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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 2025, 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 2025.
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 $157.00. 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 Maui (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and whether you use a preferred or standard pharmacy. For example, preferred generic drugs have no copay, while standard generic drugs have a $14 copay. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Maui (HMO) plan offers a variety of benefits with varying costs. You can expect to pay a copay for services like primary care ($10), specialist visits ($35), and outpatient hospital services ($0-$225). The plan also covers inpatient hospital stays, emergency services, and home health services, with some services having no copay and others having a copay or coinsurance. This plan includes coverage for preventive services, hearing and vision services, and dental services, with copays and coinsurance depending on the specific service. Additional benefits include coverage for ambulance, partial hospitalization, and skilled nursing facilities, with specific copays and conditions for each service.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, the copay is $340 for days 1-6, $70 for days 7-30, and no copay for days 31-90, and Additional Days have no copay. For Inpatient Hospital Psychiatric, the copay is $300 for days 1-6 and no copay for days 7-90, and Additional Days have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, 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 between $10 and $35, and Outpatient Blood Services with no copay. Outpatient Hospital Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Maui (HMO) plan, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $200 copay for both ground and air ambulance services, and no coinsurance. 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Transportation has a $200 copay. Worldwide Urgent Coverage has a $50 copay, and all services have no coinsurance.
Primary Care See details
The Kaiser Permanente Senior Advantage Maui (HMO) plan covers primary care physician services for a $10 copay, chiropractic services for a $20 copay, and occupational therapy services for a $10 copay. The plan also covers specialist services for a $35 copay, and physical therapy and speech-language pathology services for a $10 copay. Mental health and psychiatric services have a copay of $35 for individual sessions and $10 for group sessions, and podiatry services have a $35 copay. Telehealth services have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services like Health Education and Fitness Benefits. Kidney Disease Education Services have a $10 copay, while Medicare-covered EKG following Welcome Visit has a $15 copay, and other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams have no copay. Some preventive services, such as In-Home Safety Assessments, are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $10 copay, as well as fitting and evaluation for hearing aids. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$10 and routine eye exams with a $10 copay, and eyewear with a 20% coinsurance. 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 and Prophylaxis (Cleaning) with no copay, Dental X-Rays with 0-30% coinsurance, Other Diagnostic Dental Services and Adjunctive General Services with 30% coinsurance, and Periodontics with no copay. Other services like Fluoride Treatment, Other Preventive Dental Services, Endodontics, Prosthodontics (removable and fixed), Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are offered as optional supplemental benefits, or are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay of $14.00 - $35.00, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $14.00 - $47.00 and 0% - 20% coinsurance, and Other Medicare Part B Drugs with a copay of $14.00 - $47.00 and 0% - 20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Maui (HMO) plan, but require prior authorization and a doctor's referral. You may have to pay between 0% and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) requiring prior authorization and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, Medical Supplies have a coinsurance between 0% and 20%, and Diabetic Supplies have no coinsurance.
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 $15 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $180, Therapeutic Radiological Services have a copay of at most $40, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Maui (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 the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. 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 Maui (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20 and days 41-100, but there is a $200 copay for days 21-40. Additional days beyond Medicare and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture, with a $20 copay, up to 20 treatments per year, and other services that are not covered. Other 1 includes residential chemical dependency services, with a copay between $300 and $1800, and Other 2 includes DME not covered by Medicare, with 20% coinsurance. Some services are covered, including 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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