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Senior Care Plus Select Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care Plus Select 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 Select Plan (HMO) in 2026, please refer to our full plan details page.
Senior Care Plus Select 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 Select 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 Select 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 Select Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $180.00. 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 $1450.00 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 Select Plan (HMO) features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront deductible costs. Under this plan, there is no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions at standard pharmacies and through standard mail order. This makes filling essential everyday medications highly affordable for members. For brand-name and specialty medications, costs vary depending on the drug tier and supply. Tier 3 (Preferred Brand) drugs have a $47 copay for a one-month supply at standard pharmacies, while Tier 4 (Non-Preferred Drugs) require a 50% coinsurance. Specialty Tier 5 drugs require a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Senior Care Plus Select Plan (HMO) offers affordable medical coverage with low out-of-pocket costs, featuring no copay to a $10 copay for primary care and a $5 copay for specialists. Inpatient hospital stays require a $145 daily copay for the first two days and no copay for additional days, while emergency services have a $140 copay and no coinsurance. Outpatient surgery at ambulatory surgical centers is also highly accessible with no copay and no coinsurance. This plan also includes valuable everyday benefits, such as routine dental cleanings and routine eye exams with no copay or coinsurance. Members receive a $250 annual allowance for eyewear and a $400 annual limit per ear for hearing aids, both with no copay or coinsurance. Furthermore, the plan provides up to 24 one-way transportation trips to approved locations and a $140 over-the-counter allowance every three months with no copay.
Inpatient Hospital See details
Senior Care Plus Select Plan (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $145 daily copay for days 1 and 2, and no copay for days 3 and beyond for both acute and psychiatric stays. Non-Medicare-covered stays and acute care upgrades are not covered under this plan.
Outpatient Services See details
Senior Care Plus Select Plan (HMO) covers outpatient hospital services with no coinsurance and copays of $0 to $440 ($175 to $440 for observation services), and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Senior Care Plus Select Plan (HMO) with no coinsurance, requiring a copay of either $75 with prior authorization or $100 with a referral.
Ambulance and Transportation Services See details
Senior Care Plus Select Plan (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips (up to a $1,250 annual limit) to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Senior Care Plus Select Plan (HMO) covers emergency services with a $140 copay and urgently needed services with a $20 to $45 copay, both featuring no coinsurance. Worldwide emergency services are partially covered up to a $10,000 maximum with no coinsurance, requiring a $140 copay for emergency care and a $45 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits under the Senior Care Plus Select Plan (HMO) are partially covered, as chiropractic and podiatry services are not covered. Most covered services require no coinsurance, featuring copays such as no copay to $10 for primary care, $5 for specialists, and $15 for physical, occupational, and speech therapies.
Preventive Services See details
Preventive services under the Senior Care Plus Select Plan (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered, excluding PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, and counseling.
Hearing Services See details
Senior Care Plus Select Plan (HMO) provides partial coverage for hearing services, featuring hearing exams with a $35 copay and no coinsurance, and prescription hearing aids with no copay or coinsurance up to a $400 annual limit per ear. Over-the-counter (OTC) hearing aids, alongside inner ear, outer ear, and over-the-ear prescription hearing aid types, are not covered.
Vision Services See details
Senior Care Plus Select Plan (HMO) partially covers vision services with no deductible, as other eye exam services are not covered. Routine eye exams are provided with no copay and no coinsurance, while eyewear is covered up to $250 annually with no copay and no coinsurance, except for contact lenses which carry a 20% coinsurance.
Dental Services See details
Senior Care Plus Select Plan (HMO) partially covers dental services, offering Medicare-covered dental for a $15 copay and no coinsurance, and other covered services like cleanings, exams, and restorations with no copay and no coinsurance up to a $1,500 annual limit. Sub-services that are not covered under this plan include fluoride, other diagnostic or preventive dental, adjunctive general services, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Senior Care Plus Select Plan (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Senior Care Plus Select Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Care Plus Select Plan (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays. Members pay a 10% coinsurance for DME, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies range from no coinsurance up to 10% coinsurance. Prior authorization is required for DME and prosthetics.
Diagnostic and Radiological Services See details
Senior Care Plus Select Plan (HMO) covers diagnostic and radiological services with no coinsurance, though radiological services require a referral. Members pay no copay for lab services, a $45 copay for outpatient X-rays, a minimum $80 copay for therapeutic radiology, and copays ranging from $0 to $250 for diagnostic procedures and radiological services.
Home Health Services See details
Home Health Services are covered by the Senior Care Plus Select Plan (HMO) with no copay and no coinsurance, though a referral is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Senior Care Plus Select Plan (HMO) with no coinsurance, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. These non-covered services require copayments ranging from $10 to $15.
Skilled Nursing Facility (SNF) See details
Senior Care Plus Select Plan (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $20 daily copay for days 1 to 20, a $200 daily copay for days 21 to 34, and no copay for days 35 to 100. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Senior Care Plus Select Plan (HMO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $140 every three months. Acupuncture and meal benefits are not covered.
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