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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 2026, 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 4.5 out of 5 stars in 2026.
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 $45.00. 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) Medicare plan offers enhanced alternative drug coverage with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or standard mail, and no copay for Tier 5 specialty drugs. Standard generic drugs carry a $45 copay at preferred pharmacies, preferred brand drugs require a $90 copay, and non-preferred drugs incur a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Beneficiaries who qualify for the low-income subsidy, also known as Extra Help, may also receive a premium reduction to zero dollars.
Additional Benefits
The Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, telehealth, and preventive services. For emergency care, members pay a $150 copay, while inpatient hospital stays require a $225 daily copay for the first six days and no copay thereafter. Outpatient services are also highly accessible, with no coinsurance and copays ranging from no copay for lab work to $225 for outpatient hospital services. This plan includes valuable extra benefits such as routine vision and hearing exams with no copay, alongside a $450 annual eyewear allowance and a $600 hearing aid benefit per ear every two years. Dental care is covered up to $1,500 annually with no copay for preventive services, while comprehensive dental requires a 50% coinsurance. Additionally, members benefit from up to 26 one-way transportation trips per year with no copay and a $30 quarterly over-the-counter item allowance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS), excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Covered acute and psychiatric stays require a $225 daily copay for days 1 through 6, no copay for days 7 through 90 (plus days 91 through 999 for acute stays), and no coinsurance.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS) with no coinsurance. Under this plan, there is no copay for outpatient blood services, observation services, and group substance abuse sessions, while outpatient hospital services require a $225 copay, ambulatory surgical center services require a $100 copay, and individual substance abuse sessions require a $5 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS) with a $45 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS). Ground and air ambulance services require a $300 copay and no coinsurance, while transportation services are partially covered with no copay or coinsurance for up to 26 yearly one-way trips to plan-approved locations. Transportation to any other health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $30 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are also covered with copays ranging from $30 to $300 and no coinsurance.
Primary Care See details
Primary Care benefits are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS) with no coinsurance, featuring no copay for primary care and telehealth visits, and copays ranging from $0 to $20 for specialists, therapy, and mental health services. Chiropractic services are partially covered with a $20 copay, though routine chiropractic care is not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) provides partially covered preventive services with no coinsurance, including annual physical exams, fitness benefits, and health education for no copay. Kidney disease education is covered with a $0 to $15 copay and no coinsurance, though services like weight management, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS), offering routine hearing exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $600 per ear every two years, but OTC hearing aids and prescription aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision Services are partially covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS), offering routine eye exams and eyewear with no copay and no coinsurance, though eyewear upgrades are not covered. Members can utilize a combined maximum benefit of $450 every year for eyeglasses and contact lenses.
Dental Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) provides partially covered dental services up to a $1,500 annual maximum, with orthodontics excluded from coverage. Preventive care has no copay and no coinsurance, Medicare-covered dental has a $15 copay and no coinsurance, and comprehensive services require a 50% coinsurance and no copay.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) covers home infusion bundled services, which require prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require a copay ranging from no copay to $47 and coinsurance from no coinsurance to 20%, while Part B insulin drugs have a copay ranging from no copay to $35.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS) with a 20% coinsurance and no copay. A doctor referral is required to access this benefit.
Medical Equipment See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) covers medical equipment with prior authorization, including durable medical equipment (DME) with 0% to 20% coinsurance and no copay. Prosthetics, medical supplies, and diabetic shoes require 20% coinsurance and no copay, while diabetic supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and a doctor referral are required. Members pay no copay for lab services, diagnostic procedures, and outpatient X-rays, while therapeutic radiological services carry a $15 copay and diagnostic radiological services require a copay ranging from $35 to $275.
Home Health Services See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) covers home health services with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Silver DM (HMO-POS) plan, as none of the sub-services—including intensive cardiac, pulmonary, and SET for PAD services—are covered in practice.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) partially covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and days 36 to 100, and a $203 daily copay for days 21 to 35. Prior authorization and a referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Kaiser Permanente Senior Advantage Silver DM (HMO-POS), with acupuncture, meal benefits, and highly integrated SNP services excluded from coverage. Covered benefits include a $30 quarterly over-the-counter item allowance with no copay or coinsurance, as well as non-Medicare durable medical equipment which requires prior authorization and has no copay and a coinsurance ranging from no coinsurance to 20%.
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