Kaiser Permanente Senior Advantage Enhanced (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered under this plan. Outpatient Hospital Services and Observation Services have copays ranging from $0 to $150 and $0 to $140, respectively, while Ambulatory Surgical Center (ASC) Services have a $150 copay. Outpatient Substance Abuse Services and Outpatient Blood Services have no copay.

Partial Hospitalization See details

Partial hospitalization is covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, requiring prior authorization and a doctor's referral. There is no copay for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $200 copay and no coinsurance. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan. Emergency Services have a $140 copay, and no coinsurance; Urgently Needed Services have a $45 copay, and no coinsurance; Worldwide Emergency Coverage has a $140 copay, and no coinsurance; Worldwide Urgent Coverage has a $45 copay, and no coinsurance; and Worldwide Emergency Transportation has a $200 copay, and no coinsurance.

Primary Care See details

The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while routine chiropractic care has a $10 copay for up to 18 visits per year.

Occupational therapy services, physician specialist services, and physical therapy and speech-language pathology services have a $20 copay. Mental health specialty services, psychiatric services, and other health care professional services have a $0 copay for individual and group sessions.

Additional telehealth benefits have no copay, and opioid treatment program services have a $20 copay.

Preventive Services See details

Preventive services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services that require a doctor referral. Additional preventive services include Health Education, Alternative Therapies, Nutritional/Dietary Benefit, Home-Based Palliative Care, and Fitness Benefit, each with no copay. Other preventive services include Glaucoma Screening with a $20 copay, and Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.

Hearing Services See details

Hearing Services include hearing exams with no copay, and fitting/evaluation for hearing aids, which is an optional, supplemental benefit. Prescription and OTC hearing aids are not covered.

Vision Services See details

Vision Services include routine eye exams with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental Services are partially covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan. Medicare Dental Services require prior authorization and a doctor referral, with a $20 copay, while 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 by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan. For Medicare Part B Insulin Drugs, the copay is $10-$35. For Medicare Part B Chemotherapy/Radiation Drugs, the copay is $10-$45, and the coinsurance is 0-20%. Other Medicare Part B Drugs have a copay of $0-$45, and the coinsurance is 0-20%.

Dialysis Services See details

Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, including Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 0-20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with a $15 copay, and outpatient X-ray services with no copay. Prior authorization and a doctor's referral are required.

Home Health Services See details

Home Health Services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) 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 covered by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, but not in practice as none of the sub-services are covered. Prior authorization and a doctor referral are required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $196 copay for days 21-100.

Other Services See details

Other Services includes acupuncture, covered with a $10 copay, and Other 1, covered with a copay of $100-$600, and Other 2, covered with a 20% coinsurance; however, 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, and Self-Directed Personal Assistance Services are not covered.