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Kaiser Permanente Senior Advantage Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Basic (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 Basic (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Basic (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 Basic (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 Basic (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 Basic (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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 $7750.00 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 Basic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies based on the drug tier and the pharmacy you use. For example, the copay is $14 for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your premium may be reduced, and you may have no copay.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic (HMO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $365. Many primary care services, vision, and dental services are covered, with copays for exams and some treatments. The plan also covers emergency and ambulance services, preventive services, and home health services, often with no or low copays. Additionally, you can expect coverage for home infusion services, dialysis, medical equipment, and diagnostic services with a mix of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a copay of $365 for days 1-6, $70 for days 7-30, and no copay for days 31-90; additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you pay a copay of $350 for days 1-5 and no copay for days 6-90; additional days 91-999 have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as is the Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with no copay, ambulatory surgical center services with a $300 copay, individual and group outpatient substance abuse sessions with a copay of $45 and $15 respectively, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Basic (HMO) plan, requiring prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Basic (HMO) plan. Ground and Air Ambulance Services have a copay of $320, and there is no coinsurance, but Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Basic (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $320 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services and Chiropractic Services have a $15 copay, while Occupational Therapy, Physical Therapy, and Speech-Language Pathology Services have a $15 copay with no coinsurance. Physician Specialist Services, Individual Sessions for Mental Health Specialty Services, and Podiatry Services have a $45 copay, and Group Sessions for Mental Health Specialty Services have a $15 copay. Other Health Care Professional and Psychiatric Services have copays ranging from $15 to $45, and Additional Telehealth Benefits and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and annual physical exams with no copay. Kidney disease education services have a $15 copay, and EKG following Welcome Visit has a $25 copay. Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams have no copay.
Hearing Services See details
Hearing exams are covered with a $15 copay, including routine hearing exams and fitting/evaluation for hearing aids, but prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and routine eye exams with a $15 copay, and eyewear with 20% coinsurance for contact lenses. Contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $45 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Kaiser Permanente Senior Advantage Basic (HMO) plan. You may pay a copay of $14.00 to $35.00 for Medicare Part B Insulin Drugs, a copay of $14.00 to $47.00 and 0-20% coinsurance for Medicare Part B Chemotherapy/Radiation Drugs, and a copay of $14.00 to $47.00 and 0-20% coinsurance for Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Basic (HMO) plan and require prior authorization and a doctor's referral. There is no minimum coinsurance, but the maximum coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 0-20% coinsurance and Prosthetic Devices with 20% coinsurance. Medical Supplies have a coinsurance of 0-20%, and Diabetic Equipment is covered with varying coinsurance, including 0-0% for Diabetic Supplies and 20% for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $25 copay, Lab Services with a $15 copay, and Outpatient X-Ray Services with a $25 copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Basic (HMO) 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 there is no information provided about the cost sharing (copay or coinsurance) for these services. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. There is no copay for days 1-20 and days 41-100, but there is a $200 copay for days 21-40.
Other Services See details
Other Services includes acupuncture with a $20 copay, other services like Residential Chemical Dependency Services with a $350-$1750 copay, and DME not covered by Medicare with 20% coinsurance, but does not cover over-the-counter items, meal benefits, or several other services.
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