Senior Care Plus Complete Plan (HMO)

Senior Care Plus Complete Plan (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Senior Care Plus Complete 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 Complete 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.

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:

Drug Coverage

The Senior Care Plus Complete Plan (HMO) features no drug deductible, meaning your prescription coverage begins immediately. For Tier 6 select care drugs, you will pay no copay for standard pharmacy and mail-order prescriptions. Tier 1 preferred generic drugs start at a low $2.00 copay for a one-month supply at standard pharmacies, while Tier 2 generics cost $8.00 and Tier 3 preferred brands cost $47.00. Higher-tier medications, such as Tier 4 non-preferred drugs, require a 47% coinsurance at standard pharmacies and mail-order services. Tier 5 specialty drugs incur a 33% coinsurance for a one-month supply at standard pharmacies. For savings on multi-month supplies, standard mail-order services offer fixed copays for lower-tier drugs, such as a $4.00 copay for a three-month supply of Tier 1 drugs.

Additional Benefits

The Senior Care Plus Complete Plan (HMO) offers comprehensive coverage for essential medical needs, featuring no copays and no coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and outpatient surgical services. For urgent and emergency care, members pay predictable copays, including a $140 copay for emergency room visits and a $75 copay for ground ambulance services, with no coinsurance. Additionally, home health care and preventive services are covered with no copays or coinsurance. This plan also provides generous supplemental benefits, including routine dental care up to a $2,000 annual limit and routine vision exams and eyewear up to $170 per year, both with no copays or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $3,000 annual maximum, and members receive a $105 over-the-counter allowance every three months. For specialized medical needs like dialysis and durable medical equipment, members pay no copays and a standard 20% coinsurance.