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Kaiser Permanente Senior Advantage Enhanced (HMO-POS)

Washington Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$114
by Kaiser Permanente

Additional Coverage

HearingVision

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Overview

Plan Name
Kaiser Permanente Senior Advantage Enhanced (HMO-POS)
Insurance Carrier
Kaiser Permanente
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Washington and offered by the health insurance company Kaiser Permanente. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$114
Annual Deductible
$0
Max Out-of-Pocket
$3,000
Primary doctor visit
$0 copay
Specialist visit
$20 copay per visit
ER visit
$140 copay per visit (always covered)
Ambulance
$200 copay

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) has a monthly premium cost of $114 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Kaiser Permanente Senior Advantage Enhanced (HMO-POS) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Kaiser Permanente Senior Advantage Enhanced (HMO-POS) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Kaiser Permanente Senior Advantage Enhanced (HMO-POS) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Comparing the Quality Score of Kaiser Permanente Senior Advantage Enhanced (HMO-POS) to Other Plans in Washington

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Kaiser Permanente Senior Advantage Enhanced (HMO-POS) received an overall government quality rating of 4.0 stars out of 5 stars.

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) performed better than Washington’s State average overall quality score of 3.6 stars.

This Plan’s 5-star Gov’t Quality Score
Washington State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.6
Summary rating of health plan quality
 3.5
 3.4
Staying healthy: screenings, tests, & vaccines
 5
 3.7
Managing chronic (long term) conditions
 4
 3.5
Member experience with health plan
 2
 3.0
Member complaints & changes in the health plan's performance
 5
 4.1
Health plan customer service
 4
 4.0
Summary rating of drug plan quality
 5
 3.7
Drug plan customer service
 5
 4.1
Member complaints & changes in the drug plan's performance
 5
 4.2
Member experience with the drug plan
 5
 3.5
Drug safety & accuracy of drug pricing
 4
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) received 3.5 stars for its health plan quality score which is better than the Washington State average health plan quality score of 3.4 stars.

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) received 5 stars for its drug plan quality score which is better than the Washington State average drug plan quality score of 3.7 stars.

Plan Benefits and Coverage Details

Monthly Premium
$114
Health Portion of Premium
$114
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No
Doctor Lookup Link
http://kp.org/directory
Plan Link
http://kp.org/medicare

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0-55 copay per visit
Specialist visit
In-network: $20 copay per visit
Out-of-network: $0-55 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0-20 copay
Out-of-network: $0-25 copay
Lab services
In-network: $0 copay
Out-of-network: $0-25 copay
Diagnostic radiology services (like MRI)
In-network: $0-150 copay
Out-of-network: $0-25 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0-25 copay
Emergency care
$140 copay per visit (always covered)
Urgent care
$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $200 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0-150 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0-55 copay

Ambulance

Ground ambulance
In-network: $200 copay

Therapy services

Occupational therapy visit
In-network: $20 copay
Out-of-network: $0-55 copay
Physical therapy & speech & language therapy visit
In-network: $20 copay
Out-of-network: $0-55 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0-55 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0-55 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$10.00 copay$0 copay
Preferred Brand$45.00 copay$0 copay
Non-Preferred Drug$90.00 copay$0 copay
Specialty Tier33% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: $10-45 copay or 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Other Part B drugs
In-network: $0-45 copay or 0-20% coinsurance
Out-of-network: 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0-55 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $0 copay
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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