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Kaiser Permanente Senior Advantage Standard (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Standard (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 Standard (HMO-POS) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Standard (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 2025.
It's important to know that Kaiser Permanente Senior Advantage Standard (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 Standard (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 Standard (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $4175.00 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 Standard (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy or through mail order, and a $90 copay for preferred brand drugs at a standard pharmacy or through mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Kaiser Permanente Senior Advantage Standard (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $160. Emergency services have copays between $50 and $225, and primary care, preventive services, and vision exams are covered with no copay. The plan provides coverage for hearing exams, and partial dental coverage. Home health services, and skilled nursing facilities have no copay for some days. The plan also covers ambulance services, diagnostic services, and offers services like acupuncture, with a range of copays and coinsurance amounts depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 covered with no copay. Inpatient Hospital Psychiatric services have the same cost sharing as Inpatient Hospital-Acute. 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, including all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services and Observation Services have a copay between $0 and $160 and between $0 and $125 respectively, Ambulatory Surgical Center (ASC) Services have a $160 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan. This benefit requires prior authorization and a doctor referral, but has no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $225 copay, and there is no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $225 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, and Routine Chiropractic Care has a $15 copay for up to 18 visits per year. Occupational Therapy Services have a $30 copay. Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services each have a $30 copay. Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services have no copay. Other Health Care Professional services have a copay between $0 and $30. Psychiatric Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services have no copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive services, including the annual physical exam, are covered with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, with copays of $30 for glaucoma screening and no copay for other services.
Hearing Services See details
Hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered, but may require an additional cost. Prescription hearing aids 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 by Kaiser Permanente Senior Advantage Standard (HMO-POS). Medicare Dental Services are covered with a $30 copay, but orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Part B Insulin and Chemotherapy/Radiation Drugs. For Medicare Part B Insulin Drugs, the copay is between $10 and $35. The copay for Chemotherapy/Radiation Drugs is between $10 and $45, and Other Medicare Part B Drugs have a copay between $0 and $45, with coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan, but require prior authorization and a doctor's referral. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan, with diagnostic procedures/tests costing between $0 and $30, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $175, therapeutic radiological services have a copay of $30, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Standard (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, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan. There is no copay for days 1-20, and a $196 copay for days 21-100.
Other Services See details
Other Services includes acupuncture with a $15 copay, and other services including residential substance abuse and mental health treatment with a copay between $125 and $750, and durable medical equipment not covered by Medicare with 20% coinsurance. Over-the-counter items, meal benefits, and several other services are not covered.
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