Kaiser Permanente Senior Advantage Value (HMO-POS)
H9003 - 009 - 0
(3.5 / 5)
Kaiser Permanente Senior Advantage Value (HMO-POS) is a Medicare Advantage (Part C) Plan by Kaiser Permanente.
This page features plan details for 2024 Kaiser Permanente Senior Advantage Value (HMO-POS) H9003 – 009 – 0 available in Portland-Vancouver Metro, Salem OR, Longview WA.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Kaiser Permanente Senior Advantage Value (HMO-POS) is offered in the following locations.
Plan Overview
Kaiser Permanente Senior Advantage Value (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Kaiser Permanente |
| Health Plan Deductible: | $0.00 |
| MOOP: | $5,000.00 |
| Drugs Covered: | Yes |
Ready to sign up for Kaiser Permanente Senior Advantage Value (HMO-POS) ?
Premium Breakdown
Kaiser Permanente Senior Advantage Value (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Kaiser Permanente Senior Advantage Value (HMO-POS) 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 |
Part D Premium Reduction
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.
Initial Coverage Phase
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.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $10.00 copay | $10.00 copay | ||
| 3 (Preferred Brand) | $45.00 copay | $45.00 copay | ||
| 4 (Non-Preferred Drug) | $90.00 copay | $90.00 copay | ||
| 5 (Specialty Tier) | 33% | 33% | ||
| 6 (Vaccines ($0 cost sharing)) | $0.00 copay |
60 Day
| 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)) |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $30.00 copay | $20.00 copay | ||
| 3 (Preferred Brand) | $135.00 copay | $90.00 copay | ||
| 4 (Non-Preferred Drug) | $270.00 copay | $180.00 copay | ||
| 5 (Specialty Tier) | 33% | 33% | ||
| 6 (Vaccines ($0 cost sharing)) |
Gap Coverage Phase
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.
30 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $10.00 copay | $10.00 copay | ||
| 6 (Vaccines ($0 cost sharing)) | $0.00 copay | |||
| Generic drugs | ||||
| Brand-name drugs |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $30.00 copay | $20.00 copay | ||
| 6 (Vaccines ($0 cost sharing)) | ||||
| Generic drugs | ||||
| Brand-name drugs |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
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.
Additional Benefits
Kaiser Permanente Senior Advantage Value (HMO-POS) also provides the following benefits.
| $0 |
| In-network | No |
| $5,000 In-network |
| Yes |
| In-network | Yes, contact plan for further details |
| In-network | $0-210 copay per visit (Authorization is required.) (Referral is required.) |
| In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| out-of-network Primary | $0-55 copay per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $35 copay per visit (Authorization is required.) (Referral is required.) |
| out-of-network Specialist | $0-55 copay per visit (Authorization is required.) (Referral is required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | $0-55 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $110 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | $10-45 copay (Authorization is required.) (Referral is required.) |
| out-of-network Diagnostic tests and procedures | $0-25 copay (Authorization is required.) (Referral is required.) |
| In-network Lab services | $0 copay (Authorization is required.) (Referral is required.) |
| out-of-network Lab services | $0-25 copay (Authorization is required.) (Referral is required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $10-190 copay (Authorization is required.) (Referral is required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | $0-25 copay (Authorization is required.) (Referral is required.) |
| In-network Outpatient x-rays | $10 copay (Authorization is required.) (Referral is required.) |
| out-of-network Outpatient x-rays | $0-25 copay (Authorization is required.) (Referral is required.) |
| In-network Hearing exam | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | $0-55 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 | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Routine eye exam | $35 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| In-network Occupational therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| out-of-network Occupational therapy visit | $0-55 copay (Authorization is required.) (Referral is required.) |
| In-network Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| out-of-network Physical therapy and speech and language therapy visit | $0-55 copay (Authorization is required.) (Referral is required.) |
| In-network | $250 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | $40 copay (Authorization is required.) (Referral is required.) |
| out-of-network Foot exams and treatment | $0-55 copay (Authorization is required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay per item (Authorization is required.) (Not applicable.) |
| Covered (Authorization is required.) (Referral is required.) |
| In-network Chemotherapy | $10-45 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | 20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | $0-45 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | $10-35 copay (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | $320 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.) |
| out-of-network | Not Applicable (Authorization is required.) (Referral is required.) |
| In-network Inpatient hospital – psychiatric | $245 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is required.) (Referral is required.) |
| out-of-network Inpatient hospital – psychiatric | Not Applicable (Authorization is required.) (Referral is required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | $0-55 copay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | $0-55 copay (Authorization is required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 20 $196 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
| out-of-network | Not Applicable (Authorization is required.) (Referral is required.) |
| Monthly Premium | $44.00 |
| Deductible | nan |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $44.00 |
| Preventive dental: | Deductible: | N/A |
| Comprehensive dental: | Monthly Premium: | $44.00 |
| Comprehensive dental: | Deductible: | N/A |
| Eyewear: | Monthly Premium: | $44.00 |
| Eyewear: | Deductible: | N/A |
| Hearing exam: | Monthly Premium: | $44.00 |
| Hearing exam: | Deductible: | N/A |
| Hearing aids: | Monthly Premium: | $44.00 |
| Hearing aids: | Deductible: | N/A |
Ready to sign up for Kaiser Permanente Senior Advantage Value (HMO-POS) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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