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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 2025, 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 2025.
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 $135.00. 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, standard generic drugs have a $47 copay, and preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium will be $34.70.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced (HMO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. This plan also provides coverage for emergency services, primary care, preventive services, and home health services, often with low or no copays. Additional benefits include hearing, vision, and dental services, along with coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-6, a $50 copay for days 7-30, and no copay for days 31-90; additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-6, and no copay for days 7-90; additional days (91-999) have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $225, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $225 copay, Individual and Group Sessions for Outpatient Substance Abuse with copays of $35 and $5 respectively, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan. Ground and air ambulance services have a $250 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan. Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with a $5 copay. Chiropractic Services, including routine care, are covered with a $20 copay and require prior authorization and a referral. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services are covered with a $5 copay and require authorization and referral. Physician Specialist Services have a $35 copay. Individual and group sessions for Mental Health and Psychiatric Specialty Services have copays of $35 and $5, respectively. Podiatry Services have a $35 copay, and Other Health Care Professional services have a copay between $5 and $35. Additional Telehealth benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services including Health Education, Fitness Benefit, and Remote Access Technologies with no copay. Kidney Disease Education Services require a $5 copay, and Other Preventive Services including EKG following Welcome Visit require a $10 copay, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams have no copay.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have a $5 copay. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$5, and routine eye exams with a $5 copay. Eyewear is covered with a 20% coinsurance for contact lenses, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays with 0%-30% coinsurance, other diagnostic dental services with 30% coinsurance, prophylaxis (cleaning) with no copay, and periodontics with no copay. Fluoride treatment, other preventive dental services, implant services, prosthodontics (removable and fixed), oral and maxillofacial surgery, and endodontics are offered as optional, supplemental benefits. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan, including Medicare Part B Insulin Drugs with a copay of $14 to $35, and Medicare Part B Chemotherapy/Radiation Drugs with a copay of $14 to $47 and a coinsurance of 0% to 20%. Other Medicare Part B Drugs have a copay of $14 to $47 and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan, but require prior authorization and a doctor's referral. There is a coinsurance between 0% and 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with no coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a $10 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $230, Therapeutic Radiological Services have a copay up to $40, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO) plan, with prior authorization and a doctor referral required. For days 1-20 and 41-100, there is no copay, but for days 21-40, there is a $150 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Enhanced (HMO) plan covers acupuncture with a $20 copay for up to 20 treatments per year, and "Other 1" benefits with a copay between $275 and $1650, and "Other 2" benefits with a 20% coinsurance. The plan does not cover Over-the-Counter (OTC) Items, a 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.
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