Kaiser Permanente Senior Advantage Basic 1 (HMO) is a Medicare Advantage (Part C) Plan by Kaiser Permanente.
This page features plan details for 2024 Kaiser Permanente Senior Advantage Basic 1 (HMO) H1170 – 009 – 0 available in Atlanta Metro Area.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Kaiser Permanente Senior Advantage Basic 1 (HMO) is offered in the following locations.
Kaiser Permanente Senior Advantage Basic 1 (HMO) offers the following coverage and cost-sharing.
Insurer: | Kaiser Permanente |
Health Plan Deductible: | $0.00 |
MOOP: | $5,900 In-network |
Drugs Covered: | Yes |
Ready to sign up for Kaiser Permanente Senior Advantage Basic 1 (HMO) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
Kaiser Permanente Senior Advantage Basic 1 (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $0.00 copay | $0.00 copay | ||
3 (Preferred Brand) | $47.00 copay | $47.00 copay | ||
4 (Non-Preferred Drug) | $95.00 copay | $95.00 copay | ||
5 (Specialty Tier) | 33% | 33% | ||
6 (Vaccines ($0 cost sharing)) | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Vaccines ($0 cost sharing)) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $0.00 copay | $0.00 copay | ||
3 (Preferred Brand) | $141.00 copay | $94.00 copay | ||
4 (Non-Preferred Drug) | $285.00 copay | $190.00 copay | ||
5 (Specialty Tier) | 33% | 33% | ||
6 (Vaccines ($0 cost sharing)) |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $0.00 copay | $0.00 copay | ||
6 (Vaccines ($0 cost sharing)) | $0.00 copay | |||
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $0.00 copay | $0.00 copay | ||
6 (Vaccines ($0 cost sharing)) | ||||
Generic drugs | ||||
Brand-name drugs |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Kaiser Permanente Senior Advantage Basic 1 (HMO) also provides the following benefits.
$0 |
In-network | No |
$5,900 In-network |
Yes |
In-network | Yes, contact plan for further details |
$0-275 copay per visit (Authorization is required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0-25 copay per visit (Authorization is not required.) (Referral is required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $25 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0-35 copay (Authorization is required.) (Referral is required.) |
Lab services | $0-35 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $5-290 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $5-35 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $25 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | $0 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Restorative services | $28-580 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | $0-400 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Extractions | $22 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | $0-480 copay or 75% coinsurance (There are no limits.) (Authorization is required.) (Referral is required.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $25 copay (Authorization is not required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $25 copay (Authorization is required.) (Referral is required.) |
$225 copay (Not applicable.) (Not applicable.) |
$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Foot exams and treatment | $25 copay (Authorization is not required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay per item (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | $0-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | $0-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $0-35 copay (Authorization is required.) (Not applicable.) |
$295 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is required.) |
Inpatient hospital – psychiatric | $295 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit with a psychiatrist | $12 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $25 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit | $12 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Monthly Premium | $9.00 |
Deductible | nan |
Comprehensive dental: | Monthly Premium: | $9.00 |
Comprehensive dental: | Deductible: | N/A |
Hearing exam: | Monthly Premium: | $9.00 |
Hearing exam: | Deductible: | N/A |
Hearing aids: | Monthly Premium: | $9.00 |
Hearing aids: | Deductible: | N/A |
Ready to sign up for Kaiser Permanente Senior Advantage Basic 1 (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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