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Kaiser Permanente Senior Advantage Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced (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 Enhanced (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is a HMO-POS 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 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. 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 $3200.00 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 Enhanced (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, while you will pay 33% coinsurance for non-preferred drugs at any pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Those who qualify for the low-income subsidy will also have their premiums reduced.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have a copay, while outpatient services have copays for some services, but no copay for others. This plan includes coverage for emergency services, primary care, preventive services, hearing, vision, and dental services, with specific copays or coinsurance amounts. Additional benefits include ambulance and transportation services, home health services, and coverage for medical equipment and home infusion, offering a well-rounded healthcare plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-5, and no copay for days 6-90, while additional days have no copay. Inpatient Hospital Psychiatric has the same cost structure as Inpatient Hospital-Acute. 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 include coverage for Outpatient Hospital Services with a $190 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $145 copay, and Outpatient Substance Abuse Services with a $5 copay for individual sessions and no copay for group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan and requires prior authorization and a doctor's referral. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both 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, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $25 copay and no coinsurance, Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $250 copay, with no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $20 copay. Physician specialist services have a $20 copay, while mental health specialty services have a $5 copay for individual sessions and no copay for group sessions.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services. Additional preventive services include Health Education, In-Home Support Services, and Fitness Benefit, all with no copay.
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, with a maximum benefit of $750 every two years for all types of prescription hearing aids except for inner ear, outer ear, and over the ear hearing aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Contact lenses have a copay, and the combined maximum plan benefit coverage for all eyewear is $350 every year. Upgrades are not covered.
Dental Services See details
Dental services include a $20 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay. Restorative services have 30% - 50% coinsurance, while adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery have 50% coinsurance. Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay of $5-$35, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a copay between $5-$47 and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, requiring a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), which has a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts and Medicare-covered Diabetic Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services, and all radiological services requiring prior authorization and a doctor referral. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $130, Therapeutic Radiological Services have a copay of at most $20, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Enhanced (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 specific services like Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan. There is no copay for days 1-20, a $203 copay for days 21-36, and no copay for days 37-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $80 every three months, and Other 1, which covers DME and medical supplies not covered by Medicare with 0% - 20% coinsurance; 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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