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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 2026, 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 2026.
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.
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 $8000.00 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 Care Plus (HMO-POS) Medicare plan offers 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 drugs at standard pharmacies or through standard mail order. Additionally, select Tier 6 vaccines are covered with no copay for a one-month supply at standard pharmacies. For higher-tier medications, standard pharmacy copays for Tier 3 preferred brands start at $47, while Tier 4 non-preferred drugs start at $95 for a one-month supply. Choosing standard mail order for these tiers can offer savings, particularly with three-month supplies costing $94 for Tier 3 and $190 for Tier 4. Specialty drugs in Tier 5 require a 33% coinsurance for both standard pharmacy and mail-order options.
Additional Benefits
The Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for most doctor visits and hospital stays. Members enjoy a low $10 copay for primary care visits, no copay for telehealth services, and copays ranging from no copay to $40 for specialists. Emergency care requires a $115 copay, which is waived if admitted, while inpatient hospital stays require a $395 daily copay for the first few days followed by no copay. This plan also includes valuable supplemental benefits, such as routine dental and annual vision and hearing exams with no copay. Preventive dental care has no copay, while comprehensive dental services and eyewear are partially covered, though hearing aids are not. Additionally, members benefit from up to 18 one-way transportation trips per year and a quarterly $25 allowance with no copay for over-the-counter items.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for remaining covered days. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $275 for outpatient hospital and observation services, and a $275 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 or $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation benefits are partially covered, offering up to 18 one-way trips per year to plan-approved locations with no coinsurance and a copay ranging from no copay to $125, though trips to any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital, and urgent care with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $275, respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers primary care visits for a $10 copay and specialist visits for a $0 to $40 copay, both with no coinsurance, while chiropractic and podiatry services are not covered. Other services like physical therapy and mental health care require copays of $20 to $40 with no coinsurance, and telehealth benefits are available with no copay and no coinsurance.
Preventive Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, fitness benefits, and kidney disease education. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Care Plus (HMO-POS), which features hearing exams with a $40 copay and no coinsurance, as well as one annual routine hearing exam with no copay. Prescription hearing aids and OTC hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Care Plus (HMO-POS) with no deductibles, featuring a $0 to $40 copay and no coinsurance for covered eye exams, which includes one routine exam per year with no copay. Covered eyewear has no copay and a 20% coinsurance for contact lenses up to a $500 combined limit every two years, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) offers partially covered dental services, featuring no copay and no coinsurance for preventive care, alongside a $40 copay and no coinsurance for Medicare-covered dental. Comprehensive treatments are available 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 Care Plus (HMO-POS) covers Home Infusion bundled Services with prior authorization, offering insulin with no coinsurance and copays ranging from no copay to $35. Other covered Part B drugs, including chemotherapy and radiation, require coinsurance ranging from no coinsurance up to 20% and copays ranging from no copay to $47.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Care Plus (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Care Plus (HMO-POS) with no copays, though coinsurance applies to certain items. Durable medical equipment and medical supplies feature no copay and range from no coinsurance to 20% coinsurance, while prosthetic devices and diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers diagnostic and radiological services with no coinsurance, though referrals and prior authorizations are required. Members pay no copay for lab services, $0 to $35 for diagnostic procedures, a $10 copay for outpatient X-rays, and minimum copays of $10 for diagnostic radiology and $40 for therapeutic radiology.
Home Health Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) technically covers Cardiac Rehabilitation Services with no coinsurance, but some services are not covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, carrying individual copays ranging from $20 to $35 and requiring prior authorization and referrals.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100; however, prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under Kaiser Permanente Senior Advantage Care Plus (HMO-POS), with acupuncture and meal benefits not covered. Covered options include over-the-counter items with no copay and no coinsurance up to $25 every three months, residential mental health and chemical dependency treatment with a $395 to $1,975 copay and no coinsurance, and select durable medical equipment and prosthetics with no copay and 0% to 20% coinsurance.
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