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Kaiser Permanente Senior Advantage Core North (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Core North (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 North (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Core North (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Northern 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 North (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 North (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 North (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. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced 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 $5700.00 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 North (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. You will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail order, while Tier 2 generic drugs have no copay through standard mail order and a low $5 copay for a one-month supply at preferred pharmacies. Standard pharmacies are also available but generally carry higher copays for these routine medications. For higher-tier medications, Tier 3 preferred brands start at a $45 copay and Tier 4 non-preferred drugs start at a $90 copay when using preferred pharmacies or standard mail order. Specialty drugs in Tier 5 require a 33% coinsurance across all pharmacy options, while Tier 6 vaccines are covered with no copay for a one-month supply. Utilizing preferred pharmacies and standard mail order services provides the most cost-effective way to fill your prescriptions under this plan.
Additional Benefits
The Kaiser Permanente Senior Advantage Core North (HMO) plan offers affordable healthcare coverage with no copays or coinsurance for primary care, telehealth visits, and annual physicals. Specialist visits require a $25 copay, while inpatient hospital stays have a $275 daily copay for the first six days and no copay thereafter. Emergency care is available for a $130 copay, which is waived if you are admitted, and urgent care visits require a $40 copay. Additional perks include no copays for routine vision and hearing exams, which feature generous allowances for eyewear and prescription hearing aids. Preventive dental care is also covered with no copay up to a $1,000 annual limit, while comprehensive dental services require 50% coinsurance. Members also benefit from no-copay transportation services for up to 22 one-way trips per year and a $25 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Kaiser Permanente Senior Advantage Core North (HMO) with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 and beyond. Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Kaiser Permanente Senior Advantage Core North (HMO) with no coinsurance, featuring a $275 copay for outpatient hospital services and a $185 copay for ambulatory surgical center services. Additionally, outpatient blood and observation services require no copay or deductible, while outpatient substance abuse sessions have a $5 copay for group visits and a $10 copay for individual visits.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Core North (HMO) covers partial hospitalization with a $45.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers ground and air ambulance services with a $375 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 22 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers emergency services with a $130 copay, which is waived if you are admitted to the hospital, and no coinsurance. Urgently needed care requires a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $375 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Core North (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $15 copay and no coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers preventive services with no coinsurance and no copay for annual physicals, fitness benefits, and glaucoma screenings, though kidney disease education has a copay of up to $25. Some additional preventive services are not covered, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers hearing exams and prescription hearing aids with no copay and no coinsurance, offering up to a $450 maximum benefit per ear every two years. However, hearing services are only partially covered, as over-the-counter (OTC) hearing aids, as well as 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 North (HMO) with no copay and no coinsurance for routine eye exams and eyewear, which includes a $350 annual maximum benefit for contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers Medicare-covered dental services for a $25 copay and no coinsurance, alongside preventive care with no copay and no coinsurance up to a $1,000 annual limit. Comprehensive services like restorative care and periodontics are covered with 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 North (HMO) covers home infusion bundled services with prior authorization, including insulin with a $5.00 to $35.00 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require a copay ranging from $5.00 to $47.00 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers dialysis services with no copay and a 20% coinsurance. A referral is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Senior Advantage Core North (HMO) plan with prior authorization, including durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Prosthetic devices and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies feature no copay and diabetic therapeutic shoes require 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Core North (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for diagnostic procedures, lab services, and outpatient X-rays, while diagnostic radiological services have a minimum copay of $50 and therapeutic radiological services have a minimum copay of $25.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Core North (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Kaiser Permanente Senior Advantage Core North (HMO) with no coinsurance and a referral requirement. While some services are covered, specific programs including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, carrying copays ranging from $0 to $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Kaiser Permanente Senior Advantage Core North (HMO) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and days 50 through 100, but a $203 daily copay applies for days 21 through 49.
Other Services See details
Kaiser Permanente Senior Advantage Core North (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $25 quarterly limit, as well as select non-Medicare durable medical equipment with no copay and 0% to 20% coinsurance. Acupuncture and meal benefits are not covered.
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