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Kaiser Permanente Senior Advantage Enhanced (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced (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 Enhanced (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Island of Oahu. 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 Enhanced (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 Enhanced (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 Enhanced (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $160.00. 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 $5100.00 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 Enhanced (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay when using standard mail order, while standard retail pharmacy copays start at $4.00 for a one-month supply. Tier 2 generic medications cost a $10.00 copay for a one-month supply at both standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a $43.00 copay for a one-month supply, and Tier 4 non-preferred drugs have a $90.00 copay. Specialty drugs in Tier 5 incur a 29% coinsurance for both retail and mail-order options, while Tier 6 vaccines are available with no copay for a one-month supply at standard pharmacies. Ordering a three-month supply of Tier 2, Tier 3, or Tier 4 drugs through standard mail order offers notable savings compared to standard retail pharmacies.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced (HMO) plan offers robust medical coverage with predictable costs, featuring no copay for preventive services, telehealth, and home health care. Members pay a low $5 copay for primary care visits and routine hearing and vision exams, while specialist visits require a $35 copay. Emergency care is accessible with a $130 copay, and inpatient hospital stays require daily copays for the first several days with no coinsurance. Preventive dental care is available with no copay, though other dental procedures and medical equipment may require up to 20% to 30% coinsurance. Skilled nursing facility stays feature no copay for the first 20 days, and diagnostic lab services are also provided with no copay. However, this plan does not cover routine eyewear, hearing aids, or non-emergency transportation services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Senior Advantage Enhanced (HMO) with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For covered acute stays, there is a copay of $315 per day for days 1 to 6 and $50 per day for days 7 to 30 (no copay thereafter), while psychiatric stays require a $275 daily copay for days 1 to 6 and no copay for subsequent days.
Outpatient Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers outpatient services with no coinsurance, though referrals are required for most treatments. Patients will pay no copay for outpatient blood and observation services, a $5 to $35 copay for outpatient substance abuse sessions, and up to a $315 copay for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers partial hospitalization with copays ranging from $5.00 to $55.00 and no coinsurance. A referral is required to receive these benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Enhanced (HMO), offering Medicare-covered ground and air ambulance services with a $250 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance, featuring copays of $130, $40, and $250 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers primary care and therapy visits for a $5 copay, and specialist visits for a $35 copay, all with no coinsurance. Telehealth services feature no copay and no coinsurance, while chiropractic care is only partially covered, excluding non-routine chiropractic services.
Preventive Services See details
Preventive services are partially covered under the Kaiser Permanente Senior Advantage Enhanced (HMO) with no coinsurance, featuring no copay for annual physicals, health education, fitness benefits, glaucoma screenings, and diabetes training. A $5 copay applies to kidney disease education, a $10 copay is required for EKGs following a welcome visit, and several supplemental benefits like nutritional therapy, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO), featuring routine hearing exams and fitting evaluations for a $5.00 copay with no coinsurance or deductible, though a referral is required. Some services are covered, but prescription hearing aids (including inner ear, outer ear, and over the ear types) and OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO) provides coverage for routine eye exams with a $5 copay, no coinsurance, and a required referral, though other eye exam services are not covered. Eyewear benefits, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO) partially covers dental services, featuring Medicare-covered dental with a $35 copay and no coinsurance, and preventive care like exams and cleanings with no copay and no coinsurance. Other services such as x-rays and restorative care carry no copay and up to 30% coinsurance, though orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers home infusion bundled services, including Part D home infusion drugs and Medicare Part B drugs. Medicare Part B insulin drugs require a $10.00 to $35.00 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a $10.00 to $43.00 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) with no copay, though a referral is required. Members will pay between no coinsurance and 20% coinsurance for these covered services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and medical supplies have a 0% to 20% coinsurance, diabetic supplies have no coinsurance, and prosthetic devices and diabetic shoes or inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO) with a referral, offering lab services with no copay or coinsurance and diagnostic tests for a $10 copay. Outpatient X-rays require a $10 copay plus coinsurance, diagnostic radiology has a $10 minimum copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO) with no coinsurance, though a referral is required. While some services are covered, key sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Enhanced (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a referral and allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 41 to 100, but a $175 copay applies for days 21 to 40, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Kaiser Permanente Senior Advantage Enhanced (HMO), excluding over-the-counter (OTC) items and meal benefits. Covered benefits include acupuncture with a $20 copay and no coinsurance (limit of 20 treatments per year), residential chemical dependency services with a $275 to $1,650 copay and no coinsurance, and non-Medicare durable medical equipment with no copay and 20% coinsurance.
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