A non-government entity
Kaiser Permanente Senior Advantage Care Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Care Plus (HMO-POS). 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 Care Plus (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) is a HMO-POS 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 Care Plus (HMO-POS) 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 Care Plus (HMO-POS).
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 Care Plus (HMO-POS), 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 $10.00. 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 $6500.00 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 Care Plus (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, but will pay a $47 copay for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. Emergency, urgently needed, and worldwide emergency services are covered, as well as ambulance and transportation services. The plan also provides coverage for primary care, specialist visits, mental health, and physical therapy services, with copays applicable to most services. Additional benefits include preventive, hearing, vision, and dental services, with a mix of copays and coinsurance. Home infusion, dialysis, and medical equipment are covered, often with coinsurance. Diagnostic and radiological services, home health services, and skilled nursing facility stays also have coverage, with specific copay and coinsurance structures. The plan includes an over-the-counter allowance, with other services such as residential mental health treatment.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital-Acute, you will pay a $290 copay for days 1-7, and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you will pay a $290 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$275, Observation Services with a copay of $0-$275, Ambulatory Surgical Center (ASC) Services with a $275 copay, Outpatient Substance Abuse Services with a $35 copay for individual sessions and a $17 copay for group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for all ambulance services, with a $275 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location is covered with no copay for up to 18 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $275 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan covers primary care physician services with a $10 copay, and chiropractic services with 20% coinsurance, though routine chiropractic care is not covered. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a copay between $0 and $35. Mental Health Specialty Services, including individual and group sessions, have a copay of $35 and $17, respectively. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional telehealth benefits have no copay. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while Barium Enemas have a copay between $10 and $50. All other listed services have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, while routine hearing exams have no copay, and fitting/evaluation for hearing aids is offered as an optional supplemental benefit. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with 20% coinsurance. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. Upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $35 copay, Oral Exams with no copay and 75% coinsurance, Dental X-Rays with no copay and 75% coinsurance, Other Diagnostic Dental Services with no copay and 75% coinsurance, Prophylaxis (Cleaning) with no copay and 75% coinsurance, Fluoride Treatment with no copay and 75% coinsurance, Other Preventive Dental Services with no copay and 75% coinsurance, Restorative Services with a copay between $28 and $580 and 75% coinsurance, Adjunctive General Services with no copay and 75% coinsurance, and Oral and Maxillofacial Surgery with a $22 copay and 75% coinsurance. Other services such as Maxillofacial Prosthetics are not covered, and Endodontics, Implant Services, Prosthodontics (removable), Prosthodontics (fixed), and Orthodontics are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan. For Medicare Part B Insulin Drugs, the copay is between $0 and $35, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a copay between $0 and $47, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered under this plan. DME has a coinsurance of 0% to 20%, while Diabetic Supplies have no copay and the coinsurance is not specified.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, Lab Services have no copay, Diagnostic Radiological Services have a copay between $10 and $290, Therapeutic Radiological Services have a $35 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor's referral and prior authorization are required for this benefit, and there is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan, requiring prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The "Other Services" benefit for Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $75 every three months, and also covers other services such as Residential Mental Health/Chemical Dependency Treatment with a copay of $290-$1740, and DME and Prosthetic/medical supplies not covered by Medicare with 0%-20% coinsurance. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved