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Kaiser Permanente Senior Advantage Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Enhanced (HMO-POS). 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 Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Portland-Vancouver Metro, Salem OR, Longview WA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Senior Advantage Enhanced (HMO-POS) 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 Enhanced (HMO-POS).
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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $119.00. 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 Maximum Out-Of-Pocket cost of $3500.00 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
The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan features no drug deductible, meaning your prescription coverage begins immediately. Tier 1 preferred generic drugs and Tier 6 vaccines are available with no copay for standard pharmacy fills. For Tier 2 generic drugs, you will pay a low copay of $10 for a one-month supply at both standard pharmacies and through mail order. Tier 3 preferred brand drugs require a $45 copay for a one-month supply, while Tier 4 non-preferred drugs carry a $90 copay. Specialty drugs in Tier 5 are subject to a 33% coinsurance for both standard pharmacy and mail-order fills. You can also save on three-month supplies for Tier 2, 3, and 4 drugs by utilizing standard mail-order services.
Additional Benefits
The Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan offers predictable out-of-pocket costs with no coinsurance for many core medical services. You will pay no copay for primary care doctor visits, routine physicals, home health care, and laboratory services, while specialist visits require a $20 copay. If you require hospital care, emergency room visits have a $150 copay, outpatient services cost up to $150, and inpatient stays carry a $200 copay for days 1 through 6 with no copay for additional days. Routine eye and hearing exams are covered with no copay, though hearing aids and prescription eyewear are not covered by the plan. Dental coverage is limited to Medicare-covered dental services for a $20 copay, meaning routine cleanings and exams are excluded. For specialized needs, dialysis and durable medical equipment require no copay but carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Inpatient Hospital care through Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is covered with no coinsurance, requiring a $200 copay for days 1 through 6 and no copay for days 7 through 90 per stay. This benefit is partially covered, as unlimited additional days are covered with no copay for acute care, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers outpatient hospital and observation services with a copay of up to $150 and no coinsurance. Ambulatory surgical center services require a $150 copay and no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan with no copay and no coinsurance. Both prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. Although some transportation services are covered, transportation to plan-approved or any health-related locations is not covered in practice.
Emergency Services See details
Emergency services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan with a $150 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $150, $45, and $200 respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) provides partially covered primary care benefits with no coinsurance, featuring no copay for primary care physician visits, telehealth, psychiatric, and mental health services. Specialist visits, physical and occupational therapies, and opioid treatment require a $20 copay, routine chiropractic care has a $10 copay limited to 18 visits per year, while podiatry and other chiropractic services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) provides partially covered preventive services with no coinsurance and no copay for most benefits, such as annual physicals, though alternative therapies have a $10 copay and glaucoma screenings have a $20 copay. Non-covered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids, including inner ear, outer ear, and over-the-ear types, and OTC hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers routine eye exams with no copay and no coinsurance, though other eye exam services are not covered. Some eyewear services are covered, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered in practice.
Dental Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) partially covers dental services, limiting coverage to Medicare-covered dental services which require a $20 copay, no coinsurance, prior authorization, and a referral. Other dental services, including preventive care, cleanings, x-rays, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Kaiser Permanente Senior Advantage Enhanced (HMO-POS), requiring prior authorization. Covered insulin costs a $10.00 to $35.00 copay with no coinsurance, while chemotherapy drugs require a $10.00 to $45.00 copay and up to 20% coinsurance. Other Part B drugs range from no copay to a $45.00 copay, with coinsurance up to 20% and no minimum coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Enhanced (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by Kaiser Permanente Senior Advantage Enhanced (HMO-POS) with no copays for durable medical equipment, diabetic supplies, and medical supplies. Prior authorization is required, and coinsurance ranges from 0% to 20%, with prosthetic devices and diabetic therapeutic shoes specifically requiring 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests carry a copay of $0 to $20, and therapeutic radiological services have a minimum copay of $15.
Home Health Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers home health services 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 Enhanced (HMO-POS) with no coinsurance, though only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $196 daily copay for days 21 to 100. Prior authorization and referrals are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) provides partial coverage for other services, featuring acupuncture with a $10 copay and no coinsurance for up to 18 yearly treatments, residential substance abuse and mental health treatment with a $100 to $600 copay and no coinsurance, and non-Medicare durable medical equipment with no copay and 20% coinsurance. Over-the-counter items and meal benefits are not covered under this plan.
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