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Kaiser Permanente Senior Advantage Value Lane (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Value Lane (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 Value Lane (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) is a HMO-POS plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Lane County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Kaiser Permanente Senior Advantage Value Lane (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 Value Lane (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 Value Lane (HMO-POS), 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 a $160.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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
The Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan features an annual drug deductible of $160. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies and through standard mail order, as well as no copay for Tier 6 vaccines. For Tier 2 generic drugs, copays start as low as $10 for a one-month supply at preferred pharmacies and standard mail order. For higher-tier medications, Tier 3 preferred brand drugs carry a $40 copay at preferred pharmacies, while Tier 4 non-preferred drugs require a $93 copay for a one-month supply. Standard pharmacy copays are slightly higher, costing $47 for Tier 3 and $100 for Tier 4. Specialty drugs in Tier 5 require a 29% coinsurance across preferred, standard, and mail-order options.
Additional Benefits
The Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for home health services, preventive annual physicals, and diabetic supplies. For doctor visits, members pay a low $5 copay for primary care and a $30 copay for specialists, with no coinsurance required for either service. Inpatient hospital stays require a $450 daily copay for the first four days followed by no copay for days 5 through 90, while emergency room visits carry a $150 copay that is waived if you are immediately admitted. Diagnostic lab work and X-rays are highly affordable, requiring no copay and a $10 copay respectively, with no coinsurance. Many specialty benefits like routine eye and hearing exams, as well as Medicare-covered dental services, are available for a flat $30 copay. Additionally, essential medical equipment and dialysis services are covered with coinsurance ranging up to 20 percent, ensuring clear and manageable cost-sharing terms for your healthcare needs.
Inpatient Hospital See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 daily copay for days 1 to 4 and no copay for days 5 to 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) require no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital services and a $300 copay for ambulatory surgical center visits. Outpatient substance abuse sessions have a $2 to $5 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers partial hospitalization services with a $5.00 copay and no coinsurance. This covered benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Senior Advantage Value Lane (HMO-POS) with a $350 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While transportation is technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers emergency services with a $150 copay, which is waived if admitted immediately, and urgent care with a $65 copay, with no coinsurance required for either service. Worldwide emergency coverage is also available with no coinsurance, featuring a $150 copay for emergency care, a $65 copay for urgent care, and a $350 copay for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers primary care physician visits for a $5 copay and specialist visits for a $30 copay, both with no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance for up to 18 routine visits per year (other chiropractic services are not covered), while podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) provides partial coverage for preventive services with no coinsurance and no copay for annual physicals, fitness benefits, and diabetes self-management. While some benefits require a copayment, such as alternative therapies for $20 and glaucoma screenings for $30, other specific services like therapeutic massage, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Value Lane (HMO-POS), offering routine exams and hearing aid fittings for a $30 copay and no coinsurance. While some prescription hearing aid services are covered, prescription hearing aids—including inner ear, outer ear, and over-the-ear types—and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) partially covers vision services, offering routine eye exams with a $30 copay and no coinsurance. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Dental services are partially covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS), which covers Medicare-covered dental services for a $30.00 copay and no coinsurance, requiring prior authorization and a referral. Non-Medicare dental services, including preventive care, cleanings, x-rays, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers home infusion bundled services with prior authorization, including insulin with a $10.00 to $35.00 copay and no coinsurance. Covered Medicare Part B chemotherapy, radiation, and other drugs feature copays ranging from no copay up to $47.00 and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and medical supplies feature no copay and coinsurance ranging from no coinsurance to 20%. Prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance, while diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services, while diagnostic procedures cost between $10 and $30, outpatient X-rays cost $10, and radiological services require copays starting at $10 for diagnostic and $30 for therapeutic treatments.
Home Health Services See details
The Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Value Lane (HMO-POS) with no coinsurance and no copay, although some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and a referral are required for covered services.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Value Lane (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, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers acupuncture with a $20 copay and no coinsurance for up to 18 treatments yearly, alongside residential substance abuse and mental health treatment with a $225 to $900 copay and no coinsurance. Non-Medicare durable medical equipment is also covered with no copay and a 20% coinsurance, though over-the-counter items and meal benefits are not covered.
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