2027 Medicare Advantage plan

Kaiser Permanente Senior Advantage Enhanced (HMO-POS): 2027 benefits and costs

Kaiser Permanente HMO-POS

CMS plan ID: H9003-001-0 · Plan year: 2027

Kaiser Permanente Senior Advantage Enhanced (HMO-POS) is a 2027 Medicare Advantage plan offered by Kaiser Permanente. It is listed in Oregon, Washington.

2027 plan costs at a glance

Monthly plan premium$134.00

Drug deductible$0.00

In-network medical out-of-pocket maximum$4,000.00

Organization: Kaiser Permanente
Plan organization: KAISER FOUNDATION HP OF THE N W
Parent company: Kaiser Foundation Health Plan, Inc.
Plan type: HMO-POS
Part C premium: $134.00
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
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $4,000.00
Applies to certain in-network supplemental services.
Combined in/out-of-network medical maximum: Not applicable
Out-of-network medical maximum: Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Point-of-service	What to know
Primary care doctor	$0.00 copay Service-specific deductible No	$20.00 copay Deductible applies No Dollar benefit limit applies No
Specialist visit	$35.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Telehealth	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required Yes
Emergency care	$150.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$65.00 copay	Not summarized. Check coverage with the plan.
Home health	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Dialysis	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	0% to 20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	0% to 20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Kidney disease education services	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required Yes
Medicare-covered chiropractic	$20.00 copay Service-specific deductible No	$20.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Medicare-covered foot care	$35.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Other health professionals	$0.00 to $35.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes 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.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–6: $250.00 copay per day Days 7–90: $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 1–6: $250.00 copay per day Days 7–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required Yes 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
Service	In-network	Point-of-service	What to know
Outpatient hospital care	$0.00 to $250.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.
Hospital observation services	$0.00 to $150.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.
Ambulatory surgical center	$250.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Outpatient blood	$0.00 copay Service-specific deductible No	$0.00 to $10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	Point-of-service	What to know
Diagnostic procedures and tests	$0.00 to $35.00 copay Service-specific deductible No	$25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Laboratory services	$0.00 copay Service-specific deductible No	$0.00 to $10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$0.00 to $150.00 copay Service-specific deductible No	$25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Therapeutic radiology	$15.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
X-rays	$0.00 copay Service-specific deductible No	$25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	Point-of-service	What to know
Partial hospitalization	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Intensive outpatient program	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Substance use treatment, individual sessions	$0.00 copay Service-specific deductible No	$15.00 to $25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	$0.00 copay Service-specific deductible No	$15.00 to $25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Opioid treatment program	$35.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Mental health, individual sessions	$0.00 copay Service-specific deductible No	$15.00 to $25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Mental health, group sessions	$0.00 copay Service-specific deductible No	$15.00 to $25.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Psychiatry, individual sessions	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Psychiatry, group sessions	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	Point-of-service	What to know
Occupational therapy	$25.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Physical and speech therapy	$25.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$20.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$20.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$20.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$20.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$250.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	$250.00 copay Service-specific deductible No	Approval required Yes
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	$0.00 copay Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	$0.00 copay Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$35.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered eye exams	$0.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered hearing exams	$0.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0.00 copay	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	Point-of-service	What to know
Supplemental acupunctureAdditional plan benefit	$10.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Medicare-covered preventive servicesMedicare-covered care	Point-of-service	$0.00 copay Deductible applies No	Dollar benefit limit applies No
Glaucoma ScreeningMedicare-covered care	Point-of-service	$0.00 copay Deductible applies No	Dollar benefit limit applies No
Digital Rectal ExamsMedicare-covered care	Point-of-service	$0.00 copay Deductible applies No	Dollar benefit limit applies No
EKG after a Welcome to Medicare visitMedicare-covered care	Point-of-service	$25.00 copay Deductible applies No	Dollar benefit limit applies 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; Alternative Therapies
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: 18
How often this limit applies: Every year

Benefits for qualifying members

Acute Care at Home

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 1
Qualifying conditions: Meets clinical criteria, hospital care in home based on health status
Covered package services cost $0 until the package limit is reached: No
Benefits that apply to reduced cost sharing: Supplemental benefits; Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing: Emergency Services; Occupational Therapy Services; Other Health Care Professional; Physical Therapy and Speech-Language Pathology Services; Diagnostic Procedures/Tests; Diagnostic Radiological Services; Ground Ambulance Services; Durable Medical Equipment (DME); Medical Supplies
Non-Medicare benefits that apply to reduced cost sharing: Other 2
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: No
Do you offer reduced Coinsurance?: Yes
Types of benefits that apply to the coinsurance cost sharing: Supplemental benefits; Medicare-covered benefits
Medicare-covered benefits that will receive reduced coinsurance: Durable Medical Equipment (DME); Medical Supplies
Supplemental benefits that will receive reduced coinsurance: Other 2
Minimum Coinsurance Percentage for Durable Medical Equipment (DME): 0%
Maximum Coinsurance Percentage for Durable Medical Equipment (DME): 0%
Minimum Coinsurance Percentage for Medical Supplies: 0%
Maximum Coinsurance Percentage for Medical Supplies: 0%
Minimum Coinsurance Percentage for OTHER 2: 0%
Maximum Coinsurance Percentage for OTHER 2: 0%
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: Emergency Services; Occupational Therapy Services; Other Health Care Professional; Physical Therapy and Speech-Language Pathology Services; Diagnostic Procedures/Tests; Diagnostic Radiological Services; Ground Ambulance Services
Minimum Copayment for Emergency Services: $0.00
Maximum Copayment for Emergency Services: $0.00
Minimum Copayment for Occupational Therapy Services: $0.00
Maximum Copayment for Occupational Therapy Services: $0.00
Minimum Copayment for Other Health Care Professional: $0.00
Maximum Copayment for Other Health Care Professional: $0.00
Minimum Copayment for Physical Therapy and Speech-Language Pathology Services: $0.00
Maximum Copayment for Physical Therapy and Speech-Language Pathology Services: $0.00
Minimum Copayment for Diagnostic Procedures/Tests: $0.00
Maximum Copayment for Diagnostic Procedures/Tests: $0.00
Minimum Copayment for Diagnostic Radiological Services: $0.00
Maximum Copayment for Diagnostic Radiological Services: $0.00
Minimum Copayment for Ground Ambulance Services: $0.00
Maximum Copayment for Ground Ambulance Services: $0.00

Full package terms are not summarized here.

Acute Care at Home

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 1
Qualifying conditions: Meets clinical criteria, hospital care in home based on health status
Included services: Other 3
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: No

Full package terms are not summarized here.

Optional packages that cost extra

Advantage Plus $54.00 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: Oral Exams; Dental X-Rays; Other Diagnostic Dental Services; Dental cleaning; Fluoride Treatment; Other Preventive Dental Services; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Maxillofacial Prosthetics; Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Upgrades; 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 tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$5.00	$10.00	$15.00
Tier 3Preferred Brand	$45.00	$90.00	$135.00
Tier 4Non-Preferred Drug	$90.00	$180.00	$270.00
Tier 5Specialty Tier	32%	32%	32%
Tier 6Vaccines	$0.00	Not listed	Not 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 tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$5.00	$10.00	$10.00
Tier 3Preferred Brand	$45.00	$90.00	$90.00
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 tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$5.00
Tier 3Preferred Brand	$45.00
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 tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$5.00
Tier 3Preferred Brand	$45.00
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 2 states or territories. Availability can vary by county and ZIP code.

View all locations 12 county listings across 2 states or territories