A non-government entity
Kaiser Permanente Senior Advantage Standard (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Standard (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 Standard (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Standard (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2026 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 Standard (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 Standard (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 Standard (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 $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 Standard (HMO)
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 Standard (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs, Tier 2 generic drugs, and Tier 6 vaccines through standard retail pharmacies or standard mail-order services. This ensures that essential everyday medications and preventative vaccines remain highly affordable. For brand-name and specialty medications, standard retail copays for a one-month supply are $47 for Tier 3 preferred brands and $95 for Tier 4 non-preferred drugs. You can save on three-month supplies of these medications by utilizing standard mail order, which caps copays at $94 for Tier 3 and $190 for Tier 4. Tier 5 specialty drugs require a 33% coinsurance for both retail and mail-order prescriptions.
Additional Benefits
The Kaiser Permanente Senior Advantage Standard (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, telehealth, and routine preventive services. For emergency situations, members pay a $130 copay with no coinsurance, which is waived upon hospital admission, while urgent care visits require a low $25 copay. Inpatient hospital stays require a daily copay of $335 for the first few days and no copay for subsequent days, ensuring financial protection during major medical events. Specialty care is highly accessible, with no copay for routine eye and annual hearing exams, alongside preventive dental care covered at no cost. The plan also includes valuable extras like an $85 quarterly over-the-counter allowance and no copay for the first 20 days of skilled nursing facility care. While some services like comprehensive dental, eyewear, and specialist visits require modest copays or coinsurance, standard cardiac rehabilitation and hearing aids are not covered under this plan.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Standard (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and referrals. Acute stays require a $335 daily copay for days 1 through 6 and no copay for additional days, while psychiatric stays require a $335 daily copay for days 1 through 5 and no copay for days 6 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Kaiser Permanente Senior Advantage Standard (HMO) with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital and observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $12 group or $25 individual copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Standard (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Senior Advantage Standard (HMO) with a $280 copay and no coinsurance for ground or air ambulance services. Transportation services are partially covered with a $60 to $125 copay and no coinsurance for plan-approved locations, but transportation to any other health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Standard (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $25 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $25, and $280 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Standard (HMO) covers primary care doctor visits and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services require copays of up to $25 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by the Kaiser Permanente Senior Advantage Standard (HMO) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney disease education. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services under the Kaiser Permanente Senior Advantage Standard (HMO) cover hearing exams with no coinsurance, featuring a $25 copay for fitting and evaluation and no copay for one routine exam per year. Prescription hearing aids and OTC hearing aids are not covered under this plan.
Vision Services See details
Kaiser Permanente Senior Advantage Standard (HMO) partially covers vision services, offering routine eye exams with no copay and no coinsurance, while 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 benefit every two years, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Standard (HMO), offering preventive care with no copay and no coinsurance, and Medicare-covered dental services for a $25 copay and no coinsurance. Other comprehensive services require copays ranging from $0 to $738 and no coinsurance, while orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Standard (HMO) covers home infusion bundled services with prior authorization, offering insulin with no coinsurance and a copay ranging from no copay to $35. Covered Medicare Part B chemotherapy, radiation, and other drugs require a copay ranging from no copay to $47 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Kaiser Permanente Senior Advantage Standard (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Kaiser Permanente Senior Advantage Standard (HMO) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies. Coinsurance ranges from no coinsurance to 20% for DME and medical supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Standard (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, while diagnostic tests range from a $0 to $35 copay, and therapeutic radiological services require a minimum copay of $25.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Senior Advantage Standard (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Kaiser Permanente Senior Advantage Standard (HMO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Standard (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Kaiser Permanente Senior Advantage Standard (HMO) partially cover select benefits, including over-the-counter (OTC) items with no copay and no coinsurance up to an $85 reimbursement limit every three months. Additional covered services include residential mental health and chemical dependency treatment with a $335 to $1,675 copay and no coinsurance, and non-Medicare DME and prosthetic supplies with no copay and 0% to 20% coinsurance, while acupuncture and meal benefits 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