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Kaiser Permanente Senior Advantage Basic 2 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic 2 (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 2 (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic 2 (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Barrow, Butts, Newton, Rockdale, Spalding, Walton. 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 2 (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 2 (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 2 (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:
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Drug Coverage
The Kaiser Permanente Senior Advantage Basic 2 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $6 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic 2 (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays for specific services. Emergency, urgent, and ambulance services are covered with copays ranging from $25 to $275. Primary care, preventive, hearing, vision, and dental services are also included, with some services having no copay or a copay, and others with coinsurance. Additional benefits of this plan include home health services with no copay, and coverage for home infusion services, dialysis, medical equipment, and diagnostic services. The plan also covers cardiac rehabilitation and skilled nursing facility services. This plan also covers over-the-counter items up to $65 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a $295 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $295 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services and observation services with a copay between $0 and $275, Ambulatory Surgical Center (ASC) services with a $275 copay, individual and group outpatient substance abuse sessions with a copay between $12 and $25, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $275 copay, and transportation services to a plan-approved health-related location with no copay for up to 18 one-way trips per year. 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have 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 2 (HMO) plan covers primary care physician services with no copay, chiropractic services with 20% coinsurance, occupational therapy services with a $25 copay, physician specialist services with a $0-$25 copay, mental health specialty services with a $12-$25 copay, and physical therapy and speech-language pathology services with a $25 copay. The plan also covers telehealth services with no copay, and opioid treatment program services with a $25 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered under the Kaiser Permanente Senior Advantage Basic 2 (HMO) plan. Annual physical exams have no copay, while Barium Enemas have a copay between $5 and $35.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams have no copay. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $25. Eyewear is covered with 20% coinsurance, and contact lenses are covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $25 copay, and other dental services are also covered. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have a 75% coinsurance and no copay. Restorative services have a 75% coinsurance and a copay between $28 and $580, and adjunctive general services have a 75% coinsurance and no copay. Oral and maxillofacial surgery has a 75% coinsurance and a $22 copay. Endodontics, implant services, prosthodontics fixed, and orthodontics are optional, supplemental benefits. Maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, the copay is $6.00 - $35.00. For Medicare Part B Chemotherapy/Radiation Drugs, the copay is $6.00 - $47.00, and the coinsurance is between 0% and 20%. Other Medicare Part B Drugs have a copay of $6.00 - $47.00 and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Basic 2 (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the Kaiser Permanente Senior Advantage Basic 2 (HMO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and there is no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 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, including Diagnostic Procedures/Tests with a copay between $0 and $35, Lab Services with no copay, Diagnostic Radiological Services with a copay between $5 and $290, Therapeutic Radiological Services with a $25 copay, and Outpatient X-Ray Services with a $5 copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Basic 2 (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, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Basic 2 (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
The Kaiser Permanente Senior Advantage Basic 2 (HMO) plan covers over-the-counter items with a maximum benefit coverage amount of $65 every three months, and also covers Other 1 and Other 2 services. Acupuncture, meal benefits, Dual Eligible SNPs, 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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