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Kaiser Permanente Senior Advantage Hawaii Island (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Hawaii Island (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 Hawaii Island (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Hawaii Island (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Island of Hawaii except for 3 ZIPs. 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 Hawaii Island (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 Hawaii Island (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 Hawaii Island (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $182.00. 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 Hawaii Island (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your medications, which varies depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $14 copay at standard pharmacies and mail order, and standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. The plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services with varying copays, as well as ambulance and emergency services. Primary care, mental health, and other specialist visits have copays, while preventive services like annual exams have no copay. Vision services include eye exams with no copay, and dental services cover Medicare dental with a copay. This plan also provides coverage for home health services with no copay, and dialysis services with coinsurance. Medical equipment, including durable medical equipment and prosthetic devices, is covered with coinsurance. Additionally, the plan covers diagnostic and radiological services, and skilled nursing facility services with a copay for some days.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute, you will pay a copay of $390 for days 1-6, $70 for days 7-30, and no copay for days 31-90, with additional days 91-999 having no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric services, you will pay a copay of $300 for days 1-6 and no copay for days 7-90, with additional days 91-999 also having no copay; Non-Medicare-covered stays are not covered.
Outpatient Services See details
The Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $250, observation services with no copay, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a copay of $35 for individual sessions and $15 for group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Kaiser Permanente Senior Advantage Hawaii Island (HMO) with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan. Ground and Air Ambulance Services have a $200 copay, but there is 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 has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $200 copay for Worldwide Emergency Transportation.
Primary Care See details
The Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan covers primary care physician services with a $15 copay, chiropractic services with a $20 copay, occupational therapy with a $15 copay, and specialist visits with a $35 copay. The plan also includes mental health services with a copay of $35 for individual sessions and $15 for group sessions, and podiatry services with a $35 copay. Physical therapy and speech-language pathology services have a $15 copay, additional telehealth benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services, with no copay, and annual physical exams with no copay. Kidney Disease Education Services have a $15 copay. Other preventive services, such as EKG following Welcome Visit, have a $25 copay.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, and fitting/evaluation for hearing aids which is offered as an optional, supplemental benefit. Prescription hearing aids and over-the-counter hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0 - $15, and eyewear with 20% coinsurance for contact lenses. However, 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, endodontics, and orthodontics 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, and require prior authorization. Medicare Part B Insulin Drugs have a copay of $14-$35. Medicare Part B Chemotherapy/Radiation Drugs have a copay of $14-$47, with a coinsurance between 0-20%. Other Medicare Part B Drugs have a copay of $14-$47, with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan and require prior authorization and a doctor's referral. You will pay between 0% and 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan. Durable medical equipment (DME) has a coinsurance between 0% and 20%, and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a coinsurance of 20%. Diabetic supplies have no coinsurance, while diabetic therapeutic shoes/inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a $25 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of at most $40, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Hawaii Island (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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require 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 coverage, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, with a $20 copay, and other services including Residential Chemical Dependency Services with a copay between $300 and $1800, and DME not covered by Medicare with 20% coinsurance. Other services such as Over-the-Counter (OTC) Items, 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 are not covered.
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