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Senior Care Plus Essential plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care Plus Essential 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 Essential plan (HMO) in 2026, please refer to our full plan details page.
Senior Care Plus Essential 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 Essential plan (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 Senior Care Plus Essential 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 Essential 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.
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 $2700.00 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 Senior Care Plus Essential plan (HMO) features a $0 prescription drug deductible, meaning your coverage begins immediately without any out-of-pocket deductible costs. You will enjoy no copay for Tier 6 Select Care Drugs at both standard pharmacies and standard mail order services. For other low-tier medications, standard pharmacy copays start at just $5 for Tier 1 Preferred Generic drugs and $12 for Tier 2 Generic drugs. For brand-name and higher-tier medications, Tier 3 Preferred Brand drugs carry a $47 copay for a one-month supply at standard pharmacies. Tier 4 Non-Preferred Drugs require a 50% coinsurance for both standard pharmacy and standard mail order options, while Tier 5 Specialty Tier drugs require a 33% coinsurance for a one-month supply. You can also save on multi-month supplies of Tier 1, 2, and 3 drugs through standard mail order delivery.
Additional Benefits
The Senior Care Plus Essential plan (HMO) offers robust coverage with no coinsurance for many key medical services, including inpatient hospital care, outpatient services, and emergency room visits. Primary care visits range from no copay to a $10 copay, while specialist visits require a $30 copay and telehealth is available with no copay. Inpatient hospital stays have a $220 daily copay for days 1 through 4, with no copay required for day 5 and beyond. For additional health needs, members benefit from no copay on preventive dental care, annual routine hearing exams, home health services, and up to 24 one-way transportation trips per year. Routine eye exams carry a $30 copay, and Medicare-covered dental services require a $40 copay. Over-the-counter items are also covered with a $50 quarterly allowance featuring no copay and no coinsurance.
Inpatient Hospital See details
Senior Care Plus Essential plan (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $220 daily copay for days 1 through 4 and no copay for days 5 and beyond. Non-Medicare-covered stays and upgrades are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Senior Care Plus Essential plan (HMO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $440, while observation services require a $300 to $440 copay per stay with no coinsurance. Ambulatory surgical center services feature no copay or coinsurance, outpatient substance abuse sessions carry a $50 copay with no coinsurance, and outpatient blood services have a 20% coinsurance with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Senior Care Plus Essential plan (HMO) with no coinsurance. Depending on the service requirements, you will pay either a $130 copay with a referral or a $75 copay per year with prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Senior Care Plus Essential plan (HMO), featuring a $275 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, up to a $1,250 maximum annual benefit, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Senior Care Plus Essential plan (HMO) with a $140 copay and no coinsurance, and urgent care is covered with a $20 to $65 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $10,000 maximum with no coinsurance and copays of $140 and $65 respectively, though worldwide emergency transportation is not covered.
Primary Care See details
Senior Care Plus Essential plan (HMO) covers primary care visits with no copay to a $10 copay, and specialist visits with a $30 copay, both featuring no coinsurance. Physical, occupational, and speech therapy services require a $25 copay and no coinsurance, telehealth is offered with no copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Senior Care Plus Essential plan (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, though personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and counseling are not covered.
Hearing Services See details
Hearing Services are partially covered by the Senior Care Plus Essential plan (HMO), featuring a $45 copay (no copay for annual routine exams) and no coinsurance for hearing exams. Prescription hearing aids require a copay ranging from $495 to $1,970 with no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Senior Care Plus Essential plan (HMO), offering one routine eye exam per year with a $30 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay and 20% coinsurance up to a $250 annual maximum, with no deductibles applying to these benefits.
Dental Services See details
Dental Services are partially covered under the Senior Care Plus Essential plan (HMO), featuring a $40 copay and no coinsurance for Medicare-covered dental services. Preventive care like oral exams, cleanings, and x-rays is offered with no copay and no coinsurance, but fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Senior Care Plus Essential plan (HMO) covers Home Infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Care Plus Essential plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Care Plus Essential plan (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays. Members will pay a 20% coinsurance for DME, prosthetics, and diabetic shoes, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Senior Care Plus Essential plan (HMO) with no coinsurance, though referrals are required for radiological services. There is no copay for lab services and diagnostic radiology, while outpatient x-rays have a $35 copay, therapeutic radiology starts at an $80 copay, and diagnostic procedures range from a $0 to $275 copay.
Home Health Services See details
Home Health Services are covered under the Senior Care Plus Essential plan (HMO) with no copay and no coinsurance, although a referral is required to receive care.
Cardiac Rehabilitation Services See details
Senior Care Plus Essential plan (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered. These services require copayments of $15, $10, $20, and $30 respectively.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by the Senior Care Plus Essential plan (HMO) with no coinsurance, requiring prior authorization and daily copays of $20 for days 1 through 20, $200 for days 21 through 34, and no copay for days 35 through 100. A prior three-day inpatient hospital stay is not required, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Care Plus Essential plan (HMO) partially covers Other Services, offering up to $50 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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