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Kaiser Permanente Senior Advantage Choice South (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Choice South (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 South (PPO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Choice South (PPO) is a PPO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Southern Colorado. The overall rating for this plan is not yet available for 2025.
It's important to know that Kaiser Permanente Senior Advantage Choice South (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 South (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 South (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 South (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at preferred pharmacies, and standard mail order has no copay. After your total drug costs reach $2,000, you will enter the next coverage phase. In the catastrophic coverage phase, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice South (PPO) plan offers comprehensive coverage for various healthcare needs. This plan includes coverage for inpatient and outpatient services, with specific copays ranging from $0 to $295 depending on the service. Additionally, you'll find coverage for emergency services, primary care, preventive services, and a range of other services, including dental, vision, and hearing. The plan provides coverage for ambulance services, transportation to health-related locations, and home health services with no copay. It also covers diagnostic and radiological services, as well as medical equipment. However, it is important to note that some services like cardiac rehabilitation, and certain dental services have limited coverage, and other services such as acupuncture are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-5, and no copay for days 6-90; additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $250 copay, Observation Services with a $250 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, Individual Sessions for Outpatient Substance Abuse with a copay between $25 and $25, and Group Sessions for Outpatient Substance Abuse with a copay between $15 and $15. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Choice South (PPO) plan. This benefit requires prior authorization and a doctor referral, and has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by this plan. Ground and air ambulance services have a copay of $340, while transportation services to a plan-approved health-related location have no copay and are limited 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, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $340 copay. There is no coinsurance for any of these services.
Primary Care See details
The Kaiser Permanente Senior Advantage Choice South (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. Physician specialist services have a $30 copay, and mental health services have a copay of $25 for individual sessions and $15 for group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have no copay. Opioid treatment program services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, while additional preventive services are covered with a copay, and other services like health education and home safety assessments are not covered. Kidney disease education services have a copay between $0 and $30, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs have no copay.
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 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$30, and eyewear with no copay. The plan also covers routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses with no copay, but upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $30 copay, and other dental services, with a $1,350 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment are covered with no copay. Restorative services are covered with 30% coinsurance, and endodontics, periodontics, and implant services are covered with 50% coinsurance. Adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, oral and maxillofacial surgery, and orthodontics are either optional supplemental benefits or not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Choice South (PPO) plan with a doctor referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with coinsurance for Medicare-covered supplies and a copay for therapeutic shoes or inserts. Durable Medical Equipment for use outside of the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $150 and Therapeutic Radiological Services have a copay of at most $30. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Senior Advantage Choice South (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Kaiser Permanente Senior Advantage Choice South (PPO) plan. A doctor's referral is required for these services if they were to be covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Choice South (PPO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, 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 South (PPO) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $75 every three months, and it covers Nicotine Replacement Therapy (NRT). Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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