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Kaiser Permanente Senior Advantage Choice South (PPO)

Colorado Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$0
by Kaiser Permanente

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Overview

Plan Name
Kaiser Permanente Senior Advantage Choice South (PPO)
Insurance Carrier
Kaiser Permanente
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

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

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,100
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$340 copay

Kaiser Permanente Senior Advantage Choice South (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,950 In and Out-of-network $5,100 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 Choice South (PPO) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Kaiser Permanente Senior Advantage Choice South (PPO) 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 Choice South (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Kaiser Permanente Senior Advantage Choice South (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
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

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$8,950 In and Out-of-network
$5,100 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
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: $35 copay per visit
Specialist visit
In-network: $30 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 40% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 40% coinsurance
Diagnostic radiology services (like MRI)
In-network: $50-150 copay
Out-of-network: 40% coinsurance
Outpatient x-rays
In-network: $15 copay
Out-of-network: 40% coinsurance
Emergency care
$125 copay per visit (always covered)
Urgent care
$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $295 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $500 per day for days 1 through 18
$0 per day for days 19 through 90
Outpatient hospital coverage
In-network: $250 copay per visit
Out-of-network: 40% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 46
$0 per day for days 47 through 100
Out-of-network: $225 per day for days 1 through 40
$0 per day for days 41 through 100

Preventive services

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

Ambulance

Ground ambulance
In-network: $340 copay
Out-of-network: $340 copay

Therapy services

Occupational therapy visit
In-network: $30 copay
Out-of-network: 40% coinsurance
Physical therapy & speech & language therapy visit
In-network: $30 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $15 copay
Out-of-network: $40-50 copay
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $40-50 copay
Outpatient group therapy visit
In-network: $15 copay
Out-of-network: $40-50 copay
Outpatient individual therapy visit
In-network: $25 copay
Out-of-network: $40-50 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% coinsurance per item
Out-of-network: 40% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 40% coinsurance per item
Diabetes supplies
In-network: $0 copay per item
Out-of-network: 0-40% coinsurance per item

Prescription Drug Benefits

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

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$15.00 copay$0 copay
Generic$20.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug$100.00 copay$0 copay
Specialty Tier33% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $10 copay
Out-of-network: 40% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: 40% coinsurance
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: 30% coinsurance
Out-of-network: 30%-50% coinsurance
Endodontics
In-network: 50% coinsurance
Out-of-network: 30%-50% coinsurance
Periodontics
In-network: 50% coinsurance
Out-of-network: 30%-50% coinsurance
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
In-network: 50% coinsurance
Out-of-network: 30%-50% coinsurance
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 40% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
Not covered

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