diagnostic lab tests and diabetic supplies are fully covered with no copay or coinsurance. Other medical needs, such as durable medical equipment and dialysis, generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) partially covers inpatient hospital services, which require a $225 daily copay for days 1 through 5, no copay for days 6 and beyond, and no coinsurance. While acute and psychiatric stays are covered, non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) covers outpatient services with no coinsurance. Patients will pay a $200 copay for ambulatory surgical center services, no copay to $200 for outpatient hospital services, no copay to $150 per stay for observation services, and no copay for outpatient blood and substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Ventura Value (HMO) with no copay and no coinsurance. A doctor referral is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Kaiser Permanente Senior Advantage Ventura Value (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground and air ambulance services require a $350 copay and no coinsurance.
Emergency Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed and worldwide urgent services are covered with no copay and no coinsurance, while worldwide emergency care has a $150 copay and worldwide emergency transportation has a $350 copay, both with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered under Kaiser Permanente Senior Advantage Ventura Value (HMO), with no copay and no coinsurance for primary care, specialist, psychiatric, and telehealth visits. Occupational, physical, and speech therapies require copays ranging from $0 to $15 with no coinsurance, while routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Senior Advantage Ventura Value (HMO) plan with no copays and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness benefits. However, several supplemental sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, bathroom safety devices, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) features partially covered hearing services with no copays or coinsurance for covered exams and hearing aid fitting evaluations. The plan provides up to $1,000 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
Vision services are partially covered under the Kaiser Permanente Senior Advantage Ventura Value (HMO) plan, featuring eye exams and eyewear with no copay and no coinsurance. The plan provides a $250 combined allowance every two years for contacts and eyeglasses, but eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Ventura Value (HMO), offering covered benefits with no copay and no coinsurance. While preventive care, exams, and select restorative services are covered, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Ventura Value (HMO), with Medicare Part B chemotherapy and other Part B drugs requiring a copay ranging from no copay to $47 and coinsurance ranging from no coinsurance to 20%. Covered Medicare Part B insulin drugs require a $10 to $35 copay and no coinsurance.
Dialysis Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) covers dialysis services with a 20% coinsurance and no copay. A doctor referral is required to receive this covered benefit.
Medical Equipment See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and medical supplies have no copay and up to 20% coinsurance, while prosthetic devices and diabetic shoes require a 20% coinsurance and no copay. Diabetic supplies are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Ventura Value (HMO) with a doctor's referral and no coinsurance. Members pay no copay for lab services, diagnostic procedures, and therapeutic radiological services, a $15 copay for outpatient X-rays, and a $15 to $250 copay for diagnostic radiological services.
Home Health Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) covers Home Health Services with no copay and no coinsurance. A doctor referral is required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) indicates that some services are covered under Cardiac Rehabilitation Services, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, meaning there is no copay or coinsurance coverage available for these services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) partially covers Skilled Nursing Facility (SNF) care with a doctor referral and no coinsurance. There is no copay for days 1 to 20 and a $100 daily copay for days 21 to 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Ventura Value (HMO) offers partially covered Other Services, excluding meal benefits and dual eligible SNPs. Acupuncture and over-the-counter items feature no copay and no coinsurance, residential substance use treatment requires a $100 copay and no coinsurance, and select medical supplies carry no copay and no coinsurance to 20% coinsurance.
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