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Kaiser Permanente Senior Advantage Enhanced 1 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced 1 (HMO). 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 1 (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Atlanta Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Senior Advantage Enhanced 1 (HMO) 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 1 (HMO).
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 1 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $67.00. 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 1 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you may pay no copay for preferred generic drugs at a standard pharmacy, or a $47 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), the plan's premium may be reduced, with your monthly premium being $22.00.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while many outpatient services have no copay or low copays, with some services subject to coinsurance. Emergency, primary care, preventive, and home health services are covered. The plan also includes coverage for hearing, vision, and dental services, with copays and coinsurance depending on the service. Additional benefits cover ambulance, transportation, and home infusion services. Other services such as cardiac rehabilitation, skilled nursing facility, and diagnostic services are also covered, but may require prior authorization and have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a $295 copay for days 1-8, and a $0 copay for days 9-90 for acute care, and a $295 copay for days 1-7, and a $0 copay for days 8-90 for psychiatric care; additional days for acute care are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
The Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan covers outpatient services, including outpatient hospital services with a copay of $0-$200, observation services with a copay of $0-$200, ambulatory surgical center (ASC) services with a $200 copay, outpatient substance abuse services with a $15 copay for individual sessions and a $7 copay for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan. This benefit requires prior authorization and has a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, and no coinsurance, up to 18 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by this plan. Emergency Services have a $125 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $15 copay, and Worldwide Emergency Transportation has a $260 copay. There is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a 20% coinsurance. The plan also covers occupational therapy services with a $15 copay, and physician specialist services with a copay between $0 and $15. Mental health services, psychiatric services, and opioid treatment program services are also covered, with copays between $7 and $15 depending on the service. Physical therapy and speech-language pathology services have a $15 copay, and additional telehealth benefits have no copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Other preventive services include Health Education, and Fitness Benefit, which have no copay, and Barium Enemas which have a copay of $0-$50.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids, which is an optional supplemental benefit. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and eyewear with 20% coinsurance. Upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $15 copay, and other dental services such as oral exams, dental x-rays, and other diagnostic dental services with a 75% coinsurance and no copay. Also covered are Prophylaxis (Cleaning) and Fluoride Treatment with a 75% coinsurance and no copay, and other preventive dental services with 75% coinsurance and no copay. Restorative Services have a 75% coinsurance and a copay between $28 and $580, while Adjunctive General Services have a 75% coinsurance and no copay. Other services are offered as optional supplemental benefits. Maxillofacial Prosthetics 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 $0-$35, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $0-$47 and 0-20% coinsurance, and Other Medicare Part B Drugs with a copay of $0-$47 and 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan. The coinsurance for this benefit is 20%.
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 have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $245, Therapeutic Radiological Services have a copay of $15 or more, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) 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 by the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan, but the specific services listed are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan, with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
The "Other Services" benefit for Kaiser Permanente Senior Advantage Enhanced 1 (HMO) includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75.00 every three months, and for Residential Mental Health/Chemical Dependency Treatment with a copay between $295.00 and $2065.00. 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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