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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 2026, 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 4.5 out of 5 stars in 2026.
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 $47.00. 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 $4900.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront costs. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when filled at preferred pharmacies or through standard mail order. Tier 2 generic drugs also feature no copay through standard mail order, or a low $3 copay for a one-month supply at a preferred pharmacy. For Tier 3 preferred brand drugs, copays start at $45 for a one-month supply at preferred pharmacies and through standard mail order. Tier 4 non-preferred drugs carry a $90 copay at preferred pharmacies, while Tier 5 specialty drugs require a 33% coinsurance across all pharmacy options. Additionally, Tier 6 vaccines are available with no copay for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, telehealth, and routine preventive services. For specialized care, members pay a low $20 copay for specialist visits and a $260 copay for inpatient hospital stays during the first six days, with no copay for days seven through ninety. Emergency services carry a $130 copay, which is waived if you are admitted, while urgently needed care requires a $40 copay. This plan also includes strong supplemental benefits, such as no copays for routine dental, vision, and hearing exams, alongside a $450 annual eyewear allowance and up to $1,500 in dental benefits with a 50% coinsurance for comprehensive care. Additionally, members can access up to 26 free one-way transportation trips per year to approved medical locations and receive a $30 quarterly allowance for over-the-counter items with no copay. Diagnostic lab tests, outpatient X-rays, and home health services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS) with no coinsurance, featuring a $260 copay for days 1 through 6 and no copay for days 7 through 90 per admission. Non-Medicare-covered stays, upgrades, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services for a $260 copay and ambulatory surgical center services for a $165 copay. There is no copay for outpatient observation services, blood services, or group substance abuse sessions, while individual substance abuse sessions have a $5 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS) with a $45.00 copay and no coinsurance. This benefit requires both prior authorization and a referral.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation is partially covered, offering up to 26 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 under the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan with a $130 copay and no coinsurance, with the copay waived if you are immediately admitted to the hospital. Urgently needed care is covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $275 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $10 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers preventive services with no coinsurance and no copay for annual exams, fitness benefits, and health education, while kidney disease education carries a $0 to $20 copay. The benefit is partially covered as several services like in-home safety assessments, medical nutrition therapy, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS) with no copay and no coinsurance for Medicare-covered exams, routine exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear every two years, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) offers partially covered vision services with no copay and no coinsurance, though other eye exam services and upgrades are not covered. Covered benefits include unlimited routine eye exams and a $450 annual maximum allowance for contact lenses, eyeglass lenses, and frames with no deductibles.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS), offering up to $1,500 in annual benefits. Medicare-covered dental services require a $20 copay and no coinsurance, while most preventive services have no copay and no coinsurance. Comprehensive services like restorative and periodontic care have no copay and 50% coinsurance, but orthodontics and other preventive dental services are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers home infusion bundled services with prior authorization, requiring a $3.00 to $35.00 copay and no coinsurance for insulin. Other covered Medicare Part B drugs, including chemotherapy and radiation drugs, have a copay ranging from $3.00 to $47.00 and coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Silver North (HMO-POS) plan with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS), with prior authorization required. Durable medical equipment features no copay and no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes require 20% coinsurance and no copay. Diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. Members pay no copay for lab services, outpatient X-rays, and diagnostic tests, while therapeutic radiological services have a minimum $20 copay and diagnostic radiological services have a minimum $55 copay.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Kaiser Permanente Senior Advantage Silver North (HMO-POS) with no coinsurance and a referral requirement. While some services are covered, standard cardiac rehabilitation (ranging from no copay to a $20 copay), intensive cardiac rehabilitation (ranging from no copay to a $20 copay), pulmonary rehabilitation ($5 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered in practice.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Silver North (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 46 through 100, a $203 daily copay for days 21 through 45, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Kaiser Permanente Senior Advantage Silver North (HMO-POS), as acupuncture and meal benefits are not covered. Covered benefits include over-the-counter items with no copay and no coinsurance up to $30 every three months, and non-Medicare durable medical equipment with no copay and 0% to 20% coinsurance.
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