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 2026, 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 2026.
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 robust coverage with predictable costs, featuring no copays for preventive services, primary care visits, telehealth, and routine dental care. For specialized care, members pay low copays ranging from no copay to $30 for specialist visits, routine vision exams, and hearing exams. Inpatient hospital stays require a daily copay of $270 for the first three days, after which there is no copay for days four through ninety. Emergency room visits carry a $150 copay, while urgent care visits require a $25 copay, with no coinsurance for either service. For medical equipment, dialysis, and certain Part B drugs, members can expect a 20% coinsurance, though diabetic supplies and home health services are covered with no copay or coinsurance. This plan provides a balanced approach to healthcare costs by eliminating coinsurance on most routine and emergency services.
Inpatient Hospital See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $270 copay per day for days 1 through 3 and no copay for days 4 through 90. This benefit is partially covered because additional psychiatric days, non-Medicare-covered stays, and hospital upgrades are not covered.
Outpatient Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $225 for outpatient hospital and ambulatory surgical center services. Outpatient substance abuse services require a $20 copay for group sessions and a $30 copay for individual sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers partial hospitalization services 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 Medicare Advantage Basic (HMO) covers ground and air ambulance services with a $215 copay and no coinsurance, although prior authorization is required. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by the Kaiser Permanente Medicare Advantage Basic (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $150, $25, and $215 respectively.
Primary Care See details
Kaiser Permanente Medicare Advantage Basic (HMO) offers partially covered primary care benefits with no coinsurance for all covered services, featuring no copay for primary care visits and telehealth, and copays between $0 and $30 for specialists, therapies, and psychiatric care. Routine chiropractic care is covered with a $20 copay, but other chiropractic services and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. The benefit is partially covered as several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and home-based support.
Hearing Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers hearing exams with no coinsurance and copays ranging from no copay to $30, though prior authorization and referrals are required. While one annual routine exam and one fitting evaluation are covered, prescription and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Medicare Advantage Basic (HMO), which offers routine eye exams with a $0 to $30 copay and no coinsurance, limited to one exam per year. Eyewear is covered with no copay and no coinsurance up to a $150 annual limit, but other eye exams and eyewear upgrades are not covered.
Dental Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) offers partially covered dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental care, and no copay and no coinsurance for preventive and most comprehensive services. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Medicare Advantage Basic (HMO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization and a referral are required.
Medical Equipment See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic tests, lab services, and outpatient X-rays are offered with no copay and no coinsurance, while diagnostic radiological services require a minimum $250 copay and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Kaiser Permanente Medicare Advantage Basic (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Kaiser Permanente Medicare Advantage Basic (HMO) with no coinsurance, though referrals and prior authorization are required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered, carrying copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though referrals and prior authorization are required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the 100-day limit are not covered.
Other Services See details
Kaiser Permanente Medicare Advantage Basic (HMO) indicates that some services are covered under its Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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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