Kaiser Permanente Senior Advantage Basic 1 (HMO)

Georgia Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Kaiser Permanente

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Name
Kaiser Permanente Senior Advantage Basic 1 (HMO)
Insurance Carrier
Kaiser Permanente
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Kaiser Permanente Senior Advantage Basic 1 (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Georgia 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.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,900
Primary doctor visit
$0 copay
Specialist visit
$0-25 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$225 copay

Kaiser Permanente Senior Advantage Basic 1 (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,900 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 Basic 1 (HMO) are defined below.

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

Kaiser Permanente Senior Advantage Basic 1 (HMO) 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 Basic 1 (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Kaiser Permanente Senior Advantage Basic 1 (HMO) 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

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 2024, Kaiser Permanente Senior Advantage Basic 1 (HMO) received an overall government quality rating of 3.5 stars out of 5 stars.

Kaiser Permanente Senior Advantage Basic 1 (HMO) performed worse than Georgia’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
Georgia State Average Score
Overall Government 5 Star Quality Rating
 3.5
 3.8
Summary rating of health plan quality
 3.5
 3.8
Staying healthy: screenings, tests, & vaccines
 5
 3.4
Managing chronic (long term) conditions
 4
 3.5
Member experience with health plan
 3
 3.7
Member complaints & changes in the health plan's performance
 3
 3.8
Health plan customer service
 2
 4.1
Summary rating of drug plan quality
 4
 3.8
Drug plan customer service
 1
 4.0
Member complaints & changes in the drug plan's performance
 4
 4.0
Member experience with the drug plan
 5
 4.1
Drug safety & accuracy of drug pricing
 4
 3.2

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 Basic 1 (HMO) received 3.5 stars for its health plan quality score which is worse than the Georgia State average health plan quality score of 3.8 stars.

Kaiser Permanente Senior Advantage Basic 1 (HMO) received 4 stars for its drug plan quality score which is better than the Georgia State average drug plan quality score of 3.8 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0-25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-35 copay
Lab services
$0-35 copay
Diagnostic radiology services (like MRI)
$5-290 copay
Outpatient x-rays
$5-35 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 90 and beyond
Outpatient hospital coverage
$0-275 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$203 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$225 copay

Therapy services

Occupational therapy visit
$25 copay
Physical therapy & speech & language therapy visit
$25 copay

Mental health services

Outpatient group therapy with a psychiatrist
$12 copay
Outpatient individual therapy with a psychiatrist
$25 copay
Outpatient group therapy visit
$12 copay
Outpatient individual therapy visit
$25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

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

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


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$0.00 copay$0.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$95.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
$0-47 copay or 0-20% coinsurance
Other Part B drugs
$0-47 copay or 0-20% coinsurance

Hearing

Hearing exam
$25 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
$0 copay
Cleaning
$0 copay
Fluoride treatment
Not covered
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
$0 copay
Restorative services
$28-580 copay
Endodontics
Not covered
Periodontics
$0-400 copay
Extractions
$22 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0-480 copay or 75% coinsurance

Vision

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

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