A non-government entity
Kaiser Permanente Medicare Advantage Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Basic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Medicare Advantage Basic (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Basic (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Puget Sound Area and Counties: GY, TH, LE, SP. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Medicare Advantage Basic (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Medicare Advantage Basic (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.
For Kaiser Permanente Medicare Advantage Basic (HMO), 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
Prescription drugs are not covered by Kaiser Permanente Medicare Advantage Basic (HMO).
Additional Benefits
The Kaiser Permanente Medicare Advantage Basic (HMO) plan offers comprehensive coverage with a focus on outpatient services, preventive care, and various therapies. You'll find no copays for primary care physician services, annual physical exams, and many preventive services, along with $0 copays for home health services. Other services like inpatient hospital stays, emergency services, and hearing services have copays that vary depending on the service. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $25 to $200 depending on the service. The plan also offers dental, vision, and hearing benefits. While many services have no copay, there are some exclusions, such as certain dental, vision, and hearing services, as well as additional hours of care and personal care services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For acute care, you will pay a $200 copay for days 1-3, and no copay for days 4-90; additional days have no copay. Psychiatric care has a $200 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services include a $30 copay for individual sessions and a $20 copay for group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Medicare Advantage Basic (HMO) plan with a $55 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Medicare Advantage Basic (HMO) plan. Ground and air ambulance services have a $200 copay, and there is no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Medicare Advantage Basic (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $0 and $30, Physician Specialist Services with a $30 copay, and Mental Health Specialty Services with a copay between $20 and $30. Also covered are Other Health Care Professional services and Psychiatric Services with a copay between $0 and $30, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $30, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $30 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with a copay ranging from $0 to $30. Prescription Hearing Aids (all types) are covered, but Inner Ear, Outer Ear, and Over the Ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$30, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The Kaiser Permanente Medicare Advantage Basic (HMO) plan covers Medicare Dental Services with a $30 copay, as well as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Medicare Advantage Basic (HMO) plan and require prior authorization and a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Kaiser Permanente Medicare Advantage Basic (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics and Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and diagnostic radiological services with a copay of at most $200.00. Therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Medicare Advantage Basic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not covered in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Medicare Advantage Basic (HMO) plan. There is no copay for days 1-20, and a $50 copay for days 21-100.
Other Services See details
Other Services include acupuncture, with a $10 copay, up to 15 treatments per year. This plan does not cover over-the-counter items, meal benefits, 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, or Self-Directed Personal Assistance Services.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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