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Kaiser Permanente Senior Advantage Gold (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Gold (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 Gold (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Gold (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 Gold (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 Gold (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 Gold (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $189.00. 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 Gold (HMO-POS) plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or standard mail order. Additionally, Tier 6 vaccines are covered with no copay for a one-month supply at both preferred and standard pharmacies. For Tier 3 preferred brand drugs, copays start at $45 for a one-month supply at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs require a $90 copay. Standard pharmacies charge slightly higher copays, such as $47 for Tier 3 and $100 for Tier 4 drugs. Specialty medications under Tier 5 carry a 33% coinsurance across preferred, standard, and mail-order options.
Additional Benefits
The Kaiser Permanente Senior Advantage Gold (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing and no coinsurance for many core services. Members pay no copay for primary care visits, telehealth services, and routine preventive care, while specialist visits require a low $15 copay. For hospital stays, there is no coinsurance, with inpatient care requiring a $215 daily copay for the first six days and no copay thereafter, and emergency room visits carrying a $150 copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing services with no deductibles and no copays for routine exams. Preventive dental is covered with no copay up to a $1,500 annual limit, while routine eyewear is covered up to $350 annually and hearing aids up to $500 per ear every two years. Additionally, members benefit from no copay for home health services, up to 40 free one-way transportation trips, and a $35 quarterly over-the-counter allowance.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $215 daily copay for days 1 through 6 and no copay for days 7 through 90. Additional acute hospital days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Gold (HMO-POS) with no coinsurance across all services, featuring a $215 copay for outpatient hospital visits and a $125 copay for ambulatory surgical center services. There is no copay for outpatient blood services, observation stays, or group substance abuse sessions, while individual substance abuse sessions require a $5 copay.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers partial hospitalization with a $45.00 copay and no coinsurance. This benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services are partially covered, offering up to 40 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any other health-related locations is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers emergency services with a $150 copay (waived if admitted) and urgently needed care with a $35 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance, requiring copays of $150 for emergency care, $35 for urgent care, and $250 for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Physical and occupational therapy services have a $10 copay and no coinsurance, whereas chiropractic services are only partially covered with routine care excluded.
Preventive Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers preventive services, such as annual physical exams and diabetes training, with no copay and no coinsurance, while kidney disease education has no coinsurance and a copay of $0 to $15. Additional preventive services are only partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) provides hearing services with no deductible, no copay, and no coinsurance, which includes covered routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered up to $500 per ear every two years, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Gold (HMO-POS), featuring no copay, no coinsurance, and no deductible for routine eye exams and eyewear up to a $350 annual combined limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under Kaiser Permanente Senior Advantage Gold (HMO-POS), with orthodontics and other preventive dental services excluded from coverage. Medicare-covered dental services require a $15 copay and no coinsurance, while covered preventive services have no copay and no coinsurance up to a $1,500 annual maximum. Covered comprehensive services, such as restorative and endodontic care, require no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin with no coinsurance and a copay ranging from no copay to $35.00. Other covered Part B chemotherapy, radiation, and miscellaneous drugs feature a copay ranging from no copay to $47.00 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan with no copay and a 20% coinsurance. A referral is required to access these covered services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers medical equipment with no copay, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic supplies are covered with no copay, while therapeutic shoes or inserts carry a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers diagnostic and radiological services with no coinsurance, subject to prior authorization and referral requirements. Members pay no copay for lab services, diagnostic tests, and outpatient X-rays, while diagnostic radiological services require a minimum $45 copay and therapeutic radiological services require a minimum $15 copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan with no coinsurance and require a referral, although some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 10 and a $20 daily copay for days 11 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Gold (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to $35 every three months, and select non-Medicare covered DME and medical supplies with no copay and 0% to 20% coinsurance. Acupuncture and meal benefits are not covered under this plan.
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