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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 2026, 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 2026.
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 $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 South (PPO)
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Drug Coverage
The Kaiser Permanente Senior Advantage Choice South (PPO) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while Tier 2 generics also offer no copay via standard mail order and low copays starting at $5 at preferred pharmacies. Additionally, Tier 6 vaccines are available with no copay for a one-month supply at both preferred and standard pharmacies. For brand-name and specialty medications, costs vary depending on the tier and pharmacy type. Tier 3 preferred brands carry a $45 copay for a one-month supply at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs require a flat $100 copay. Specialty medications in Tier 5 are subject to a 33% coinsurance rate across preferred, standard, and standard mail-order services.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice South (PPO) plan offers comprehensive coverage with predictable out-of-pocket costs for essential medical services. Members enjoy no copay and no coinsurance for primary care visits, telehealth, and most preventive care, while specialist visits require a $30 copay. Inpatient hospital stays feature no coinsurance and a $300 daily copay for the first six days, followed by no copay for days 7 through 90. This plan also includes valuable supplemental benefits, such as routine dental, hearing, and vision exams with no copay, alongside allowances for eyewear and hearing aids. Emergency care is covered with a $130 copay, and qualified transportation services are available for up to 18 one-way trips per year with no copay or coinsurance. Additionally, home health services and laboratory tests are covered with no copay and no coinsurance, helping to keep your healthcare affordable.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers outpatient services with no coinsurance, featuring a $295 copay for outpatient hospital and observation services and a $125 copay for ambulatory surgical center services. Outpatient substance abuse services require a $10 copay for individual sessions and a $5 copay for group sessions with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 18 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Senior Advantage Choice South (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $40 to $275 and no coinsurance.
Primary Care See details
Kaiser Permanente Senior Advantage Choice South (PPO) features primary care and telehealth services with no copay and no coinsurance, while specialist visits cost a $30 copay with no coinsurance. Physical, occupational, and speech therapies require a $20 copay with no coinsurance, mental health and psychiatric sessions cost a $5 to $10 copay with no coinsurance, and podiatry is not covered. Some chiropractic services are covered, though routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services offered by Kaiser Permanente Senior Advantage Choice South (PPO) are partially covered with no coinsurance and no copay for most services, including annual physicals, fitness benefits, and screenings, while kidney disease education has a copay of up to $30 and no coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers hearing exams with a $10 copay for Medicare-covered exams and no copay for routine exams and fittings, with no deductible or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $300 annual limit, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Choice South (PPO), featuring routine eye exams with no copay and no coinsurance, and a $150 annual allowance for eyewear with no copays or coinsurance. Other eye exam services and eyewear upgrades are not covered, and there is no deductible for any covered vision services.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Choice South (PPO), featuring a $500 annual limit for both in-network and out-of-network care. Most preventive and diagnostic services have no copay and no coinsurance, while Medicare-covered dental services require a $30 copay and no coinsurance; however, orthodontics and other preventive dental services are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry no copay and range from no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Kaiser Permanente Senior Advantage Choice South (PPO) with no copay and a 20% coinsurance. Members will need a referral to access these covered services.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Choice South (PPO), with prior authorization required. Durable medical equipment features no copay and ranges from no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes require no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. There is no copay for lab services, diagnostic tests, and outpatient X-rays, while diagnostic radiological services have a minimum $35 copay and therapeutic radiological services have a minimum $30 copay.
Home Health Services See details
Home health services are covered by Kaiser Permanente Senior Advantage Choice South (PPO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Choice South (PPO) with no coinsurance and require a referral. In practice, some services are covered, but cardiac rehabilitation (ranging from no copay to $30), intensive cardiac rehabilitation (ranging from no copay to $30), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Kaiser Permanente Senior Advantage Choice South (PPO) with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 51 through 100, a $203 daily copay for days 21 through 50, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Choice South (PPO) provides partial coverage for other services, featuring over-the-counter (OTC) items via debit card with no copay and no coinsurance, and non-Medicare covered DME with no copay and 0% to 20% coinsurance. However, acupuncture, meal benefits, and Naloxone OTC items are not covered under this plan.
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