A non-government entity
Kaiser Permanente Senior Advantage Core DM (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Core DM (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 Core DM (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Core DM (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Denver Metro Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Core DM (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 Core DM (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 Core DM (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 $10.00. 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 $3300.00 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:
Sign up for Kaiser Permanente Senior Advantage Core DM (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Senior Advantage Core DM (HMO) plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, preferred generic drugs have a $3 copay at preferred pharmacies and a $20 copay at standard pharmacies. In the initial coverage phase, the plan covers your drug costs until your total drug costs reach $2,000. After this, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Core DM (HMO) plan offers a wide range of benefits with varying costs. You can expect to pay a copay for services like inpatient hospital stays, outpatient services, and specialist visits, with some services like primary care, preventive services, and home health services having no copay. The plan also covers dental, vision, and hearing services with copays and coinsurance, and offers additional benefits like ambulance, emergency, and transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $195 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $180 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $90 copay, Outpatient Substance Abuse Services with a $10 copay for Individual Sessions and a $5 copay for Group Sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Core DM (HMO) plan, requiring prior authorization and a doctor referral. The copay for this benefit is $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $290 copay, and transportation services with no copay. Transportation Services to any health-related location are not covered, but the plan covers 12 one-way trips per year to a plan-approved health-related location, using rideshare services, bus/subway, medical transport, or other methods.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $140 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services have no copay, Chiropractic Services have a $20 copay, Occupational Therapy Services have a $10 copay, Physician Specialist Services have a $15 copay, Mental Health Specialty Services have a $10 copay for individual sessions and a $5 copay for group sessions, Podiatry Services have a $15 copay for Medicare-covered services and routine foot care, Other Health Care Professional services have a copay between $0 and $15, Psychiatric Services have a $10 copay for individual sessions and a $5 copay for group sessions, Physical Therapy and Speech-Language Pathology Services have a $10 copay, Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $15 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, along with an annual physical exam with no copay. Other preventive services include Health Education, In-Home Support Services, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services has a maximum copay of $15, while Other Preventive Services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount per period, up to $600 every two years, with a doctor referral required. Prescription hearing aids are covered for all types, but are limited to two visits every two years. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, and eyewear has no copay, with a combined maximum plan benefit coverage of $500 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $15 copay, Oral Exams with no copay, Dental X-Rays with no copay, Other Diagnostic Dental Services with no copay, Prophylaxis (Cleaning) with no copay, and Fluoride Treatment with no copay, with a maximum benefit of $1450 per year. Restorative Services are covered with a 30% coinsurance, Endodontics and Periodontics are covered with a 50% coinsurance, and Implant Services are covered with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Part B insulin drugs with a copay between $3 and $35, Medicare Part B Chemotherapy/Radiation Drugs with a copay between $3 and $47, and Other Medicare Part B Drugs with a copay between $3 and $47 and a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Core DM (HMO) plan, and a doctor referral is required. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay between $40 and $90, Therapeutic Radiological Services with a copay of $15, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Core DM (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 the plan does not cover the services themselves. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. There is no copay for days 1-20, a $203 copay for days 21-39, and no copay for days 40-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items with a maximum benefit of $80 every three months, and other services that may have a coinsurance of 0% to 20%. Acupuncture, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved