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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 2026, 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 4.5 out of 5 stars in 2026.
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 $7.00. 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 $3800.00 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 Core DM (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, preferred generic drugs have a $3 copay at preferred pharmacies and no copay through standard mail. Standard generic drugs carry a $45 copay at preferred pharmacies, while preferred brand drugs cost a $90 copay at preferred pharmacies and standard mail. Non-preferred drugs require a 33% coinsurance, but specialty tier drugs are covered with no copay at both preferred and standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you will enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, those who qualify for the low-income subsidy will pay nothing for their Part D coverage.
Additional Benefits
The Kaiser Permanente Senior Advantage Core DM (HMO) plan offers comprehensive medical coverage with many essential services requiring no copay and no coinsurance, including primary care visits, telehealth, and routine preventive exams. For inpatient hospital stays, members pay a $245 copay for days one through six and no copay for days seven through ninety, with no coinsurance. Outpatient hospital services require a $245 copay, while emergency room visits carry a $130 copay that is waived if the patient is admitted. This plan also features valuable supplemental benefits, such as a $400 annual vision allowance and a $1,000 yearly dental limit with no copay for preventive dental care. Routine hearing exams have no copay, and members receive a $550 prescription hearing aid allowance per ear every two years alongside a $25 quarterly over-the-counter credit. Additionally, the plan covers up to 12 one-way transportation trips per year to approved locations with no copay or coinsurance.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers inpatient acute and psychiatric hospital services with a $245 copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Core DM (HMO) with no coinsurance, featuring a $245 copay for outpatient hospital services and a $135 copay for ambulatory surgical center services. Additionally, there is no copay for observation or blood services, while outpatient substance abuse services require a $5 copay for group sessions and a $10 copay for individual sessions.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers partial hospitalization services with a $45 copay and no coinsurance. Prior authorization and a doctor referral are required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Kaiser Permanente Senior Advantage Core DM (HMO), though transportation is only partially covered because trips to any health-related location are not covered. Ground and air ambulance services require a $325 copay and no coinsurance, while up to 12 yearly one-way trips to plan-approved locations are provided with no copay and no coinsurance.
Emergency Services See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $130, $30, and $325 respectively, and no coinsurance.
Primary Care See details
Primary care benefits are covered by Kaiser Permanente Senior Advantage Core DM (HMO), although chiropractic services are only partially covered because routine chiropractic care is not covered. Members pay no copay and no coinsurance for primary care physician visits and telehealth services, while other covered services like specialist and therapy visits require copays ranging from $5 to $20 with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Kaiser Permanente Senior Advantage Core DM (HMO), featuring no coinsurance and no copay for annual exams, fitness benefits, and most screenings, while kidney disease education has a copay of up to $20. Sub-services that are not covered include 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, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered under the Kaiser Permanente Senior Advantage Core DM (HMO) plan, offering routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $550 maximum allowance per ear every two years, but over-the-counter (OTC) hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Kaiser Permanente Senior Advantage Core DM (HMO), featuring no copay, no deductible, and no coinsurance for routine eye exams and eyewear. The benefit is partially covered because eyewear upgrades are not covered, but members receive a $400 yearly allowance for contact lenses and eyeglasses.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Core DM (HMO) up to a $1,000 annual limit, though orthodontics is not covered. Preventive services require no copay or coinsurance, Medicare-covered services carry a $20 copay and no coinsurance, and comprehensive services like endodontics require a 50% coinsurance and no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Kaiser Permanente Senior Advantage Core DM (HMO) and require prior authorization. Covered chemotherapy, radiation, and other Part B drugs require a $3.00 to $47.00 copay and no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $3.00 to $35.00 copay and no coinsurance.
Dialysis Services See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers dialysis services with no copay and a 20% coinsurance. A doctor referral is required to receive these covered benefits.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Core DM (HMO), with durable medical equipment requiring no copay and between no coinsurance and 20% coinsurance. Prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance, while diabetic supplies feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and doctor referrals are required. Members pay no copay for diagnostic procedures, lab services, and outpatient x-rays, while therapeutic radiological services require a $20 copay and diagnostic radiological services have a copay ranging from $40 to $280.
Home Health Services See details
Kaiser Permanente Senior Advantage Core DM (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically offered by the Kaiser Permanente Senior Advantage Core DM (HMO) plan, and while some services are covered, in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Kaiser Permanente Senior Advantage Core DM (HMO), as additional days beyond the Medicare-covered limit are not covered. Patients pay no coinsurance, with no copay for days 1 through 20 and days 40 through 100, and a $203 daily copay for days 21 through 39.
Other Services See details
Other Services for Kaiser Permanente Senior Advantage Core DM (HMO) are partially covered, with acupuncture, meal benefits, and dual eligible SNP services not covered. Covered benefits include a $25 quarterly over-the-counter allowance with no copay or coinsurance, as well as non-Medicare DME and medical supplies which require prior authorization and feature no copay and no coinsurance to 20% coinsurance.
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