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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 2025, 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 2025.
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 $10.00. 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 $175.00 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 $3800.00 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 has a $175 deductible for prescription drugs. After the deductible, you'll pay a copay for your prescriptions, which varies depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. The plan has an "Enhanced Alternative" drug benefit type.
Additional Benefits
The Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $450 copay for days 1-4, and then no copay for the remainder of the stay. Outpatient services have copays that range from $0 to $300. Emergency services have a $140 copay, and primary care visits cost $5. The plan also covers a variety of services with copays, including primary care, specialist visits, and some therapies. Preventive services include an annual physical exam with no copay. Hearing and vision services are covered with copays and some coverage for eyewear. Dental services have a $30 copay for Medicare dental services.
Inpatient Hospital See details
Inpatient Hospital benefits for the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan include acute and psychiatric care, with a $450 copay for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with copays ranging from $0 to $300 and $0 to $140, respectively. Ambulatory Surgical Center (ASC) Services have a $300 copay, and Outpatient Substance Abuse Services have copays of $5 for individual sessions and $2 for group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, and requires prior authorization and a doctor referral. You will have a $5 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan. Medicare-covered ground and air ambulance services have a $350 copay with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgently Needed Services are covered, with a $65 copay and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage with a $140 copay, Worldwide Urgent Coverage with a $65 copay, and Worldwide Emergency Transportation with a $350 copay.
Primary Care See details
Primary Care Physician Services have a $5 copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services each have a $35 copay, and Physician Specialist Services have a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Other Health Care Professional services have varying copays, and Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a copay of $30.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services that require a copay, including glaucoma screenings ($35 copay) and EKG following a Welcome Visit ($10 copay). Additional services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $30 copay, and fitting/evaluation for hearing aids, though this is an optional, supplemental benefit. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $30, and routine eye exams with a $30 copay. Eyewear is partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan, with a $30 copay for Medicare Dental Services. 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a copay of $10-$35, while Medicare Part B Chemotherapy/Radiation Drugs have a copay of $10-$47 with 0-20% coinsurance, and Other Medicare Part B Drugs have a copay of $0-$47 with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and a $0 copay, but DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and 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 $10 and $30, lab services with no copay, diagnostic radiological services with a copay up to $350, therapeutic radiological services with a $30 copay, and outpatient X-ray services with a $10 copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Value Lane (HMO-POS) 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 not covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Value Lane (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay no copay for days 1-20, and a $196 copay for days 21-100, and there is no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, which has a $20 copay for up to 18 treatments per year. Other services such as Over-the-Counter (OTC) Items, meal benefits, 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. Other 1 is covered with a copay between $225 and $900, and Other 2 is covered with 20% coinsurance.
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