Kaiser Permanente Senior Advantage Core (HMO)
Medicare Plan Details
2022 Plan
Monthly Premium
| (select county for price) |
by Kaiser Permanente
Additional Coverage
HearingVisionDental
Overall Government Star Rating
5.0out of 5 stars
State: Colorado
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
Medical Benefits
Doctor Services
$0 copay
$20 copay per visit
Tests, labs, & imaging
$0 copay
$0 copay
$30-100 copay
$0 copay
$90 copay per visit (always covered)
$30 copay per visit (always covered)
Hospital Services
$195 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
$200 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$160 per day for days 21 through 47
$0 per day for days 48 through 100
$160 per day for days 21 through 47
$0 per day for days 48 through 100
Preventive services
$0 copay
Ambulance
$165 copay
Therapy services
$15 copay
$15 copay
Mental health services
$5 copay
$10 copay
$5 copay
$10 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $19.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | |||
| Specialty Tier | 33% |
Part B Drugs
$0-47 copay or 20% coinsurance
$0-47 copay or 20% coinsurance
Extra Benefits
Hearing
$0 copay
$0 copay
$0 copay
Preventive Dental
$10 copay
$10 copay
$10 copay
$10 copay
Comprehensive dental
Not covered
$10 copay
50% coinsurance
Not covered
50% coinsurance
Not covered
Not covered
Vision
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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