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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 2026, 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 2026.
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 $37.00. 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 $4500.00 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 vaccines at standard pharmacies and through standard mail order. Tier 2 generic medications are available for a low copay starting at $10 for a one-month supply, with additional savings available on three-month mail-order refills. For Tier 3 preferred brand drugs, copays start at $45, while Tier 4 non-preferred drugs carry a $90 copay for a one-month supply. Standard mail order options for Tier 2, Tier 3, and Tier 4 drugs offer cost savings on three-month supplies compared to standard retail pharmacies. Specialty drugs in Tier 5 require a 33% coinsurance for all filling options and supply durations.
Additional Benefits
The Kaiser Permanente Senior Advantage Standard (HMO-POS) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance, including primary care visits, routine hearing and vision exams, and home health care. For inpatient hospital stays, members pay a $250 daily copay for the first six days and no copay for subsequent days, while specialist visits require a $30 copay. Emergency room visits carry a $125 copay, which is waived if admitted, and urgent care services have a $50 copay. Diagnostic lab work and X-rays are available with no copay, whereas skilled nursing facility stays have no copay for the first 20 days followed by a $196 daily copay. While Medicare-covered dental services require a $30 copay, routine dental care, eyewear, and hearing aids are not covered under this plan. Durable medical equipment and dialysis services generally require no copay but carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as unlimited additional acute care days are included at no copay, but psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $160 for outpatient hospital services and no copay to $125 per stay for observation services. Ambulatory surgical center services require a $160 copay with no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan require prior authorization and have a $225 copay and no coinsurance for both ground and air transport. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Kaiser Permanente Senior Advantage Standard (HMO-POS) with a $125 copay (waived if admitted) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with no coinsurance and copays of $125, $50, and $225, respectively.
Primary Care See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) offers primary care, mental health, psychiatric, and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and opioid treatment require a $30 copay and no coinsurance, while chiropractic care is partially covered with a $15 copay and no coinsurance, and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers preventive services with no coinsurance and mostly no copays, except for alternative therapies which have a $15 copay and glaucoma screenings which have a $30 copay. Additional preventive benefits are partially covered, excluding medical nutrition therapy, weight management, therapeutic massage, adult day health, counseling, caregiver support, tobacco cessation counseling, disease management, telemonitoring, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, in-home support, and home safety modifications.
Hearing Services See details
Hearing services are covered by Kaiser Permanente Senior Advantage Standard (HMO-POS), which offers routine hearing exams and fitting evaluations with no copay and no coinsurance. However, over-the-counter hearing aids and prescription hearing aids—including inner ear, outer ear, and over-the-ear types—are not covered.
Vision Services See details
Vision services are partially covered by Kaiser Permanente Senior Advantage Standard (HMO-POS), featuring unlimited routine eye exams with no copay and no coinsurance. Other eye exams and all eyewear products, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Dental services are partially covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan, which only covers Medicare-covered dental services for a $30 copay and no coinsurance. All other dental benefits, including preventive cleanings, exams, X-rays, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Kaiser Permanente Senior Advantage Standard (HMO-POS) plan with prior authorization. Covered Part B insulin carries a $10.00 to $35.00 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs feature copays from no copay up to $45.00 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Kaiser Permanente Senior Advantage Standard (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. These covered benefits feature no copays, with coinsurance ranging from no coinsurance to 20% for DME and medical supplies, and a flat 20% coinsurance for prosthetic devices and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Kaiser Permanente Senior Advantage Standard (HMO-POS) with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab and outpatient X-ray services, a $0 to $30 copay for diagnostic procedures and tests, and a minimum $30 copay for therapeutic radiological services.
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. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Standard (HMO-POS) with no copay and no coinsurance, but only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and a $196 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Standard (HMO-POS) partially covers other services, including acupuncture with a $15 copay and no coinsurance for up to 18 treatments per year, residential substance abuse and mental health treatment with a $125 to $750 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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