Kaiser Permanente Senior Advantage Basic 1 (HMO)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by Kaiser Permanente
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 5.0
out of 5 stars

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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

 

$0
$0
$0
$0
$5,900 In-network
No
Yes
Yes
Yes

Doctor Services

$0 copay
$0-25 copay per visit

Tests, labs, & imaging

$0-35 copay
$0-35 copay
$5-290 copay
$5-35 copay
$110 copay per visit (always covered)
$25 copay per visit (always covered)

Hospital Services

$295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
$0-275 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$196 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$225 copay

Therapy services

$25 copay
$25 copay

Mental health services

$12 copay
$25 copay
$12 copay
$25 copay

Opioid treatment services

Covered

Other services

0-20% coinsurance per item
20% coinsurance per item
$0 copay

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay$5.00 copay
Generic$0.00 copay$0.00 copay$5.00 copay
Preferred Brand$47.00 copay$15.00 copay
Non-Preferred Drug
Specialty Tier33%$15.00 copay
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

$0-47 copay or 0-20% coinsurance
$0-47 copay or 0-20% coinsurance

Hearing

$25 copay
Not covered
Not covered
Not covered
Not covered

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
$0 copay
$28-580 copay
Not covered
$0-400 copay
$22 copay
$420-480 copay

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
 5
 5
 5
 4
 5
 5
 5
 5
 5
 5
 4

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


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