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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 2026, 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 2026.
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.
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 $6750.00 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Plan members pay no copay for Tier 1 preferred generic drugs and Tier 6 vaccines at standard pharmacies. For Tier 2 generic medications, standard pharmacy copays start at $6 for a one-month supply, though you can get a two- or three-month supply with no copay through standard mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply at standard pharmacies and mail order, with savings available on three-month mail order refills. Tier 4 non-preferred drugs cost $95 for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance for both pharmacy and mail order fills.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic 2 (HMO) plan offers robust coverage with no copays for primary care, telehealth visits, and routine preventive services. For hospital care, inpatient stays require a $375 daily copay for the first 5 to 6 days followed by no copay, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient services and diagnostic lab tests are also highly affordable, featuring no coinsurance and many services available with no copay. Members also benefit from valuable everyday care, including routine vision and hearing exams with no copay, alongside preventive dental services with no copay. Comprehensive dental care is available with copays ranging from no copay to $738, and the plan provides a $35 quarterly allowance for over-the-counter items. Additionally, home health services are covered with no copay, while skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $375 daily copay for the first 6 days of acute stays and the first 5 days of psychiatric stays, followed by no copay for remaining covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by the Kaiser Permanente Senior Advantage Basic 2 (HMO) feature no coinsurance, with copays ranging from $0 to $350 for outpatient hospital and observation services, and a $350 copay for ambulatory surgical center services. Outpatient substance abuse services require a $15 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 18 one-way trips per year to plan-approved locations with a copay ranging from $0 to $125 and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are immediately admitted to the hospital. Urgently needed services have a $30 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $30 for urgent care, $130 for emergency care, and $275 for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) features primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays between $15 and $30 with no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by Kaiser Permanente Senior Advantage Basic 2 (HMO) with no copays and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, and diabetes self-management. However, additional preventive benefits are only partially covered with no copay or coinsurance, excluding services such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers hearing exams with a $30 copay and no coinsurance, including one routine hearing exam annually with no copay. Prescription and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision services under the Kaiser Permanente Senior Advantage Basic 2 (HMO) are partially covered, featuring annual routine eye exams with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance for contact lenses up to a $500 combined maximum every two years, excluding upgrades.
Dental Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) partially covers dental services, providing preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental services for a $30 copay and no coinsurance. Comprehensive benefits like restorative, endodontic, and periodontic services are covered with copays ranging from $0 to $738 and no coinsurance, though orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers Home Infusion bundled Services with prior authorization, offering Part B insulin at a $6.00 to $35.00 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require a copay ranging from $6.00 to $47.00 and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Kaiser Permanente Senior Advantage Basic 2 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Senior Advantage Basic 2 (HMO) with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies. Members will pay a 0% to 20% coinsurance for DME and medical supplies, and a 20% coinsurance for prosthetic devices and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Kaiser Permanente Senior Advantage Basic 2 (HMO) with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services, a $0 to $35 copay for diagnostic procedures, a $5 copay for outpatient X-rays, and minimum copays of $5 for diagnostic radiology and $30 for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Basic 2 (HMO) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Kaiser Permanente Senior Advantage Basic 2 (HMO) with no coinsurance, but require prior authorization and a referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Basic 2 (HMO) provides partial coverage for other services, including a $35 quarterly over-the-counter item allowance with no copay or coinsurance. Residential mental health treatment is covered with a $375 to $1,875 copay and no coinsurance, and non-Medicare covered DME and prosthetics are covered with no copay and 0% to 20% coinsurance, while acupuncture and meal benefits are not covered.
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