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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 2026, 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 2026.
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 $188.00. 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 Hawaii Island (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay when using standard mail order, while standard retail pharmacies charge a $4 copay for a one-month supply. Tier 2 generic drugs cost a $10 copay for a one-month supply through both standard retail and mail-order services. Tier 3 preferred brand drugs require a $43 copay for a one-month supply, and Tier 4 non-preferred drugs carry a $90 copay. Specialty drugs in Tier 5 require a 30% coinsurance for both retail and mail order, while Tier 6 vaccines are available with no copay for a one-month supply at standard pharmacies. Choosing a three-month mail-order supply for generic, brand, and non-preferred drugs offers additional savings compared to standard retail options.
Additional Benefits
The Kaiser Permanente Senior Advantage Hawaii Island (HMO) plan offers comprehensive medical coverage with a low $15 copay for primary care doctor visits and a $50 copay for specialists. For hospital care, inpatient stays require a $400 daily copay for the first six days and have no copay after day 30, while emergency room visits carry a $115 copay. Additionally, members enjoy no copay for home health services, routine dental cleanings, and many preventive screenings. For specialized health needs, routine vision and hearing exams are covered with a $15 copay, though eyewear and hearing aids are not included. Diagnostic lab tests and diabetic supplies are available with no copay, while durable medical equipment requires up to 20% coinsurance. The plan also covers acupuncture for a $20 copay and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) partially covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For acute care, you pay a $400 daily copay for days 1 to 6, $70 daily for days 7 to 30, and no copay for days 31 and beyond; psychiatric care requires a $300 daily copay for days 1 to 6 and no copay for subsequent days.
Outpatient Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services, a $350 copay for ambulatory surgical center visits, and no copay for outpatient blood or observation services. Outpatient substance abuse services require a referral and have a copay of $50 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers partial hospitalization benefits with a copay ranging from $15.00 to $55.00 and no coinsurance. A referral is required to access this covered service.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, and this copay is not waived if you are admitted to the hospital. Routine transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers emergency services 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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $40 to $275.
Primary Care See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers primary care visits for a $15 copay and specialist visits for a $50 copay, both with no coinsurance. Additional benefits like physical therapy, mental health, and telehealth are covered with no coinsurance and copays ranging from no copay up to $50, though chiropractic services are only partially covered since non-routine chiropractic care is excluded.
Preventive Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers preventive services with no coinsurance, offering annual physical exams, glaucoma screenings, and diabetes training with no copay. Other supplemental benefits are partially covered, providing health education, fitness benefits, and remote technologies with no copay, though sub-services like in-home safety assessments, medical nutrition therapy, and weight management programs are not covered. Referrals are required for most preventive services, and copays of $15 for kidney disease education and $25 for post-welcome-visit EKGs apply.
Hearing Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers routine hearing exams and hearing aid evaluations with a $15 copay, no coinsurance, and no deductible, though a referral is required. Prescription hearing aids and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) provides partially covered vision services with no deductible, featuring routine eye exams for a $15 copay and no coinsurance. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copay or coinsurance. Medicare-covered dental services require a $50 copay with no coinsurance, and restorative services have no copay and 30% coinsurance, though orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers home infusion bundled services, including Medicare Part B insulin with a $10.00 to $35.00 copay and no coinsurance. Other covered Medicare Part B drugs, including chemotherapy and radiation, require a copay of $10.00 to $43.00 and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Hawaii Island (HMO) with no copay and coinsurance ranging from no coinsurance to 20% coinsurance, though a referral is required.
Medical Equipment See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay. Diabetic supplies have no coinsurance, while DME and medical supplies have a 0% to 20% coinsurance, and prosthetic devices and diabetic shoes require 20% coinsurance. Prior authorization is required for these covered services.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers diagnostic and radiological services with a referral, offering lab services with no copay and diagnostic tests or outpatient X-rays for a $25 copay. Diagnostic services carry no coinsurance, while diagnostic radiological services require a $25 copay and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers home health services 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 Hawaii Island (HMO) with no copay, no coinsurance, and a required referral, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 41 to 100, and a $218 copay for days 21 to 40. A referral is required for this benefit, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Hawaii Island (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, residential chemical dependency services with a $300 to $1,800 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 under this plan.
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