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Kaiser Permanente Senior Advantage Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Value (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 (HMO-POS) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Value (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 Value (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 (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 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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 (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. For Tier 2 generic medications, standard pharmacy copays are highly affordable, starting at just $5 for a one-month supply. 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 require a 33% coinsurance for all supply durations. Standard mail order options also offer cost savings, capping three-month copays at $10 for Tier 2 generics and $90 for Tier 3 preferred brands.
Additional Benefits
The Kaiser Permanente Senior Advantage Value (HMO-POS) plan offers comprehensive coverage for core medical services, featuring no copays and no coinsurance for primary care visits, routine hearing and vision exams, and home health services. For specialized care, members pay a $45 copay for specialist visits, while emergency room visits carry a $130 copay that is waived if admitted. Inpatient hospital stays require a daily copay of $320 for the first six days of acute care, with no copay required for subsequent days. Diagnostic lab services and outpatient X-rays are available with no copay, while durable medical equipment has no copay but may require up to 20% coinsurance. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $196 daily copay for days 21 through 100. However, this plan does not cover routine dental care, hearing aids, eyewear, or cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital services are partially covered under the Kaiser Permanente Senior Advantage Value (HMO-POS) plan with no coinsurance, requiring a daily copay of $320 for days 1 through 6 of acute stays and $275 for days 1 through 6 of psychiatric stays, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $250 for outpatient hospital services and $0 to $130 per stay for observation services. There is a $250 copay for ambulatory surgical center visits, while outpatient substance abuse sessions and blood services have no copays, though prior authorization and referrals are required for most services.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Senior Advantage Value (HMO-POS), featuring a $250 copay and no coinsurance for both ground and air ambulance trips, which require prior authorization. Routine transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services carry a $50 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $130 for emergency care, $50 for urgent care, and $250 for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Value (HMO-POS) offers primary care, mental health, psychiatric, and telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and therapy services require a $35 copay with no coinsurance. Chiropractic services are partially covered, featuring a $20 copay for up to 18 routine visits per year while other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) offers partially covered preventive services with no coinsurance and generally no copays, except for a $20 copay for alternative therapies and a $45 copay for glaucoma screenings. Sub-services including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, therapeutic massage, adult day health, in-home support, caregiver support, and home safety modifications are not covered.
Hearing Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Hearing aids, including all prescription and over-the-counter (OTC) options, are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) offers partial coverage for vision services, featuring routine eye exams with no copay and no coinsurance, though other eye exams are not covered. For eyewear, some services are covered with no copay and no coinsurance, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Kaiser Permanente Senior Advantage Value (HMO-POS), offering coverage only for Medicare-covered dental services with a $45.00 copay and no coinsurance. Preventive and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, 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 Value (HMO-POS) plan with prior authorization. Covered Part B insulin drugs require a $10.00 to $35.00 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have copays ranging 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 Value (HMO-POS) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers medical equipment with no copays, though coinsurance ranges from no coinsurance up to 20% and prior authorization is required. Under this plan, durable medical equipment, medical supplies, and diabetic supplies have no copay, while prosthetic devices and diabetic therapeutic shoes require 20% coinsurance.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. Lab services and outpatient X-rays feature no copay, while diagnostic procedures range from a $0 to $45 copay, therapeutic radiological services start at a $40 copay, and diagnostic radiological services have copays starting at $0.
Home Health Services See details
Home health services are covered by the Kaiser Permanente Senior Advantage Value (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 not covered under the Kaiser Permanente Senior Advantage Value (HMO-POS) plan, as none of the sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD)—are covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Value (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $196 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Kaiser Permanente Senior Advantage Value (HMO-POS), which includes acupuncture for a $20 copay and no coinsurance up to 18 treatments annually, residential substance abuse and mental health treatment with a $137 to $822 copay and no coinsurance, and non-Medicare durable medical equipment for no copay and a 20% coinsurance. Over-the-counter items and meal benefits are not covered.
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