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Kaiser Permanente Senior Advantage Maui (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Maui (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 Maui (HMO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Maui (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Island of Maui. 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 Maui (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 Maui (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 Maui (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $181.00. 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:
Sign up for Kaiser Permanente Senior Advantage Maui (HMO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Maui (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using standard mail order, while standard retail pharmacy copays start at $4 for a one-month supply. Tier 2 generic drugs carry a $10 copay for a one-month supply, and Tier 6 vaccines are available at standard pharmacies with no copay. For brand-name and higher-tier medications, Tier 3 preferred brands require a $43 copay for a one-month supply, while Tier 4 non-preferred drugs carry a $90 copay. Specialty drugs in Tier 5 require a 30% coinsurance for both standard retail and mail order fills. Choosing standard mail order for multi-month supplies of Tier 2, 3, and 4 drugs can provide extra savings on your prescription costs.
Additional Benefits
The Kaiser Permanente Senior Advantage Maui (HMO) offers comprehensive medical coverage with most services requiring no coinsurance. For routine care, members pay a low $10 copay for primary care visits and a $35 copay for specialist visits, while preventive services like annual physicals and fitness benefits have no copay. Emergency room visits carry a $130 copay that is waived if admitted within 24 hours, while acute inpatient hospital stays require a daily copay of $340 for days one through six and $70 for days seven through thirty. Home health visits and laboratory services are covered with no copay, while diagnostic tests, outpatient X-rays, and routine eye or hearing exams require a $10 to $15 copay. While dental care is partially covered with copays up to $35 or coinsurance up to 30%, this plan does not cover eyewear or prescription hearing aids. Additionally, durable medical equipment and dialysis services feature no copay but may require coinsurance up to 20%.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Maui (HMO) covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For acute stays, there is a copay of $340 per day for days 1 to 6 and $70 per day for days 7 to 30, while psychiatric stays require a $300 daily copay for days 1 to 6, with no copay required for subsequent days for either service.
Outpatient Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers outpatient services with no coinsurance, though referrals are required for most services. Outpatient hospital services carry a $0 to $325 copay, ambulatory surgical center visits require a $325 copay, outpatient substance abuse sessions have a $10 to $35 copay, and blood and observation services are provided with no copay.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Maui (HMO) covers partial hospitalization services with copays ranging from $10.00 to $35.00 or a $55.00 copay, and no coinsurance. A referral is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Kaiser Permanente Senior Advantage Maui (HMO), which features a $250 copay and no coinsurance for both ground and air ambulance services. While ambulance services are covered, transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with no coinsurance, requiring copays of $130, $40, and $250 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Maui (HMO) covers primary care visits for a $10 copay and specialist visits for a $35 copay, both with no coinsurance. Therapy services require a $10 copay and no coinsurance, while chiropractic benefits are partially covered with a $20 copay and no coinsurance for routine care, though other chiropractic services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers preventive services with no coinsurance and no copay for annual physical exams, fitness benefits, and glaucoma screenings, though referrals are required for some services. Additional preventive services are only partially covered, excluding options like nutritional therapy and in-home safety assessments, while kidney disease education requires a $10 copay and an EKG after a welcome visit requires a $15 copay, both with no coinsurance.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Senior Advantage Maui (HMO), offering routine exams and fitting evaluations with a $10 copay, no coinsurance, and no deductible, though a referral is required. While prescription hearing aids are technically covered, some services are covered but all prescription types (inner ear, outer ear, and over the ear) and over-the-counter hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Maui (HMO) vision services are partially covered, featuring routine eye exams with a $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear benefits, including contact lenses, eyeglasses, frames, lenses, and upgrades, are not covered under this plan.
Dental Services See details
Kaiser Permanente Senior Advantage Maui (HMO) provides partially covered dental services, though orthodontics and maxillofacial prosthetics are not covered. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered dental services feature no copay and coinsurance ranging from no coinsurance up to 30%.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers home infusion bundled services, including Medicare Part B insulin with a $10.00 to $35.00 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require a copay of $10.00 to $43.00 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers dialysis services with no copay and coinsurance ranging from no coinsurance to 20%. A referral is required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Maui (HMO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment and medical supplies have coinsurance ranging from no coinsurance to 20%, while prosthetic devices and diabetic therapeutic shoes or inserts require 20% coinsurance, and diabetic supplies feature no coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Maui (HMO) covers diagnostic and radiological services with a referral, offering lab services with no copay and no coinsurance. Diagnostic tests, outpatient X-rays, and diagnostic radiological services require a $15 copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Senior Advantage Maui (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Kaiser Permanente Senior Advantage Maui (HMO) require a referral and have no coinsurance, but they are not covered in practice because sub-services like cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Maui (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a referral and 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, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Kaiser Permanente Senior Advantage Maui (HMO) are partially covered, featuring acupuncture for a $20 copay and no coinsurance (up to 20 treatments per year), residential chemical dependency services for a $300 to $1,800 copay and no coinsurance, and non-Medicare durable medical equipment with no copay and 20% coinsurance. Meal benefits and over-the-counter items are not covered.
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