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Kaiser Permanente Senior Advantage Choice DM (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Choice DM (PPO). 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 Choice DM (PPO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Choice DM (PPO) is a PPO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Denver Metro Area. The overall rating for this plan is not yet available for 2025.
It's important to know that Kaiser Permanente Senior Advantage Choice DM (PPO) 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 Choice DM (PPO).
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 Choice DM (PPO), 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 combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Choice DM (PPO) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you'll pay varying copays for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at a preferred pharmacy, while standard generic drugs have a $45 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan offers a variety of benefits, including inpatient and outpatient hospital services with varying copays. Primary care, preventive services, and some vision and dental services are included, with specific copays and coinsurance amounts depending on the service. The plan also covers ambulance and transportation services, emergency services, and home health services. Additional benefits include hearing exams, prescription hearing aids, and medical equipment, with specific coverage limits and cost-sharing. There is also coverage for diagnostic and radiological services, skilled nursing facility services, and other services like over-the-counter items. However, some services, such as podiatry, additional dental services, and certain therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is a $295 copay for days 1-5, and no copay for days 6-90, with additional days having no copay. Inpatient Hospital Psychiatric has a $295 copay for days 1-5, and no copay for days 6-90, but additional days are not covered.
Outpatient Services See details
Outpatient services are covered under the Kaiser Permanente Senior Advantage Choice DM (PPO) plan, with different cost-sharing for each service. Outpatient Hospital Services and Observation Services have a $250 copay, Ambulatory Surgical Center (ASC) Services have a $190 copay, and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a copay of $25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Choice DM (PPO) plan, requiring prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Kaiser Permanente Senior Advantage Choice DM (PPO). Ground and Air Ambulance Services have a $340 copay, with no coinsurance, and Transportation Services to a plan-approved health-related location have no copay and no coinsurance for up to 18 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $35 copay with no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $340 copay, with no coinsurance for any of the worldwide services.
Primary Care See details
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services and additional telehealth benefits have no copay, chiropractic services have a $20 copay, physician specialist services and physical therapy/speech-language pathology services have a $30 copay, occupational therapy has a $30 copay, mental health and psychiatric individual sessions have a $25 copay, mental health and psychiatric group sessions have a $15 copay, and opioid treatment program services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services, including Fitness Benefit with no copay. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $400 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $30, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $500 every year.
Dental Services See details
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan offers dental services with a $30 copay for Medicare dental services. Oral exams and dental X-rays have no copay, while restorative services have a 30% coinsurance, endodontics and periodontics have a 50% coinsurance, and implant services have a 50% coinsurance. Other services such as adjunctive general services, prosthodontics, maxillofacial prosthetics, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Choice DM (PPO) plan, and a doctor's referral is required. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance, and Diabetic Equipment with a 20% coinsurance for Therapeutic Shoes/Inserts and no copay for Diabetic Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Kaiser Permanente Senior Advantage Choice DM (PPO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $130, Therapeutic Radiological Services have a $30 copay, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Choice DM (PPO) with no copay and no coinsurance, though Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but the plan does not cover Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. The plan has a copay for Cardiac Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Choice DM (PPO) plan, with a doctor's referral and prior authorization required. For days 1-20, there is no copay, a $203 copay for days 21-46, and no copay for days 47-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit coverage of $75.00 every three months, including nicotine replacement therapy. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other 1 benefits are covered with coinsurance between 0% and 20% and require prior authorization.
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