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Kaiser Permanente Senior Advantage Basic 1 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic 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 Basic 1 (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic 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 Basic 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 Basic 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 Basic 1 (HMO), 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 $7500.00 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 Basic 1 (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled through standard pharmacies or standard mail order. Additionally, Tier 6 vaccines are covered with no copay for a one-month supply at standard pharmacies. For Tier 3 preferred brand drugs, copays start at $47 for a one-month supply, while Tier 4 non-preferred drugs carry a $95 copay for a one-month supply. Mail-order options for these tiers offer savings on three-month supplies, capping copays at $94 for Tier 3 and $190 for Tier 4. Specialty drugs in Tier 5 require a 33% coinsurance for both pharmacy and mail-order fills.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic 1 (HMO) plan offers robust medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $395 copay per day for the first six days and no copay for subsequent days, while outpatient services range from no copay up to a $375 copay. Emergency room visits require a $115 copay, which is waived if you are admitted, and ambulance services carry a $275 copay with no coinsurance. Routine hearing and vision exams are covered with no copays, though hearing aids are not covered and eyewear requires a 20% coinsurance. Preventive dental services feature no copays, while diagnostic labs and diabetic supplies are also fully covered with no copays or coinsurance. Additionally, members benefit from no copays on skilled nursing facility stays for the first 20 days and no copays on over-the-counter items.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers inpatient acute hospital stays with no coinsurance and a $395 copay for days 1 to 6, with no copay for subsequent days. Inpatient psychiatric stays are also covered with no coinsurance and a $395 copay for days 1 to 5, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers outpatient services with no coinsurance, featuring a $0.00 to $375.00 copay for outpatient hospital and observation services and a $375.00 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $15.00 to $30.00 copay with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Kaiser Permanente Senior Advantage Basic 1 (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services to plan-approved locations are partially covered with no coinsurance and a $0 to $125 copay for up to 18 one-way trips per year, though trips to non-approved health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $115 for emergency care, $30 for urgent care, and $275 for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) features primary care and telehealth benefits with no copay and no coinsurance, while specialist visits require a $0 to $30 copay and no coinsurance. Physical, occupational, mental health, psychiatric, and opioid treatment therapies are covered with copays ranging from $15 to $35 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Senior Advantage Basic 1 (HMO) with no copay and no coinsurance for annual physical exams, fitness benefits, and remote access technologies. The benefit is partially covered, as services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers hearing exams with no coinsurance, featuring no copay for an annual routine visit and a $30 copay for fitting evaluations. Hearing aids, including both prescription and over-the-counter models, are not covered under this plan.
Vision Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) offers partially covered vision services, featuring annual routine eye exams with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is also covered with no copay and a 20% coinsurance for contact lenses up to a $500 combined limit every two years, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Basic 1 (HMO), featuring no copay and no coinsurance for preventive services, and a $30 copay with no coinsurance for Medicare-covered dental. Comprehensive dental services require copays ranging from no copay up to $738 with no coinsurance, while orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Kaiser Permanente Senior Advantage Basic 1 (HMO) with prior authorization, featuring Medicare Part B insulin with no coinsurance and no copay to a $35 copay. Other covered Part B chemotherapy, radiation, and specialty drugs range from no coinsurance to 20% coinsurance and no copay to a $47 copay.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers durable medical equipment (DME) and medical supplies with no copay and no coinsurance to 20% coinsurance. Prosthetic devices and diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance, while diabetic supplies feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization and referral requirements. Lab services have no copay, diagnostic tests range from a $0 to $35 copay, outpatient X-rays and diagnostic radiological services require a minimum $10 copay, and therapeutic radiological services require a minimum $30 copay.
Home Health Services See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Kaiser Permanente Senior Advantage Basic 1 (HMO) with no coinsurance, though referrals and prior authorization are required. Under this plan, patients pay a $30 copay for cardiac and intensive cardiac rehabilitation, a $25 copay for pulmonary rehabilitation, and a $20 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic 1 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Referrals and prior authorization are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO), excluding acupuncture and meal benefits. Covered benefits include over-the-counter items with no copay and no coinsurance, residential mental health and chemical dependency treatment with a $395.00 to $1,975.00 copay and no coinsurance, and non-Medicare durable medical equipment and prosthetics with no copay and 0% to 20% coinsurance.
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