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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 2026, 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 4.5 out of 5 stars in 2026.
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 $55.00. 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 Enhanced (HMO-POS) plan features no drug deductible, allowing your prescription coverage to begin immediately. You will pay no copay for Tier 1 preferred generic drugs filled at a preferred pharmacy or through standard mail order, as well as no copay for Tier 6 vaccines. Tier 2 generic drugs also offer savings with no copay for standard mail orders and a low $5 copay for a one-month supply at preferred pharmacies. For higher-tier medications, standard mail order and preferred pharmacies provide the most cost-effective options, with Tier 3 preferred brands starting at a $45 copay and Tier 4 non-preferred drugs starting at a $90 copay for a one-month supply. Specialty drugs in Tier 5 require a 33% coinsurance across all pharmacy types. Choosing standard mail order or preferred pharmacies over standard retail pharmacies consistently minimizes your out-of-pocket costs under this plan.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health services. For inpatient hospital care, members pay a $270 daily copay for days 1 to 6 and no copay for days 7 to 90. Outpatient hospital services require a $270 copay, while specialist visits require a $25 copay, with no coinsurance applied to either service. This plan also includes valuable supplemental benefits, including routine dental, vision, and hearing care with no copays for preventive services and exams. Members benefit from a $1,500 yearly dental maximum, a $350 annual eyewear allowance, and up to 26 one-way transportation trips per year with no copay. Additionally, the plan offers a $30 quarterly allowance for over-the-counter items and up to $600 per ear every two years for hearing aids with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Kaiser Permanente Senior Advantage Enhanced (HMO-POS) with no coinsurance, requiring a $270 daily copay for days 1 to 6 and no copay for days 7 to 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers outpatient services with no coinsurance, featuring a $270 copay for outpatient hospital services, a $145 copay for ambulatory surgical center services, and no copay for observation services. Outpatient substance abuse services require a $5 copay for individual sessions and no copay for group sessions, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan with a $45.00 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 26 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan with a $130 copay (waived if admitted immediately) and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $25, and $275, respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical and occupational therapy have a $20 copay and no coinsurance, but chiropractic services are only partially covered, with routine and other chiropractic services not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) offers partially covered preventive services with no coinsurance and no copay for annual physicals, fitness benefits, and screenings, while kidney disease education has a copay of $0 to $25 with no coinsurance. Uncovered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers hearing services with no copay and no coinsurance for exams, fitting evaluations, and prescription hearing aids, which have a $600 maximum benefit per ear every two years. Prescription hearing aids are partially covered, as inner ear, outer ear, and over the ear models are not covered, and over-the-counter (OTC) hearing aids are also not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) partially covers vision services with no copay, no coinsurance, and no deductible. Routine eye exams and eyewear, including contacts and eyeglasses, are covered with a combined maximum benefit of $350 every year, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) partially covers dental services up to a $1,500 yearly maximum, though orthodontics and other preventive services are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, preventive services have no copay and no coinsurance, and comprehensive services require no copay and 50% coinsurance.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers home infusion bundled services with prior authorization, offering insulin with a $5.00 to $35.00 copay and no coinsurance. Other covered Medicare Part B chemotherapy, radiation, and standard drugs require a copay ranging from $5.00 to $47.00 and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced (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 Enhanced (HMO-POS) with no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment. Prosthetics, medical supplies, and diabetic therapeutic shoes are covered with no copay and a 20% coinsurance, while diabetic supplies are covered with no copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Kaiser Permanente Senior Advantage Enhanced (HMO-POS) with no coinsurance, though prior authorization and referrals are required. There is no copay for diagnostic procedures and lab services, while outpatient X-rays have a $5 copay, therapeutic radiological services have a minimum $25 copay, and diagnostic radiological services have a minimum $40 copay.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO-POS) with no copay and no coinsurance, but a referral is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 46 to 100, a $203 copay per day for days 21 to 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 Enhanced (HMO-POS), offering over-the-counter (OTC) items with no copay and no coinsurance up to $30 every three months, and select non-Medicare DME and medical supplies with no copay and 0% to 20% coinsurance. Acupuncture and meal benefits are not covered under this plan.
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