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Kaiser Permanente Senior Advantage Bronze DM (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Bronze DM (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 Bronze DM (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Denver Metro Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Bronze DM (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 Bronze DM (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 Bronze DM (HMO-POS), 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 $5900.00 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 Bronze DM (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your drugs. For example, you'll pay $3.00 for preferred generic drugs at a preferred pharmacy and $45.00 for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. The plan offers an enhanced alternative drug benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $250 copay for the first five days, and outpatient services with various copays depending on the service. It also covers emergency services, primary care, and preventive services, often with no copay, and provides coverage for hearing, vision, and dental services, with specific copays, coinsurance, and maximum benefits. Additional covered services include ambulance, partial hospitalization, home infusion, dialysis, and medical equipment, with varying copays or coinsurance. This plan provides no copay for home health services, and skilled nursing facilities for a limited time. The plan also offers over-the-counter items with a maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of an Inpatient Hospital-Acute stay or Inpatient Hospital Psychiatric stay, there is a $250 copay per admission, and for days 6-90, there is no copay; additional days for Inpatient Hospital-Acute have no copay, while additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $250 copay, observation services with no copay, Ambulatory Surgical Center (ASC) services with a $150 copay, individual substance abuse sessions with a copay between $10 and $10, group substance abuse sessions with a copay between $5 and $5, and outpatient blood services with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under this 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 include coverage for ground and air ambulance services with a $350 copay, and transportation services to a plan-approved health-related location with no copay for up to 18 one-way trips per year. 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. Emergency Services has a $125 copay, Urgently Needed Services has a $40 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $350 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $35 copay. Mental Health Specialty Services have a $10 copay for individual sessions and a $5 copay for group sessions, while Podiatry Services have a $35 copay for Medicare-covered services and no copay for routine foot care. Other Health Care Professional services have copays ranging from $0 to $35. Psychiatric Services have a $10 copay for individual sessions and a $5 copay for group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have no copay, while Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like health education, fitness benefits, and remote access technologies which may have a copay. Additional preventive services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams, fitting and evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while prescription hearing aids have a maximum plan benefit of $700 every two years. Prescription hearing aids are covered, but the sub-services "Prescription Hearing Aids - Inner Ear", "Prescription Hearing Aids - Outer Ear", and "Prescription Hearing Aids - Over the Ear" are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and routine eye exams have no copay, and eyewear has a combined maximum of $550.00 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, but upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay. Other dental services include oral exams with no copay and 2 visits per year, dental x-rays with no copay, and other diagnostic dental services, prophylaxis (cleaning) with no copay and 2 visits per year, fluoride treatment with no copay and 1 visit per year, restorative services with 30%-50% coinsurance, adjunctive general services with 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics, removable with 50% coinsurance, maxillofacial prosthetics with 50% coinsurance, implant services with 50% coinsurance, prosthodontics, fixed with 50% coinsurance, and oral and maxillofacial surgery with 50% coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan. For Medicare Part B Insulin Drugs, the copay ranges from $3.00 to $35.00; for Medicare Part B Chemotherapy/Radiation Drugs, the copay ranges from $3.00 to $47.00 with a coinsurance between 0% and 20%; and for Other Medicare Part B Drugs, the copay ranges from $3.00 to $47.00 with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $140, while Therapeutic Radiological Services have a copay of $35. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) plan. There is no copay for days 1-20, a $203 copay for days 21-41, and no copay for days 42-100; however, additional days beyond Medicare 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 $120 every three months, and Other 1, which covers DME and medical supplies not covered by Medicare with coinsurance between 0% and 20%. 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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