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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 2026, 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 2026.
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 $6000.00 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 features a $0 drug deductible, meaning your prescription coverage starts immediately. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs, Tier 2 generic drugs, and Tier 6 vaccines filled through standard pharmacies or mail-order services. This budget-friendly structure helps keep your everyday health maintenance costs to a minimum. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs cost a $95 copay. Tier 5 specialty medications carry a 33% coinsurance at standard pharmacies and through mail order. Additionally, choosing a three-month mail-order supply for Tier 3 and Tier 4 drugs offers significant cost savings compared to standard retail pharmacies.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan offers robust medical coverage with low out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and routine lab work. Specialist visits require no copay to a $20 copay, while inpatient hospital stays carry a $350 daily copay for the first few days and no copay thereafter. Emergency care is available with a $130 copay, which is waived upon admission, and urgent care visits require a low $20 copay. For supplemental care, the plan provides routine dental cleanings and annual eye exams with no copay, alongside a $500 eyewear allowance every two years. Routine hearing exams and home health services also feature no copay, while durable medical equipment is available with no copay and up to 20% coinsurance. Additionally, members receive a $35 over-the-counter quarterly allowance with no copay or coinsurance to help cover everyday health wellness products.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) with no coinsurance, featuring a $350 daily copay for days 1-6 of acute stays and days 1-5 of psychiatric stays, with no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) feature no coinsurance across all categories, with copays ranging from $0 to $300 for outpatient hospital and observation stays. Ambulatory surgical center services require a $300 copay, outpatient substance abuse sessions cost a $10 or $20 copay, and outpatient blood services are available with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) with a $50.00 copay and no coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) covers ambulance services with a $260 copay and no coinsurance for both ground and air transport. Transportation services are partially covered with no coinsurance and no copay to a $125 copay for up to 18 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $20 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $20 to $260.
Primary Care See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $20 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies require copays between $10 and $25 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and health education. Several services are not covered under this plan, including 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/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) include one annual routine hearing exam with no deductible, no copay, and no coinsurance, and fitting evaluations for a $20 copay and no coinsurance. Although prescription hearing aids are technically covered, some services are covered but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) covers routine eye exams once per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $500 combined maximum every two years with no copay and a 20% coinsurance for contact lenses, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO), featuring a $20 copay for Medicare dental services and no copay or coinsurance for preventive care like cleanings and exams. Covered comprehensive services, including restorative and periodontics, have copays ranging from $0 to $738 with no coinsurance, though orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin with no coinsurance and copays ranging from no copay to $35. Covered Part B chemotherapy, radiation, and other drugs require copays ranging from no copay to $47 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) with no copays for durable medical equipment (DME), medical supplies, and diabetic supplies. DME and medical supplies feature coinsurance ranging from no coinsurance to 20%, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) covers diagnostic and radiological services with no coinsurance, subject to referral and prior authorization requirements. Outpatient X-rays and lab services have no copay, while diagnostic tests and procedures carry a copay of $0 to $20, and therapeutic radiological services require a minimum copay of $20.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Enhanced 1 (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These rehabilitation services require a referral and prior authorization, with copays of $25 for SET for PAD and $30 for cardiac, intensive cardiac, and pulmonary services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Kaiser Permanente Senior Advantage Enhanced 1 (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, but a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Enhanced 1 (HMO) provides partial coverage for other services, excluding acupuncture and meal benefits. Covered benefits include over-the-counter (OTC) items with no copay and no coinsurance up to $35 every three months, residential mental health and chemical dependency treatment with a $350.00 to $1,750.00 copay and no coinsurance, and non-Medicare DME and prosthetics with no copay and 0% to 20% coinsurance.
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