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Kaiser Permanente Senior Advantage Bronze North (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Bronze 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 Bronze North (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Bronze 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 Bronze 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 Bronze 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 Bronze North (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 $4100.00 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 North (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, you'll pay a $5 copay at a preferred pharmacy, $20 at a standard pharmacy, and no copay for standard mail order. For specialty tier drugs, there is no copay at a preferred or standard pharmacy. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Bronze North (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $220 copay for the first five days, with no copay after, and outpatient services have a $200 copay. Emergency services have a $140 copay, while primary care visits have no copay, and specialist visits have a $30 copay. Preventive services, including annual physical exams, have no copay, and hearing, vision, and dental services are also covered. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered with a plan-specified amount of $1100 every two years. Vision services, including eye exams and eyewear, have no copay and a combined maximum benefit of $650.00 per year. Dental services have a $30 copay for Medicare dental services, with other services like cleanings and x-rays having no copay and other services having 30-50% coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric care, with a $220 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital acute care are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $200 copay, observation services with no copay, ambulatory surgical center services with a $110 copay, and outpatient substance abuse services with a $10 copay for individual sessions and a $5 copay for group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Bronze 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 by the Kaiser Permanente Senior Advantage Bronze North (HMO-POS) plan, with no coinsurance. Ground and Air Ambulance Services have a $300 copay. Transportation Services to a plan-approved health-related location has no copay, and covers 18 one-way trips per year using rideshare services, bus/subway, medical transport, or other modes of transportation, while 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 have a $140 copay, Urgently Needed Services have a $30 copay, Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Bronze North (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $25 copay. Physician specialist services have a $30 copay. Mental health specialty services, podiatry services, other health care professional services, and psychiatric services have varying copays. Physical therapy and speech-language pathology services have a $25 copay, while additional telehealth benefits have no copay, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and other services like health education, fitness benefits, and remote access technologies may have copays. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services has a copay of up to $30, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a plan-specified amount of $1100 every two years. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear with no copay. Eyewear has a combined maximum benefit of $650.00 per year, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay. Other dental services include oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, 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, including Medicare Part B insulin drugs with a copay of $5 to $35, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $5 to $47 and 0% to 20% coinsurance, and other Medicare Part B drugs with a copay of $5 to $47 and 0% to 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Bronze North (HMO-POS) plan and require a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 0-20% coinsurance, while Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have no copay, lab services have no copay, and diagnostic radiological services have a copay of at most $120.00 (minimum $40.00). Therapeutic radiological services have a copay of at most $30.00 (minimum $30.00), and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Bronze 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 not covered by the Kaiser Permanente Senior Advantage Bronze North (HMO-POS) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor 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 Bronze North (HMO-POS) plan, with a doctor referral and prior authorization required. For days 1-20 and 42-100, there is no copay, while days 21-41 have a $203 copay; additional and non-Medicare-covered SNF days are not covered.
Other Services See details
The "Other Services" benefit covers Over-the-Counter (OTC) Items, with a maximum benefit coverage of $120 every three months, and covers Nicotine Replacement Therapy (NRT). 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. Other 1 benefits are covered with 0% - 20% coinsurance and require prior authorization.
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