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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 2026, 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 4.5 out of 5 stars in 2026.
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 $5500.00 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:
Sign up for Kaiser Permanente Senior Advantage Core South (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Core South (HMO) plan features no drug deductible, allowing your prescription coverage to begin immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at preferred pharmacies or through standard mail order, as well as no copay for Tier 6 vaccines. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a one-month supply at preferred pharmacies and no copay through standard mail order. For brand-name and specialty medications, costs vary depending on the tier and your choice of pharmacy. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs require a $90 copay. Tier 5 specialty drugs require a 33% coinsurance across preferred, standard, and mail-order options.
Additional Benefits
The Kaiser Permanente Senior Advantage Core South (HMO) offers comprehensive medical coverage featuring no copay for primary care visits and telehealth, while specialist visits require a $30 copay. Inpatient hospital stays require a $340 copay for days 1 through 6, followed by no copay for days 7 through 90 with no coinsurance. Emergency room services carry a $130 copay, which is waived if admitted, and urgent care visits require a $40 copay. This plan also provides valuable supplemental benefits, including no copays or coinsurance for routine dental, vision, and hearing exams. Members benefit from a $1,000 annual dental maximum, a $200 yearly eyewear allowance, and up to 22 one-way transportation trips per year to health-related locations at no cost. Additionally, the plan includes a $25 quarterly over-the-counter item allowance with no copay.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Core South (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $340 copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers outpatient services with no coinsurance, including a $340 copay for outpatient hospital services, a $210 copay for ambulatory surgical center services, and no copay for observation services. Outpatient substance abuse sessions carry a $5 to $10 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Kaiser Permanente Senior Advantage Core South (HMO) plan with a $45.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers ground and air ambulance services with a $375 copay and no coinsurance. Transportation services are partially covered, offering up to 22 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Kaiser Permanente Senior Advantage Core South (HMO) with a $130 copay (waived if admitted) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance, featuring a $130 copay for emergency services, a $40 copay for urgent care, and a $375 copay for emergency transportation.
Primary Care See details
Primary care benefits under the Kaiser Permanente Senior Advantage Core South (HMO) are partially covered, as chiropractic services are not covered in practice. Covered services feature no copay and no coinsurance for primary care and telehealth, a $30 copay and no coinsurance for specialist visits and opioid treatment, and a $25 copay and no coinsurance for physical, occupational, and speech therapies. Mental health and psychiatric sessions are also available with a $5 to $10 copay and no coinsurance.
Preventive Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers preventive services with no coinsurance and no copay for annual physicals, glaucoma screenings, and diabetes training, though kidney disease education carries a copay of $0 to $30. Additional preventive benefits are partially covered with no copay or coinsurance for fitness and health education, while services such as in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers hearing exams, fittings, and prescription hearing aids with no copay and no coinsurance, providing up to $300 per ear every two years for prescription aids with a referral. However, this benefit is only partially covered, as 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 Core South (HMO), offering routine eye exams and eyewear with no copays and no coinsurance. Eyewear has a combined maximum benefit of $200 per year, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Core South (HMO) offers partially covered dental services with a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care such as cleanings and exams. Medicare-covered dental requires a $30 copay and no coinsurance, while comprehensive services like restorative care have no copay and 50% coinsurance, though orthodontics and other preventive dental services are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers home infusion bundled services with prior authorization, featuring Part B insulin drugs with a $5.00 to $35.00 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and infusion drugs require a copay of $5.00 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 Core South (HMO) plan with no copay and a 20% coinsurance, although a referral is required to receive care.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Core South (HMO), featuring no copay and no coinsurance to 20% coinsurance for durable medical equipment. Prosthetics and medical supplies require no copay and 20% coinsurance, diabetic therapeutic shoes carry 20% coinsurance, and diabetic supplies are covered with no copay, with prior authorization required.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Diagnostic tests, procedures, and lab services have no copay, while radiological services carry a $5 copay for outpatient X-rays, a minimum $30 copay for therapeutic radiology, and a minimum $75 copay for diagnostic radiology.
Home Health Services See details
Kaiser Permanente Senior Advantage Core South (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Kaiser Permanente Senior Advantage Core South (HMO) with no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered, with copays ranging from $0 to $30.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Core South (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 49 to 100, and a $203 daily copay for days 21 to 48. Prior authorization and referrals are required, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Core South (HMO) offers partially covered other services, excluding acupuncture and meal benefits. Covered benefits include over-the-counter (OTC) items with no copay and no coinsurance up to $25 every three months, and non-Medicare durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance.
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