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Senior Care Plus Patriot Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care Plus Patriot Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Care Plus Patriot Plan (HMO) in 2026, please refer to our full plan details page.
Senior Care Plus Patriot Plan (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Washoe, Carson City, Storey Counties, NV. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Senior Care Plus Patriot Plan (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Care Plus Patriot Plan (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 Senior Care Plus Patriot Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $65.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2750.00 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
Prescription drugs are not covered by Senior Care Plus Patriot Plan (HMO).
Additional Benefits
The Senior Care Plus Patriot Plan (HMO) offers comprehensive medical coverage with predictable cost-sharing, featuring no coinsurance for inpatient hospital stays and a $350 daily copay for the first four days. Primary care visits range from no copay to a $10 copay, while specialist visits require a $45 copay, both with no coinsurance. Additionally, emergency care is covered with a $140 copay, and urgent care visits carry a copay ranging from $25 to $65. This plan also includes valuable extra benefits, such as preventive services, routine eye exams, and routine hearing exams with no copay. Dental care is covered with no copay up to a $1,500 annual limit, and prescription hearing aids are covered with no copay up to $400 per ear annually. Furthermore, members benefit from an over-the-counter allowance of $25 every three months with no copay, alongside home health services and telehealth options that also require no copay.
Inpatient Hospital See details
Senior Care Plus Patriot Plan (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 4 and no copay for days 5 and beyond. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Outpatient services are covered by the Senior Care Plus Patriot Plan (HMO) with no coinsurance for outpatient hospital and substance abuse services, featuring hospital copays of $0 to $440 and substance abuse session copays of $40. Ambulatory surgical center services are offered with no copay and no coinsurance, while outpatient blood services require a 20% coinsurance with no copay.
Partial Hospitalization See details
Senior Care Plus Patriot Plan (HMO) covers partial hospitalization with no coinsurance, requiring either a $75 copay with prior authorization or a $130 copay with a referral.
Ambulance and Transportation Services See details
Senior Care Plus Patriot Plan (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance (up to a $1,250 annual limit), while transportation to any other health-related locations is not covered.
Emergency Services See details
Senior Care Plus Patriot Plan (HMO) covers emergency services with a $140 copay and urgently needed services with a $25 to $65 copay, both with no coinsurance and copays waived if admitted within 12 hours. Worldwide emergency services are partially covered up to a $10,000 limit with no coinsurance, featuring a $140 copay for emergency care and a $65 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Senior Care Plus Patriot Plan (HMO) covers primary care physician services with no coinsurance and a copay ranging from no copay to $10, as well as telehealth services with no copay and no coinsurance. Specialist, mental health, and psychiatric services require a $45 copay with no coinsurance, while physical, occupational, and speech therapies have a $20 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by the Senior Care Plus Patriot Plan (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered with no copay or coinsurance, though services like personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies are not covered.
Hearing Services See details
Hearing services are covered by the Senior Care Plus Patriot Plan (HMO), offering routine hearing exams with no copay and fitting evaluations for a $50 copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to $400 per ear annually, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Senior Care Plus Patriot Plan (HMO), featuring routine eye exams with no copay and no coinsurance, and other covered eye exams with a $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, except for contact lenses which require a 20% coinsurance, up to a combined annual maximum of $170.
Dental Services See details
Senior Care Plus Patriot Plan (HMO) dental services are partially covered, featuring Medicare-covered dental with a $40 copay and no coinsurance, and other covered dental benefits with no copay and no coinsurance up to a $1,500 yearly maximum. However, other diagnostic services, fluoride treatment, other preventive services, adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by the Senior Care Plus Patriot Plan (HMO) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Senior Care Plus Patriot Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Senior Care Plus Patriot Plan (HMO) with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay and range from no coinsurance to 20% coinsurance, with prior authorization required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Senior Care Plus Patriot Plan (HMO) covers diagnostic and radiological services with no coinsurance, though referrals are required for radiological services. Diagnostic procedures have a copay ranging from $0 to $300, outpatient X-rays have a $60 copay, therapeutic radiological services have a minimum copay of $80, and lab services and diagnostic radiological services have no copay.
Home Health Services See details
Home Health Services are covered by the Senior Care Plus Patriot Plan (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Senior Care Plus Patriot Plan (HMO) provides coverage for Cardiac Rehabilitation Services with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation are not covered. These non-covered services carry copayments ranging from $10 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Care Plus Patriot Plan (HMO) with no coinsurance and prior authorization required, and do not require a prior three-day inpatient hospital stay. Covered individuals pay a $20 copayment per day for days 1 through 20, a $200 copayment per day for days 21 through 34, and no copayment for days 35 through 100, while additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Senior Care Plus Patriot Plan (HMO) offers partial coverage for other services, featuring an over-the-counter (OTC) benefit with no copay and no coinsurance up to $25 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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