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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 2026, 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 2026.
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 $42.00. 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:
Sign up for Kaiser Permanente Senior Advantage Basic (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Basic (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using standard mail order, while standard pharmacy copays start at $4 for a one-month supply. Tier 2 generic drugs and Tier 3 preferred brand drugs are also accessible, with standard pharmacy copays starting at $10 and $43 respectively for a one-month supply. Higher-tier medications under this plan include Tier 4 non-preferred drugs starting at a $90 copay for a one-month supply and Tier 5 specialty drugs which require a 30% coinsurance. Additionally, Tier 6 vaccines are available with no copay for a one-month supply at standard pharmacies. Utilizing standard mail order for multi-month supplies of Tier 2, 3, and 4 drugs can also offer additional savings.
Additional Benefits
The Kaiser Permanente Senior Advantage Basic (HMO) plan offers robust medical coverage featuring no coinsurance for many core services. Under this plan, you will pay no copay for telehealth services, a $15 copay for primary care visits, and a $50 copay for specialist visits. Emergency care requires a $115 copay, which is waived if you are admitted, while inpatient hospital stays incur daily copays depending on the length and type of your stay. Preventive care, home health services, and cardiac rehabilitation are fully covered with no copay and no coinsurance. Routine hearing and vision exams require a $15 copay, while preventive dental care has no copay, though more advanced dental services can require up to 30% coinsurance. Additionally, skilled nursing facility stays feature no coinsurance and require no copay for the first 20 days of care.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Basic (HMO) covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For acute care, there is a $400 daily copay for days 1 to 6 and a $70 daily copay for days 7 to 30, while psychiatric care requires a $350 daily copay for days 1 to 5, with no copays for additional days under either benefit.
Outpatient Services See details
Kaiser Permanente Senior Advantage Basic (HMO) covers outpatient services with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services, a $375 copay for ambulatory surgical center services, and no copay for observation and blood services. Outpatient substance abuse services require a $15 copay for group sessions and a $50 copay for individual sessions, with referrals required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Kaiser Permanente Senior Advantage Basic (HMO) plan with copays ranging from $15.00 to $55.00 and no coinsurance. A referral is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Basic (HMO), which features a $320 copay and no coinsurance for both ground and air ambulance services. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Kaiser Permanente Senior Advantage Basic (HMO) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $320 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Basic (HMO) covers primary care visits for a $15 copay and specialist visits for a $50 copay, both with no coinsurance. Chiropractic services are partially covered, offering routine care for a $20 copay and no coinsurance while other chiropractic services are not covered, and telehealth benefits are available with no copay and no coinsurance.
Preventive Services See details
Kaiser Permanente Senior Advantage Basic (HMO) covers preventive services with no coinsurance, offering no copay for annual physicals, health education, fitness programs, glaucoma screenings, and diabetes self-management. Kidney disease education requires a $15 copay, an EKG after a welcome visit has a $25 copay, and referrals are required for several of these services. Additional preventive benefits are only partially covered, excluding 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, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Basic (HMO) covers routine hearing exams and fitting evaluations with a $15 copay, no coinsurance, and no deductible, with a referral required. Some prescription hearing aid services are covered, but all types of prescription hearing aids, including inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Basic (HMO), offering routine eye exams with a $15 copay, no coinsurance, and a required referral. Other eye exam services and eyewear, including contacts and eyeglasses, are not covered under this plan.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Senior Advantage Basic (HMO) plan, excluding maxillofacial prosthetics and orthodontics. Medicare-covered dental services require a $50 copay and no coinsurance, while preventive care has no copay and no coinsurance, and other covered diagnostic and restorative services range from no copay up to a 30% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Kaiser Permanente Senior Advantage Basic (HMO) plan, with Part B insulin drugs requiring a $10.00 to $35.00 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, have a copay of $10.00 to $43.00 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Kaiser Permanente Senior Advantage Basic (HMO) covers dialysis services with no copay and coinsurance ranging from no coinsurance up to 20%. A referral is required to access these covered services.
Medical Equipment See details
Medical equipment is covered by the Kaiser Permanente Senior Advantage Basic (HMO) with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance to 20% for durable medical equipment, medical supplies, prosthetics, and diabetic shoes, while diabetic supplies require no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Basic (HMO) covers diagnostic and radiological services with a required referral, offering diagnostic tests for a $25 copay and lab services for a $15 copay with no coinsurance. Outpatient X-rays and diagnostic radiological services require a $25 copay, while therapeutic radiological services carry a 20% minimum coinsurance.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Senior Advantage Basic (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 Basic (HMO) with no copay, no coinsurance, and a referral requirement. However, only some services are covered in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a referral but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 41 to 100, a $218 copay for days 21 to 40, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Basic (HMO) partially covers other services, including acupuncture for a $20 copay and no coinsurance up to 20 treatments annually, residential chemical dependency services for a $350 to $1750 copay and no coinsurance, and non-Medicare durable medical equipment with no copay and 20% coinsurance. Over-the-counter items and meal benefits are not covered.
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