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Kaiser Permanente Senior Advantage Silver North (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Silver North (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 Silver North (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Silver North (HMO-POS) is a HMO-POS 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 Silver North (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 Silver North (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 Silver North (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $3500.00 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 Silver North (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay varying copays for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at preferred and standard mail pharmacies. The plan enters the catastrophic coverage phase after your total drug costs reach $2,000. In this phase, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. It provides coverage for emergency services, primary care, preventive services, and mental health services, often with no copay, along with specific copays for specialist visits. Vision and hearing services are included, with coverage for eye exams and eyewear, and hearing exams, hearing aids, and hearing aid fittings. Dental services are covered with a copay, and other services like ambulance, transportation, and home health services are also included, with no copays. This plan also covers home infusion, dialysis, medical equipment, and diagnostic services, with copays or coinsurance depending on the service. Additionally, it offers coverage for skilled nursing facilities and certain other services, with some limitations and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan. For acute inpatient hospital stays, there is a $140 copay for days 1-5, and no copay for days 6-90, while additional days have no copay; for psychiatric stays, there is a $140 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $140 copay, observation services with no copay, ambulatory surgical center services with a $90 copay, individual and group sessions for outpatient substance abuse with no copay, and outpatient blood services with no copay. A doctor referral is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan, with a $45 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $250 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 26 one-way trips per year, and transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $20 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan covers primary care services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $10 copay, and specialist services with a $10 copay. Mental health individual and group sessions have no copay, while podiatry services, other health care professional visits, psychiatric individual and group sessions, physical therapy and speech-language pathology services, and opioid treatment program services have a copay of $10. Additional telehealth benefits have no copay.
Preventive Services See details
The Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan covers preventive services, including annual physical exams with no copay. Additional preventive services, such as Health Education, In-Home Support Services, Fitness Benefit, and Remote Access Technologies, are covered with no copay, while Kidney Disease Education Services has a copay up to $10. Other services like In-Home Safety Assessment, Personal Emergency Response System, and others are not covered.
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 up to $1,050 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. Eye exams and eyewear have no copay, with a combined maximum benefit of $600 per year for eyewear.
Dental Services See details
The Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan covers Medicare dental services with a $10 copay, along with other dental services with a $1650 annual maximum. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay, with the exception of dental x-rays, which are limited in the number of x-rays covered per year. Restorative services are covered with 30% to 50% coinsurance, while Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery have 50% coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a copay between $0 and $35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay between $0 and $47, with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a copay between $0 and $47, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan, and require a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetic Devices with a 20% coinsurance and no copay, Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 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 under the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $25 and $100, while Therapeutic Radiological Services have a copay of $10, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Silver North (HMO-POS) 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 Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and SET for PAD services are not covered. A doctor referral is required, and more copay information can be found in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, a $203 copay for days 21-38, and no copay for days 39-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $105 every three months, and Other 1, with coinsurance between 0% and 20% for durable medical equipment and medical supplies not covered by Medicare; however, 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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