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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 2025, 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 out of 5 stars in 2025.
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.
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 North (HMO) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, preferred generic drugs have a $3 copay at a preferred pharmacy and a $0 copay with standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan also has a premium reduction for those who qualify for the low-income subsidy.
Additional Benefits
The Kaiser Permanente Senior Advantage Core North (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $205 copay for days 1-5, with no copay for subsequent days. Outpatient services, including emergency and urgent care, have copays, and ambulance services have a $290 copay. This plan includes coverage for primary care, hearing, vision, and dental services, with copays ranging from $0 to $20 depending on the service. Additional benefits include home health services with no copay, and coverage for medical equipment, with coinsurance or no copay. This plan also offers an allowance for over-the-counter items and covers skilled nursing facility stays with no copay for the initial 20 days.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $205 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $205 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a $205 copay, Ambulatory Surgical Center (ASC) Services have a $100 copay, and Observation Services and Outpatient Blood Services have no copay. Individual and group sessions for outpatient substance abuse have copays between $5 and $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Core North (HMO) plan and requires prior authorization and a doctor referral. The copay for this benefit is $45.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered, including ground and air ambulance services with a $290 copay, and transportation services to a plan-approved health-related location with no copay. 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 by the Kaiser Permanente Senior Advantage Core North (HMO) plan. Emergency Services has a $140 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have copays of $15, $20, and $15, respectively. Mental Health and Psychiatric Services have minimum and maximum copays of $5 or $10, depending on the session type. Podiatry Services and Other Health Care Professional visits have copays that range from $0 to $20, and Opioid Treatment Program Services have a $20 copay. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, while additional preventive services such as Health Education, Fitness Benefit, and Remote Access Technologies may have copays. This plan does not cover In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Enhanced Disease Management. Other covered preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with a doctor referral required. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $950 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear 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. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, and has a combined maximum of $550 per year. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $20 copay, and other dental services with a $1,450 maximum benefit per year. Oral exams and dental x-rays have no copay, while other diagnostic services and cleanings have no copay, with fluoride treatments also having no copay. Restorative services, endodontics, periodontics, and implant services have 30% and 50% coinsurance, respectively. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Core North (HMO) plan. This includes coverage for Medicare Part B Insulin Drugs with a copay between $3.00 and $35.00, Medicare Part B Chemotherapy/Radiation Drugs with a copay between $3.00 and $47.00 and a coinsurance between 0% and 20%, and Other Medicare Part B Drugs with a copay between $3.00 and $47.00 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Core North (HMO) plan. A doctor referral is required, and there is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have no copay, while Lab Services also have no copay. Diagnostic Radiological Services have a copay between $30 and $110, Therapeutic Radiological Services have a $20 copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Core North (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not specify the copay or coinsurance. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Core North (HMO) plan, with a doctor referral and prior authorization required. You will have no copay for days 1-20, a $203 copay for days 21-39, and no copay for days 40-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $85 every three months, and DME and medical supplies not covered by Medicare with 0% to 20% coinsurance. Acupuncture, Meal Benefit, 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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