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Kaiser Permanente Senior Advantage Silver DM (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Silver DM (HMO-POS). 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 Silver DM (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) is a HMO-POS 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 Silver DM (HMO-POS) 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 Silver DM (HMO-POS).
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 Silver DM (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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 $3000.00 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 Silver DM (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay varying copays for your prescriptions depending on the drug tier and pharmacy. For example, you'll have no copay for preferred generic drugs at a preferred pharmacy or through the mail, and $20.00 at a standard pharmacy. For non-preferred drugs, you'll pay 33% coinsurance. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you will pay nothing for your drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan provides comprehensive coverage with a range of benefits. This plan offers inpatient hospital care, outpatient services, and emergency services with varying copays. You'll also have access to primary care, preventive services, hearing, vision, and dental services, with some services having no copay. Additional benefits include ambulance and transportation services, home health, and cardiac rehabilitation services, along with coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility care. This plan also provides home infusion bundled services, dialysis services, and other services, such as an over-the-counter item benefit. Some services require referrals or prior authorization, so it's important to check the details for each service.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan. For acute and psychiatric care, there is a $155 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $155 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with an $80 copay, Outpatient Substance Abuse Services with a $5 copay for individual sessions and no copay for group sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered and requires prior authorization and a doctor referral, with a $45 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 26 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $25 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Primary Care Physician Services, and Additional Telehealth benefits have no copay. Chiropractic Services has a $20 copay. Occupational Therapy Services has a $10 copay and requires a referral. Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a $10 copay and require a referral. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have varying copays. Podiatry Services has varying copays, and Routine Foot Care is not covered.
Preventive Services See details
Preventive Services include no copay for Medicare-covered services, annual physical exams, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, along with other preventive services. Health Education, In-Home Support Services, and Fitness Benefits are covered with no copay, while In-Home Safety Assessments, Personal Emergency Response Systems (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, Nutritional/Dietary Benefit, Home-Based Palliative Care, 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, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,000 per ear every two years, and are limited to 2 visits every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, with no copay for eye exams and eyewear. Eyewear has a combined maximum benefit of $550 every year.
Dental Services See details
Dental services include a $10 copay for Medicare dental services. Other dental services offer oral exams and dental X-rays with no copay. Restorative services have 30% to 50% coinsurance, while adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery have 50% coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $0 and $35, and Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47, and 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 Silver DM (HMO-POS) plan, and a doctor referral is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan, including Durable Medical Equipment with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment, with no copay for Diabetic Supplies and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $35 and $65, Therapeutic Radiological Services have a copay of $10, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for services, but the amount is not specified in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan. There is no copay for days 1-20 and days 38-100, but there is a $203 copay for days 21-37.
Other Services See details
Other Services include over-the-counter items with a maximum benefit of $100 every three months, and other services with coinsurance of 0% - 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.
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