2027 Medicare Advantage plan

Kaiser Permanente Senior Advantage Basic (HMO): 2027 benefits and costs

Kaiser Permanente HMO

CMS plan ID: H1230-003-0 · Plan year: 2027

Kaiser Permanente Senior Advantage Basic (HMO) is a 2027 Medicare Advantage plan offered by Kaiser Permanente. It is listed in Hawaii.

2027 plan costs at a glance

Monthly plan premium$61.00
Drug deductible$0.00
In-network medical out-of-pocket maximum$8,750.00
Organization
Kaiser Permanente
Plan organization
KAISER FOUNDATION HP, INC.
Parent company
Kaiser Foundation Health Plan, Inc.
Plan type
HMO
Part C premium
$61.00
Part D premium
$0.00
Prescription drug coverage
Yes
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
In-network medical maximum
$8,750.00

Applies to certain in-network supplemental services.

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$15.00 copay

Service-specific deductible
No
Specialist visit

$50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Telehealth

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Emergency care

$115.00 copay

Urgent care

$40.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Dialysis

0% to 20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
Yes
Part B chemotherapy and radiation drugs

$7.00 to $43.00 copay; 0% to 20% coinsurance

Deductible applies
No
Approval required
No
Other Part B drugs

$7.00 to $43.00 copay; 0% to 20% coinsurance

Deductible applies
No
Approval required
No
Kidney disease education services

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Medicare-covered foot care

$50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Other health professionals

$15.00 to $50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–6: $400.00 copay per day

Days 7–30: $70.00 copay per day

Days 31–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–5: $350.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
No
Referral required
Yes
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–40: $221.00 copay per day

Days 41–100: $0.00 copay per day

Approval required
No
Referral required
Yes
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $400.00 copay

Service-specific deductible
No
Hospital observation services

$0.00 copay

Service-specific deductible
No
Ambulatory surgical center

$400.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Laboratory services

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Diagnostic radiology (CT, MRI)

$30.00 to $355.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
Yes
X-rays

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$55.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Intensive outpatient program

$15.00 to $50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Substance use treatment, individual sessions

$50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Substance use treatment, group sessions

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Opioid treatment program

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Mental health, individual sessions

$50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Mental health, group sessions

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Psychiatry, individual sessions

$50.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Psychiatry, group sessions

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Physical and speech therapy

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Cardiac rehabilitation

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Intensive cardiac rehabilitation

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Pulmonary rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Supervised exercise for peripheral artery disease

$20.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$370.00 copay

Service-specific deductible
No
Approval required
No
Air ambulance

$370.00 copay

Service-specific deductible
No
Approval required
No
Durable medical equipment

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

0% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$50.00 copay

Oral examsAdditional plan benefit

$0.00 copay

Dental X-raysAdditional plan benefit

0% to 30% coinsurance

Other diagnostic dentalAdditional plan benefit

30% coinsurance

Dental cleaningAdditional plan benefit

$0.00 copay

Restorative dental careAdditional plan benefit

30% coinsurance

Gum treatment (periodontics)Additional plan benefit

$0.00 copay

Other dental servicesAdditional plan benefit

30% coinsurance

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$15.00 copay

Approval required
No
Referral required
No
Medicare-covered eyewear

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine hearing examsAdditional plan benefit

$15.00 copay

Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Supplemental acupunctureAdditional plan benefit

$20.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

Combined Supplemental Benefits 1

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance
Routine Chiropractic Care; Acupuncture Treatments
How benefits are provided
Claims Processing
Advance choice of benefits required
No
Shared limit on visits or trips
Yes
Indicate number of shared visits/trips
20
How often this limit applies
Every year

Benefits for qualifying members

2

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Diabetes
Covered package services cost $0 until the package limit is reached
No
Benefits that apply to reduced cost sharing
Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing
Lab Services
Some package benefits are exempt from the deductible
No
Do you offer reduced Coinsurance?
No
Service-specific deductible
No
Reduced Copayment?
Yes
Types of benefits that apply to the copayment cost sharing
Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment
Lab Services
Minimum Copayment for Lab Services
$0.00
Maximum Copayment for Lab Services
$0.00

1

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Other 1; Other 2
Qualifying conditions
Liver Disease
Qualifying conditions
Certain bleeding disorders
All listed conditions required
No
Combination of conditions required
No
Covered package services cost $0 until the package limit is reached
No
Benefits that apply to reduced cost sharing
Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing
Lab Services
Some package benefits are exempt from the deductible
No
Do you offer reduced Coinsurance?
No
Service-specific deductible
No
Reduced Copayment?
Yes
Types of benefits that apply to the copayment cost sharing
Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment
Lab Services
Minimum Copayment for Lab Services
$0.00
Maximum Copayment for Lab Services
$0.00

3

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Chronic Obstructive Pulmonary Disease (COPD); Congestive Heart Failure (CHF); Hypertension
All listed conditions required
No
Combination of conditions required
No
Covered package services cost $0 until the package limit is reached
No
Benefits that apply to reduced cost sharing
Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing
Lab Services
Some package benefits are exempt from the deductible
No
Do you offer reduced Coinsurance?
No
Service-specific deductible
No
Reduced Copayment?
Yes
Types of benefits that apply to the copayment cost sharing
Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment
Lab Services
Minimum Copayment for Lab Services
$0.00
Maximum Copayment for Lab Services
$0.00

Optional packages that cost extra

Advantage Plus $45.00 extra per month

Advantage Plus

The limits below apply only to this optional package.

Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
No
Deductible applies
No
Included services
Fluoride Treatment; Other Preventive Dental Services; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Implant Services; Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Hearing aid fitting and evaluation; Prescription Hearing Aids (all types)

Prescription drug coverage

Costs shown are for initial coverage.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$7.00

$14.00

$21.00

Tier 3Preferred Brand

$43.00

$86.00

$129.00

Tier 4Non-Preferred Drug

$90.00

$180.00

$270.00

Tier 5Specialty Tier

32%

32%

32%

Tier 6Vaccines

$0.00

Not listedNot listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$7.00

$14.00

$14.00

Tier 3Preferred Brand

$43.00

$86.00

$86.00

Tier 4Non-Preferred Drug

$90.00

$180.00

$180.00

Tier 5Specialty Tier

32%

32%

32%

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$7.00

Tier 3Preferred Brand

$43.00

Tier 4Non-Preferred Drug

$90.00

Tier 5Specialty Tier

32%

Tier 6Vaccines

$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$7.00

Tier 3Preferred Brand

$43.00

Tier 4Non-Preferred Drug

$90.00

Tier 5Specialty Tier

32%

Tier 6Vaccines

$0.00

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 6: Vaccines

Drugs included in this tier
Part D Drugs Only

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Hawaii