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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 2025, 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 out of 5 stars in 2025.
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 $170.40. 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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at preferred and mail order pharmacies. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Gold (HMO-POS) plan offers comprehensive coverage with a focus on outpatient services. It includes no copay for primary care, annual physical exams, and many other services. The plan provides coverage for hospital stays, with a copay for the first few days, and offers additional benefits like dental, vision, and hearing services, with specific copays and annual maximums for some services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For the first 5 days of an inpatient stay, there is a $140 copay per day, and for days 6-90, there is no copay; additional days for acute inpatient hospital stays are covered with no copay, but additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $100 copay, observation services with no copay, ambulatory surgical center services with a $75 copay, and outpatient substance abuse services with no copay for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan, but requires prior authorization and a doctor's referral. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan. Ground and air ambulance services have a $200 copay, while transportation services to a plan-approved health-related location have no copay, with a limit of 40 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $130 copay and no coinsurance, Urgently Needed Services has a $25 copay and no coinsurance, Worldwide Emergency Coverage has a $130 copay and no coinsurance, Worldwide Urgent Coverage has a $25 copay and no coinsurance, and Worldwide Emergency Transportation has a $200 copay and no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $10 copay. Physician Specialist Services have a $10 copay. Mental Health Specialty Services and Psychiatric Services both have no copay for individual and group sessions. Podiatry Services and Other Health Care Professional services have a copay between $0 and $15. Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams, and other preventive services. Annual physical exams have no copay. Other preventive services have a $0-$10 copay, depending on the service.
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 with a plan maximum of $1,000 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for eye exams and eyewear. Eyewear has a combined maximum benefit of $550 every year, and contact lenses are covered. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $10 copay, and other dental services with a $1,650 annual maximum. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay. Restorative Services are covered with 30% - 50% coinsurance, and Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are covered with 50% coinsurance. Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan. Medicare Part B Insulin Drugs have a copay between $0.00 and $35.00, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a copay between $0.00 and $47.00, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan, requiring a doctor's referral. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies also have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay between $20 and $75, therapeutic radiological services with a copay of $10, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage Gold (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-10, and a $20 copay for days 11-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Gold (HMO-POS) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $100 every three months, and Other 1 benefits are covered with coinsurance between 0% and 20% for DME and medical supplies not covered by Medicare; prior authorization is required for Other 1.
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