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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 2025, 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 2025.
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.
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 $5000.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you may pay a $3 copay for preferred generic drugs at a standard pharmacy, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Kaiser Permanente Senior Advantage Value (HMO-POS) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays. You'll find no copay for primary care physician services, many preventive services, and home health services. Vision and hearing exams are covered with no copay, and dental services are partially covered with a $35 copay. This plan also covers ambulance services with a $250 copay, and emergency services with a $125 copay. Prescription hearing aids, OTC hearing aids, and many dental, vision, and other services are not covered. Additionally, the plan covers home infusion and dialysis services, with various copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric you will pay a $275 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$175, Observation Services with a copay of $0-$125, Ambulatory Surgical Center (ASC) Services with a $175 copay, Outpatient Substance Abuse Services with no copay for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Kaiser Permanente Senior Advantage Value (HMO-POS) plan with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Kaiser Permanente Senior Advantage Value (HMO-POS) plan, with a $250 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage each have a copay, but no coinsurance. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Urgent Coverage has a $55 copay. Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Kaiser Permanente Senior Advantage Value (HMO-POS) plan offers primary care, with no copay for primary care physician services. Chiropractic services have a $20 copay, and routine chiropractic care has a $20 copay for 18 visits per year. Occupational Therapy Services have a $35 copay, while Physician Specialist Services and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Mental Health Specialty Services and Psychiatric Services have no copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $35. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive services, including annual physical exams, Medicare-covered preventive services, and kidney disease education services, are covered with no copay. Additional preventive services, Health Education, and Alternative Therapies are covered, with a copay of $20. Glaucoma Screening has a $35 copay. Fitness Benefit, Nutritional/Dietary Benefit, Home-Based Palliative Care, Remote Access Technologies, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and routine eye exams with no copay. Eyewear is partially covered, with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades not covered.
Dental Services See details
Dental services are partially covered by the Kaiser Permanente Senior Advantage Value (HMO-POS) plan. Medicare Dental Services require prior authorization and a doctor referral with a $35 copay, while 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, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a copay between $3 and $35, as well as Medicare Part B Chemotherapy/Radiation Drugs with a copay between $3 and $45, and a coinsurance between 0% and 20%. Other Medicare Part B Drugs are also covered, with a copay between $0 and $45, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Senior Advantage Value (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with no copay. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance of 0% to 20%. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $35, and lab services with no copay. Diagnostic Radiological Services have a copay up to $185, while Therapeutic Radiological Services have a copay of $30 or more. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Kaiser Permanente Senior Advantage Value (HMO-POS) plan with no copay and no coinsurance. However, 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Senior Advantage Value (HMO-POS) plan, with prior authorization and a doctor's referral required. You will have no copay for days 1-20, and a $196 copay for days 21-100.
Other Services See details
Under "Other Services", acupuncture is covered with a $20 copay per visit, up to 18 treatments per year. Other services such as over-the-counter items, meal benefits, and several others are not covered. Other 1 benefits are covered with a copay ranging from $137 to $822, and Other 2 benefits are covered with 20% coinsurance.
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