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Kaiser Permanente Senior Advantage Core South (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Core South (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 South (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Core South (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Southern Colorado. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Core South (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 South (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 South (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.
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 $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 South (HMO) plan has an enhanced alternative drug benefit. The plan has a $0 deductible. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $0 copay for mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Core South (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $235 for days 1-5, then no copay for days 6-90, while outpatient services have copays between $0 and $215. Emergency services have a $140 copay. This plan includes no copay for many services, such as eye exams, hearing exams, and primary care physician services. It also offers coverage for home health services with no copay, and provides benefits for dental, vision, and hearing services. The plan also covers prescription hearing aids, with a benefit of $600 per ear every two years.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered. For days 1-5, there is a $235 copay, and for days 6-90, there is no copay; additional days for acute care have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $215 copay, observation services with no copay, ambulatory surgical center services with a $140 copay, outpatient substance abuse services with a copay of $10 for individual sessions and $5 for group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Core South (HMO) plan, and requires prior authorization and a doctor referral. The copay for this service is $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Kaiser Permanente Senior Advantage Core South (HMO) plan. Ground and air ambulance services have a $290 copay, and transportation services to a plan-approved health-related location have no copay, with a limit of 22 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Core South (HMO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $25 copay and no coinsurance, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $290 copay, with no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (with Routine Care not covered), a $25 copay for Occupational Therapy Services, and a $25 copay for Physician Specialist Services (referral required). Mental Health Specialty Services include a $10 copay for Individual Sessions, and a $5 copay for Group Sessions. Podiatry Services include a $25 copay for Medicare-covered services and Routine Foot Care (limited to 4 visits per year). Other Health Care Professional services have a copay between $0 and $25, and Psychiatric Services have a $10 copay for Individual Sessions and a $5 copay for Group Sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay, Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
The Kaiser Permanente Senior Advantage Core South (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, with specific services such as health education, fitness benefits, and remote access technologies having a copay. Other services such as in-home safety assessments, personal emergency response systems, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered with a plan-specified amount of $600 per ear 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 includes coverage for eye exams and eyewear. Eye exams and eyewear have no copay, while eyewear has a combined maximum benefit of $350 every year. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, Oral Exams and Dental X-Rays with no copay, and other diagnostic and preventive services with no copay. Restorative Services are covered with a 30% coinsurance, while Endodontics, Periodontics, and Implant Services have a 50% coinsurance. Orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a copay between $5.00 and $35.00, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $5.00 and $47.00 with coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $5.00 and $47.00 with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment with various cost-sharing. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay between $35 and $130, therapeutic radiological services with a $25 copay, and outpatient X-ray services with a $5 copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Core South (HMO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan does not specify a copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Core South (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20 and days 40-100, but there is a $203 copay for days 21-39; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include over-the-counter items with a maximum benefit of $70 every three months, and other services with a 0-20% coinsurance for DME and medical supplies not covered by Medicare. 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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