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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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:
Sign up for Kaiser Permanente Senior Advantage Basic 1 (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Basic 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 type. For example, preferred generic drugs and specialty tier drugs have no copay at standard pharmacies, while standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic 1 (HMO) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, with some services having copays, coinsurance, or both. Additional benefits include ambulance and transportation services, home infusion, home health, and medical equipment coverage.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $345 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $275, Observation Services with a copay between $0 and $275, Ambulatory Surgical Center (ASC) Services with a $275 copay, Individual and Group Sessions for Outpatient Substance Abuse with copays of $25 and $12 respectively, and Outpatient Blood Services with no copay. Prior authorization may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan, with a $55 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $275 copay, while transportation services to a plan-approved health-related location have no copay, with coverage for 18 one-way trips per year using rideshare services, bus/subway, medical transport, or other methods.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Transportation has a $275 copay; there is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Basic 1 (HMO) plan covers primary care physician services with no copay, and chiropractic services with 20% coinsurance. Occupational therapy services have a $25 copay, and mental health specialty services have a copay of $12-$25 depending on the session. The plan does not cover podiatry services. Additional telehealth benefits and opioid treatment program services are covered with a $25 copay. Physical therapy and speech-language pathology services have a $25 copay, and physician specialist services have a $0-$25 copay. Other health care professional services have a 20% coinsurance and $0-$25 copay. Psychiatric services have a $12-$25 copay depending on the session.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services including health education, fitness benefits, and remote access technologies, with no copay. Other preventive services like Barium Enemas have a copay between $5 and $35.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids; hearing exams have a $25 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Kaiser Permanente Senior Advantage Basic 1 (HMO) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
Dental services include a $25 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with 75% coinsurance and no copay. Restorative services are covered with 75% coinsurance and a copay between $28 and $580. Adjunctive general services are covered with 75% coinsurance and no copay. Periodontics and oral and maxillofacial surgery are covered with 75% coinsurance; periodontics has a copay between $0 and $400, and oral and maxillofacial surgery has a $22 copay. Prosthodontics, removable has a copay between $420 and $480. Maxillofacial prosthetics is not covered. Endodontics, implant services, prosthodontics, fixed, and orthodontics are offered as optional supplemental benefits; contact the plan for details.
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 for this benefit.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20% and no copay. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $290, Therapeutic Radiological Services have a $25 copay, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Basic 1 (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, acupuncture, meal benefits, 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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered. Over-the-counter (OTC) items are covered, with a maximum benefit of $80 every three months. Other 1 benefits are covered with a copay of $345-$2070, and Other 2 benefits are covered with 0-20% coinsurance.
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