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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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $7.00. 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.
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 $10000.00 (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 $10000.00 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:
Sign up for Kaiser Permanente Senior Advantage Choice DM (PPO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $15 copay for a one-month supply. Tier 2 generics also offer no copay through standard mail order and low copays starting at $5 at preferred pharmacies, while Tier 6 vaccines are available with no copay. For brand-name and specialty medications, costs vary depending on the drug tier and where you fill your prescription. Tier 3 preferred brands require a $45 copay for a one-month supply at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs carry a flat $100 copay across all pharmacy options. Specialty medications in Tier 5 require a 33% coinsurance regardless of whether you use a preferred pharmacy, standard pharmacy, or standard mail order.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice DM (PPO) plan offers comprehensive medical coverage with no copays for primary care visits, annual physicals, routine vision exams, and home health services. For more specialized care, members pay fixed copays, such as $30 to $35 for specialist visits, $295 daily for the first six days of inpatient hospital stays, and $130 for emergency room visits, all with no coinsurance. Outpatient hospital services require a $295 copay, while diagnostic lab tests and routine dental care are available with no copay. The plan also features valuable allowances, including a $300 annual limit for routine eyewear and a $400 annual limit for prescription hearing aids, both with no copay or coinsurance. While many services have no coinsurance, members will pay a 20% coinsurance for dialysis and up to 20% coinsurance for durable medical equipment and Medicare Part B drugs. Additionally, up to 18 one-way transportation trips per year to approved locations and select over-the-counter items are covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Kaiser Permanente Senior Advantage Choice DM (PPO) with no coinsurance, requiring a $295 copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $295 copay, and ambulatory surgical center services for a $190 copay. Outpatient substance abuse sessions require a copay of $15 for group or $25 for individual visits, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 18 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Kaiser Permanente Senior Advantage Choice DM (PPO) are covered with a $130 copay and no coinsurance, with the copay waived if you are immediately admitted to the hospital. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $350 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, occupational therapy, physical therapy, and opioid treatment require copays of $30 to $35 and no coinsurance. Mental health and psychiatric sessions have copays ranging from $15 to $25 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers preventive services with no coinsurance and no copay for annual physicals, fitness benefits, and screenings, while kidney disease education requires no coinsurance and a $0 to $35 copay. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional or dietary benefits, home-based palliative care, caregiver support, additional smoking and tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services are partially covered under the Kaiser Permanente Senior Advantage Choice DM (PPO), featuring a $10 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fittings. Prescription hearing aids are covered with no copay or coinsurance up to a $400 annual limit, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Choice DM (PPO) with no coinsurance and no deductibles. Routine eye exams and eyewear (including contacts, lenses, and frames) have no copay and a $300 annual maximum benefit, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Choice DM (PPO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive services up to a $500 annual limit. Other preventive dental services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Choice DM (PPO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, incur a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Choice DM (PPO) with no copay and a 20% coinsurance, and a referral is required.
Medical Equipment See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers medical equipment with no copays, requiring prior authorization for all services. Durable medical equipment ranges from no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts incur 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers diagnostic and radiological services with no coinsurance. Diagnostic procedures, tests, and lab services have no copay, while outpatient x-rays require a $10 copay, therapeutic radiological services require a minimum $35 copay, and diagnostic radiological services require a minimum $50 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, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Kaiser Permanente Senior Advantage Choice DM (PPO) plan. This means there is no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Choice DM (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and referrals but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 52 to 100, while days 21 to 51 require a $203 daily copay, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Kaiser Permanente Senior Advantage Choice DM (PPO) offers partial coverage for other services, including over-the-counter (OTC) items with no copay and no coinsurance, and non-Medicare covered DME and medical supplies with no copay and 0% to 20% coinsurance. Acupuncture, meal benefits, and Naloxone OTC items are not covered under this plan.
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